I, too, have heard nurses tell mothers that "nipple confusion is rare
in premies".  Then why is it that, as the ONE inpatient LC for a
hospital that does >7000 deliveries a year (35 bed NICU), I keep being
paged to "fix" the premies who are screaming at the breast or shutting
down and putting themselves back to sleep because they don't want to
BRF?  I think one of the most powerful interventions that we can do in
the NICU, or suggest to mothers, is skin-to-skin holding.  I consider
this a first step toward BRF.  It's totally harmless and is incredibly
healing for both parents and babies. From there you can put the premie
near the nipple and let her get used to the feel, smell, taste.  I have
been blown away by what many premies can do.  If the neonatologists are
concerned about intake, have the mother pump to "empty" her breasts just
before putting the baby skin-to-skin and then they can be satisfied it
is only "practice" and the baby may be able to sneak extra BRM.  Give
copies of Paula Meier's articles to drs and nurses..post on bulletin
boards.  I have been lucky enough to have people listen to me in many
instances but still have HUGE resistance from the nurses.  How can
skin-to-skin be harmful?? It's free and doesn't require much nursing
time to implement.  I model the behaviors I want to see others do
and, although not a quick solution, has an impact over time.  Another
way we are fighting resistance is to educate parents.  Every NICU mother
gets a flyer about Kangaroo Care and its benefits and we have a parent
bulletin board with info that talks about S. Ludington's book "Kangaroo
Care: the best you can do for your Premie" and we sell it in our gift
shop.  Educating parents to be good consumers can be very powerful!
About colostrum at one week post birth...Having a premie is very
stressful!  Many times our mothers are very sick and initiation of
pumping is not optimal. Again, modeling the behavior and educating
nurses about the importance of timely initiation is important. P. Meier
stresses the importance of mothers starting to pump early and often (10
times a day in the first week).  I would have her keep a pumping log if
she's concerned and make sure shes pumping enough.  But 60 ccs at each
pumping sounds like a pretty good start to me.  It's ideal for her to
end up with 1 1/2 times what the baby needs so the milk is as easy to
get as possible when the baby goes to breast (again, according to P.
Meier and I find it works really well).
Sorry this is so long but I feel so strongly about premies.  We don't
give them enough credit or enough chances!
Edie Armstrong