Pamela,

It may be that the WAY your moms express milk is the answer for your great
results for VLBW babies.

Here, I have a hard time convincing moms to hand express - which has been
proven to give higher fat content (don't have the research, but know it
exists).

Then, they get a pump and I have a very hard time convincing them to pump
even the minimum 120 minutes per day - in 5 to 6 pumpings.  They are very
depressed because their babies are so sick, they are sent home so they are
separated from the baby, then they are "allowed to visit" for 30 minutes
twice a day (recently increased to 2 hours twice a day but only if there is
no baby in NICU receiving any special care - which is rare).
(Skip this part if it's getting too long...)
____

It usually goes like this:
Day one - mom recovering from c-section (usually in these cases), family
around mourning the loss of the baby (the one they planned) and accepting
the baby they got.  Father is the one that goes to the nursery and gets the
information, at times the Ped goes to the mom's room to give the big
picture about the baby's condition.  If breastfeeding is mentioned, she is
told baby is too weak to nurse, but she should pump.

Day two - family rallying to mom's side, when breastfeeding educator
suggests pumping, they are told mom needs to rest and baby won't be able to
eat for a long time anyway...

Day three - mom realizes she wants to pump, a pump is brought to her, but
family keeps telling her she needs to rest.

Day four - discharge - Dad rents a pump to take home with mom, family takes
mom to Grandma.

Day five and on - During follow up visits (LC meets them during visiting
hours at NICU or they come to the office) it is clear pumping is at a
minimum - two to three times a day.  Encouragement is given, moms talk to
other moms who are further along and learns that babies DO survive and moms
CAN pump, so she starts doing it more regularly.

I have tried to get support groups started, but the complications of
travel, transportation, parking, mom's recuperation, etc. create a limited
time for them to meet.  When a baby is hospitalized for a long period of
time, mom's maternity leave may be over and she may even be back at work
and unable to come but once a day.

Then baby gets better, needs milk at a very fast rate - and mom has not
pumped enough to get a good supply stored or keep up with the rapidly
increasing needs of the baby.  Baby is given mother's milk mixed with
fortifier or even ABM at some feeds...

____

(continued...)

Perhaps if moms were nearer their babies and taught to hand express or at
least to massage regularly before and during the pumping, the milk would be
more like the milk you are getting.  It sounds like your moms are very
involved and aware of their importance to their baby's survival.  Here, the
professionals take over and the mom "adores" the nurses and doctors who are
keeping her baby alive.  (Sure makes one as a nurse or doctor want to
stress one's importance and that of all the equipment attached to the
baby!)

So - our differences in expectations and teaching lead to a difference even
in the "quality" of the milk???

Who knows... Another study???

Jeanette Panchula, BSW, RN, IBCLC, LLLL
mailto:[log in to unmask]
Project Director - Proyecto Lacta - Puerto Rico
http://netdial.caribe.net/~prlacta/
Lactancia Materna '98 - La Mejor Inversion