In response to Tressa's posting, I have a number of suggestions.

1) First read Paula Meier's work on premies.  She has done some excellent
research in this regard with marvelous success rates in low income women.
When I first went to her talk, I had been taught by my supervisors that you
didn't need to pump more than the baby needs.  Not so for premies, because
they often do not take much initially, the mother needs to set her supply
up to the level of the intake of a full term baby so that when these sleepy
babies wake up, mom's supply is ready for them.  So, pumping is important
for these babies so they do not end up having to have formula later on.

2) Do not always assume that what mothers tell you is the whole picture,
have a discussion with this LC and approach it with an open mind.  Ask her
what it is she does suggest for these women and why.

3) Read Dee Kassings article in the Journal of Human Lactation on paced
bottle feeding.  Some NICU nurses are very focused on ensuring these babies
pick up weight and may not pay as much attention to how the baby feeds.
Teaching mothers how to pace the bottle feedings is particularly important
for premies.

4) Encourage the moms to do skin to skin contact and kangaroo care.  This
is especially important for babies that are not getting the breast.

5) Teach the moms how to do practice feeds at the breast and watch for
signs of fatigue. Watch carefully for rhythmic swallowing and stop when the
baby tires. You might engage the LC by asking how vigorous any one
particular baby is at the breast.  Did the LC do a test weighing?  How long
might the particular baby feed vigorously before tiring?  These types of
questions might open the door for dialogue.

6) Find out if the LC is skilled at using the nipple shield and using a
weighign scale to determine whether the shield helps milk transfer.  Some
small premies respond well to a nipple shield, others do not.

Hope these suggestions help.

Susan E. Burger, MHS, PhD, IBCLC

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