Denny's story of the 36 weeks breastfeeding twins who were cold and
dehydrated when she arrived just makes me shiver.  This is the population I
deal with daily, and thank goodness Denny got a sitter and arrived in time
to prevent those babies from having a real disaster.

 We must be cheerleaders for breastfeeding, but we MUST do a better job of
identifying and protecting the moms/babies who are at risk for poor feeding
early on.  The combination of issues this mom had was a set-up for
problelms:  the multiple birth, babies who are small in size and
neurologically immature, an inexperienced , engorged, primip mom with large
nipples.  Yikes!

Yes, pre-term infants can breastfeed, but they almost always have stamina
and stability problems which require some special advice in terms of
feeding.  Very often they don't breastfeed well.  If the parents want to
avoid supplements, there has to be some in-person assessment which assures
everyone that the babies can take in sufficient volumes to grow.  Even then
they are going to need to be kangaroo cared for, with multiple episodes at
breast EVERY HOUR while being kept close and warm.  If parents can't do
this, then babies prob. will need supplementation.  Post-feed pumping is
usually a good idea too, because small, early twins sometimes can't
stimulate the kind of milk supply needed down the road.  I have not found
pre-term infants to get particularly "confused" when supplemented, no matter
how that decision is made (ie bottles, feeding tubes, syringes, cups, etc.)
They are so easily transitioned back to full breastfeeding at term providing
milk supply is stable.

We can't treat abnormal situations with normal discharge management advice
and phone assessments.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

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