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Subject:
From:
Karen Kerkhoff Gromada <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 2 Nov 2003 14:17:09 EST
Content-Type:
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In a message dated 11/1/03 10:50:09 PM Eastern Standard Time,
[log in to unmask] writes:

> Mom pumped from the beginning,
> and is now making his needs, so he is getting only breastmilk.  Corrected
> age is now about 35 weeks 4 days.  Baby shows interest in the breast and
> latches, but still can't transfer enough milk.
> The situation is complicated by the fact that this first time mom originally
> during her pregnancy thought she wanted to pump and bottlefeed her milk.
> Then she decided to at least start off breastfeeding, but she is nervous
> about it.  Add in a poorly feeding, premature baby, and she doesn't have
> much confidence that her baby will ever be able to breastfeed.
> Can I expect this baby as he gets stronger to become more effective at the
> breast?  Any words of wisdom to share with this mom to help her confidence?
> She is now putting him to breast at most feedings during the day, with a
> small shield, then feeding him pumped milk by bottle.  Baby's weight gain is
> good.
>

Sure, she can expect this baby to become more effective! This type of
situation is the norm rather than the exception for the mothers of multiples I work
with, yet those that hang in get more than one baby to breastfeed fully or
almost so, unless any has an underlying feeding issue of which ineffective
breastfeeding is only the "messenger"/symptom.

In addition to what others have already written, my suggestions would be to:
1. Celebrate what is going right!  This baby is apparently healthy now --
just a bit immature -- and way ahead of the game. Baby demonstrates good latching
and has the basic idea about suckling -- yea! Mother is moving milk
effectively -- protecting production and eventual direct breastfeeding -- yea!  Moms
(and supporters) often "wallow in the problem" and forget to focus on the
positives when living in the eternity of each early postpartum day. Hard for them to
think tomorrow may improve, much less next week! I also take moms backward a
week or two to remind them of how far baby/babies have come.

2. Reinforce breastfeeding behaviors while using alternative feeding
method/device -- whether with shield, tube at breast, bottle, etc. Elicit rooting,
wide mouth gape, and deep latch. (Takes a slow-flow teat if using a bottle.) If
mom has helpers for some alternative feedings so she can focus on "practice"
breastfeeds and pumping, they will need instruction on reinforcing breastfeeding
behaviors.

3. Encourage as much skin-to-skin Kangaroo mother care as she can accomplish.
Helps a new mom get comfortable with a really tiny baby and learn baby's
cues, and baby often progresses to breast while kangarooing.

4. Think of current breastfeeds as "practice" vs. "effective." Takes some of
the pressure to perform away from both mom and baby.

5. Follow baby's lead via cues. Babies tell us when they are ready for the
next step. Many of my multiple moms find their premies make progress in spurts
-- "big" jump and then level out for a while again. But eventually they move
from "practice" to "expert" breastfeeders -- and first-time mothers move from
tentative to confident!

Keep us posted on baby's and mother's progress.

Karen G

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