Jan wrote
"It's very discouraging for a mom to have to pump 7 to 8 to 10 full pumpings
with a hospital grade pump and barely get dampness around the flange....I
see
this frequently in moms who have babies going to the NICU and who wait 8 to
10 hours to start pumping.  If it is a full term baby who needs to be fed
(possibly by NG tube for transient tachypnea), then most likely it will get
formula because mom isn't getting anything from the pump."

Here is Australia it is usual to get the mothers to hand express. In my
experience hand expression is far more productive that using the pump until
the onset of lactogensis 2.   It is not unusual to get 5 or 10 mls colostrum
from that first hand expression.  I work in a SCN and if the mother is
visiting her baby I show her hand expression and get her expressing
immediately if it is not likely the baby will be well enough to breast feed.
  Often if the baby is term with transient tachypnoea expressed colostrum
will then be enough to tide them over for a few hours and maintain their
blood sugars. More severe cases with very rapid respirations usually have IV
therapy, so we have time on our hands to get the expressing going and slowly
grade down the IV. Depending on the oxygen levels required and the degree of
tachypnoea, for mild cases of transient tachypnoea it is still quite
feasible to breast feed with funnel oxygen.  Obviously the situation is more
complicated if the mother is not well enough to visit the nursery.

Yes some of the babies still end up with formula, but not nearly as many as
used to in the past.  With committment from both the mother and the nursing
staff, a higher percentage of babies who pass through SCN never have
formula.  Quite recently we had a mother who had had a general anaesetic
(and was still not feeling well enough to sit up in a wheel chair) wheeled
round to SCN on her bed where she fed her term baby with a relatively mild
case of transient tachypnoea with funnel oxygen near baby's face.  Oxygen
saturations were maintained beautifully, baby was more settled on the breast
and after weaning to air was discharged to postnatal ward with mother with
formula never passing his lips.
Marian Rigney RN IBCLC




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