In a message dated 12/5/00 11:17:46 PM Pacific Standard Time,
[log in to unmask] writes:

<<  I sent this mother home with BF
 (no more than 30 min.) with compression and massage, pumping after and
 supplement with EBM and or AIM. I really believe that once this baby gains
 wt. and mother's milk supply increases so will his stamina and  he will be
 able to go back to feeding
 exclusively at the breast. >>


This is the typical phone call that I get.  Mom has gotten these instructions
from the LC at the hospital.....usually 1-3 wks pp after going in with
whatever problem.  They call me (about 5 of these calls a week) because they
feel that they can't keep up with the pumping, baby is screaming and wants to
be held, it's so confusing and overwhelming etc etc.  The story I hear from
these mom's is *consistent*.  They leave the LC's office shaking their head
"yes, I'll follow these instructions", pump in one hand, baby bucket in the
other, they get home and are in tears.

I did *not* get the above quoted message, so I don't have the full story to
go on, and in this case, it was probably the appropriate course of action.
But I have worked *closely* (seeing mom every day....or even all day) with
several mom's who've been told to follow the above protocol (feed on cue,
pump following feeds, then give supplementary EBM or ABM) for various reasons
(slow weight gain, low weight gain, jaundice, low milk supply etc etc)
Without exception, and with *careful* *close* follow up, I've had these mom's
stop pumping and take the baby to bed or place baby in a sling and simply
breastfeed more frequently (as long as baby is latching well, sucking and
swallowing).


This includes a mom who wastold "at this point, your supply is so low, that
you should only be pumping and bottlefeeding the milk.....he'll use up more
calories than he can take in while nursing.....if he wants more, supplement
with formula" This was a baby who was gaining 3.5 oz per week and by all
other signs was doing smashingly well.  Three LC's at one hospital told her
this.  One of them told her that she was sad that "you might not ever be able
to produce enough milk for your baby".  Oh dear. After much thinking and
searching, and 3 frustrating tearful days trying to follow the hospital
instructions mom decided to simply nurse, nurse, nurse.   We covered cues,
stressed that feeding q 2-3 h intervals isn't biologically optimal for mom's
and babies, taught her to nurse lying down and using a sling.  Baby had one
more week of 'low' wt gain (3.5 oz.....it's important to note that the ped
was *never* at any point concerned), then started gaining a lb per week for
several weeks.

Another mom was sent home at 72 h pp with the same instructions.  Baby hadn't
started nursing well until 12 h pp (but was previously licking colostrum off
of mom's nipples), but when he did start nursing, he nursed beautifully q 30
minutes....few minutes each time.  It was quite suprising when an LC said, at
48  hours,  baby was dehydrated, and that (with accordance to rule #1) they
needed to feed the baby.   I had been there virtually every minute from 1 h
to 40 h but then went out of town. Baby was fed formula, mom was sent home
with instructions that her milk wasn't in, her colostrum wasn't enough for
this baby, and that she needed to nurse the baby every four hours, and follow
with a bottle of formula to baby's satiation (does that word exist?) then
pump to stimulate her supply.  After a great deal of discussion decided not
to follow this course of action...simply took baby to bed with her and nursed
nursed nursed.  Baby gained a lb by 10 days and at 12 mos, is bigger than my
20 mo old.

Another mom, planning a homebirth, was sent to hosp at 37 wks with a very
sudden onset of pre-eclampsia.  Induction was followed by the normal vaginal
deliver of a 5 lb baby who was a 'reluctant' nurser.  LC  said they could try
to latch her on for five minutes, but at that point, formula would be given
by bottle.  When mom expressed nipple confusion concerns, the LC told her
that there was no evidence that it existed.  Formula was given.  during the
48 h hosp stay, baby nursed twice, mom got *zero* of anything with a hosp
grade pump.  Since mom had experienced very little breast change/tenderness
during pregnancy, the LC was mentioning something called "primary lactation
failure" and the mom was wondering what that meant, but was too afraid to ask
while stil in the hospita. Baby was given formula via bottle, the fun red
preemie nipples to boot and sent home with instructions for a reluctant
nurser which included  - 'if baby does not successfuly latch and nurse within
the five minutes of the specified feeding time, give  __mls of fomula via
bottle"  It went on to say that feeding should be done as "often as baby
shows signs of hunger, every two to three hours"  Mom was told to pump after
every feeding, or in place of feeding if baby wouldn't nurse and give that
bmilk via bottle as well.  Mom was also told to nurse for no more than 10
minutes per side during a feeding because otherwise baby would use more
calories than she'd be taking in.  I saw mom at 5 days pp with a baby who
actually was latching most of the time.....she decided to quit pumping, nurse
the baby frequently.  We had to talk alot about feeding cues, as the hospital
staff told her to feed the baby only when she cried...and the discharge
instructions said "whenever baby wants, every 2-3 hours"....which *isn't*
when the baby wants, but is 'every 2-3 hours'...so mom was trying to go every
two to three hours.


I have so many experiences like this.  this is for sure my number one phone
call.  Mom feels that she can't breastfeed/pump on the recommended plan and
is afraid that she'll have to give up breastfeeding altogether because it's
too much work.   Usually that I'm able to work with and find a different
solution, one that mom finds more workable.....but I also have equally as
many, or more experiences with hearing these stories much later, down the
line at 6 wks or four months, when mom decided that breastfeeding "was just
to difficult, with all of the pumping to keep my supply up, washing the pump
parts" etc..... "baby seemed to like the bottle just fine, so why deal with
all of the hassle of breastfeeding."  I can see why they thought
breastfeeding was such a hassle, and can't help but wonder, in light of my
other experiences, if these mom's really needed to be doing all of this extra
work, when perhaps, they could (maybe) just nurse more frequently, be taught
to learn to nurse lying down and with a sling.

It makes me wonder if this is really the solution it seems to be (pumping
following feeds, then feeding pumped milk)....keeping in mind that without
exception, these mom's all told the LC's that this sounded like a good plan
of action and were willing to follow it.  Certainly it's appropriate at
times, but it's starting to seem to me like this route is also overused, when
it would be possible (in *some* cases) to simply have mom nurse...then nurse
again (instead of giving the supplement after nursing).

katherine in atl

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