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Lactation Information and Discussion <[log in to unmask]>
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Thu, 16 Mar 2000 13:09:27 EST
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At the risk of sounding well, simple-minded, I submit the following reminder.
 If we do nothing at all about pumping and the mother doesn't put the baby to
the breast at all, colostrum and milk will still "come in".  (Remember the
olden days when bottlefeeding mothers had to have their breasts bound or take
meds to stop this natural process?)

So, I don't think we should get too hung up on numbers or arbitrary time
frames.
Where I work, we've recently revised our policies for "normal" newborns and
breastfeeding expectations.  Our expected normal for the baby within the
first 24 hours of life is:  one latch/suck/breastfeeding. More is fine,
obviously.  We found that nurses were spending 20, 20 or 40 minutes w/ a mom
and baby "trying" to get the poor baby to latch.  This led to frustration,
babies' being quite turned off  about feeding, increased maternal anxiety
(what was the problem really--I think it was our expectations of what the
baby "should" do).  We do have some epidural use, probably about 40-50%, some
Fentanyl, so some babies just aren't ready to wake up and nurse well every 3
hours that first day.  In addition, 24 hours gives us time to look at other
factors:  weight loss (all our scales are a brand that is fairly accurate), #
of wet diapers, # of BM's, baby's overall behavior.

We try to emphasize this time for mom and baby (and rest of family) to get to
know each other.  Baby can be held, gazed at, put skin to skin, whatever.
All babies are kept in mom's room as we have LDRP's and no central nursery.

After 24 hours, staff or LC's work a little more on identifying the problem
(this itakes much more thought than it seems...) and then trying solutions.

As far as pumping for a baby in SCN or unable to feed at all, I take my cues
from the mothers.  Some are keen to "do something"; others are really still
in shock or are grieving.  Some are concerned that their baby will live (this
may or may not bear any relation to the baby's actual condition, but they are
caught up for whatever reason).  I don't believe we've seen any significant
differences in milk production regardless of when the mom starts pumping.
Really,  based on physiology of lactogenesis, we have two weeks for milk
production to proceed, so what's the hurry??

Jeanne M. Brotherton, RNC, IBCLC
Bellingham, Washington

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