I think a study comparing groups with and/or without feeding tubes or
pumping. However, I think it would also be important to try to control for
the effectiveness of the tube device that was being used. Using the SNS,
IMO, would be likely to turn in results that suggested that pumping was
better at stimulating milk production than suckling with a feeding tube.
However, this would be due to the ease of delivery of the supplement through
the tube device, requiring much less nutritive suckling at the breast.
Some babies become very efficient at expressing the tube without expressing
the breast well. Many more may be suckling pretty well with the tube, but
spend less time at the breast because they get their tummies full too
quickly.
In my opinion, the best way to control the results in the groups that were
suckling with tube would be to have all of the mothers use the Lact-Aid,
preferably with specific instructions on how to control the flow of it. One
thing would be to have the mothers try to have the supplement at the same
temperature, since warmer supplement flows a bit faster than cooler. Also,
you would have to take into account what supplement was being use. EBM
flows significantly faster than the standard formulas. Even adding a little
EBM to formula will cause it to flow a little faster. Another way to
control flow is how far the bag is hung above the mother's nipple. Also
very important is to make sure that the mother is not wearing the Lact-Aid
in a way that puts pressure on the bag and creates a constant, as well as
faster, flow. A common way that some mothers have done this is to stick the
unit inside their bra, between their breasts. Wearing the Lact-Aid in a
pouch that is attached to the mother's bra can be a satisfactory way to use
it, but only if the pouch is large enough that it does not squeeze the bag,
when full. I would suggest that the best way to wear it, for the sake of
controlling variables, would be with the neck ribbon.
If you used the SNS, I think it would be even more important to give very
specific instructions, since there is such a wide variety of ways to control
the flow. The tube size is one, of course. I would suggest that mothers
use the smallest tubing, with both tubes open. Closing the other tube will
slow the flow more and more and then cut it off completely, as a vacuum is
formed. The mother will either need to open the opposite tube periodically
to get it flowing again, or the baby will learn to break his suction on it
to get it flowing again. The variability of the frequency of breaking the
suction would make it much more difficult to determine the ease at which any
one baby was able to express the supplement. Also, a baby who was getting a
widely varied flow would also be less likely to settle in and suck well.
The homemade setup with a tube would probably have more consistent results
than the SNS, but I can't comment any further on that. I would love to hear
from anyone who has personal experience with it, though!
Darillyn Starr
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