Prematures often have trouble transferring what milk there is from breast to
tummy.   Having a larger than needed milk supply has been recommended by
Paula Miere as a way to assist in this particular problem; even at the time
of discharge it is best  for mom to have MORE milk than the baby needs; to
continue pumping to artificially keep the milk supply higher than needed and
to gradually taper off as baby nears or passes his original predicted birth
date and is growing and thriving on direct breastfeeding alone.  Many NICU
babies are discharged at a still very vulnerable age as far as breastfeeding
goes.
I would not recommend moms decrease pumping and I would also not want any
decreases done to eliminate night pumpings or to have long periods between
some pumpings while clustering pumpings together during other periods of the
day.   This said, it still depends on the mom's state of mind.  Is she ready
to give up on all pumping?  Can other ways of coping be found?  If not,
something needs to give.  Can she maintain one night time pumping if she
just has to roll over and  pump but doesn't get up to store the milk or
clean the pump?   At least she will be keeping up the potential; only the
supply in the freezer will suffer.   Can she pump just before going to sleep
and then again 5 to 6 hours later then again in 4 to 5 hours then every 2
through the day, how about every 3 through the day?  Can she nap more while
someone else visits the baby?  Can she eat at the hospital?  Can she pump
while visiting baby?  Can someone else do the kit cleaning?  Would  a second
or third kit allow her to  clean less often and simplify things?  Can she
take a little vacation from this schedule with the plan to come back to full
force pumping soon?
On another NICU subject, nipple shields - I just had a great success getting
a near discharge premature to sustain a latch much longer and to transfer
lots more milk using a contact nipple shield.   This mom had great supply
and perfect anatomy.  Baby could latch but not sustain.  The shield really
made a difference.    We of course also corrected her hold to the enhance
the asymmetric latch and used the nipple sandwich to go in the burger way
instead of the taco way  but that wasn't enough, the shield made a
difference.  Goal remains to get rid of shield as soon as possible but not
if it is helping and to continue pumping to maintain a higher than needed
supply.
Carla

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