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Subject:
From:
Janet Simpson <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 1 Jan 1999 23:45:34 -0800
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Hi All,
Bonnie writes:

>>If there are NICU moms pumping 9-12 oz. every 3 hours, don't they need
>>to be instructed in reducing oversupply.  The baby will probably NEVER
>>need that much milk.  Also, how is this affecting the percentage of fat
>>in the milk baby is getting?

>>Other opinions on this issue?

First of all, great question!

My opinion is this:

Why the baby is in the NICU and how long the baby is going to be there play
an important role in deciding if the mom should worry about an oversupply or
not.
If mom has a 30 wk +/- baby in NICU then she should not even concern herself
with oversupply as being a problem.  In fact it is preferable at that point,
imnsho, because so many moms seem to begin having supply probs around 6wks
into full-time pumping.  Almost every mom I worked with whose baby was not
at breast and feeding well within a few weeks had some sort of supply
problem occur around 6 wks, sometimes earlier, sometimes later.  Some had a
catastrophic failure of production and were unsuccessful at regaining their
supplies, others were able to stave off compleate loss with herbs or reglen
(we don't have domperidone here).  These moms were very religious about
their pumping regimine, btw.  The ones who had an oversupply and had tons of
back-up milk stored in their freezer (and their families freezers, and even
mine at one point!) were thankful that even tho their milk production had
ceased (even with heroic efforts to get it back) they had several weeks or
months worth of EBM stored so that their baby did not have to receive ABM
any time soon.  The moms who did NOT have oversupply "problems" were greatly
distressed because they did not have enough of their own milk left over and
their babies had to be put immediately on ABM.
I encourage my moms to bring in a healthy milk supply if their baby is going
to be in the hosp for a while.  So many things can affect the milk
production (stress is a BIG one, as is exhaustion), so why take any chances?
The better the milk supply the longer baby will get breastmilk.  If baby
comes home, is BF well, and mom is now having probs with oversupply, no
problem.  We can take care of that fairly easily.  I tell my moms it is
better to have an oversupply, than an undersupply.  They all agree with that
one!  Another thing I do is tell the mom that the second she notices any
change in the amount of milk she gets (getting less) to call me so we can
discuss what is going on in her life at that moment (not getting enough time
to pump, too much stress, no support, supply is dropping with no obvious
cause) and discuss ways to aleviate that challenge and increase the supply
again.
The only reason I can think of for a mom to have supply probs around 6 wks
or so, is that the pump does not take milk from the breast the way the baby
does (there is never the complete stimulation or drainage that a baby can
give) so the breast just little by little produces a bit less, until there
is a marked, noticeable change in supply.  Am I off base here, or is this a
rational thought process?  (it is late and I am very tired, but where am I??
Obviously NOT in bed sleeping!  :D )
As to the percentage of fat the baby is getting, I don't see that as a
problem.  The percentage is probably the same as if the supply was exactly
what the baby needed.  There is no foremilk/hindmilk imbalance because both
breasts are being "drained" (I hate that term...) by the pump and the
hindmilk comes along with the foremilk, unlike a fm/hm imbalance where the
baby gets too much FM and not enough HM because s/he is not spending enough
time on one breast to get to the HM.

OK, those are my opinions...hope I made sense!  Someone correct me if I got
something off base, please!

TIA!

Jay
Jay Simpson, CLE
Sacramento (State Capital), California, West Coast, USA
"No Miracles performed here, just a lot of love and hard work."

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