I agree with Jean that hand expression is a very powerful antidote to the
supplementation mentality. BTW, I have seen a few moms able to squirt their
colostrum, much like mature milk:-). What I have become a huge fan of when
baby cannot latch or is too sleepy to suck, is first do reverse pressure
softening if any edema is present, and then hand express directly into a
spoon. I teach the parents how to spoon feed the baby. They are usually
thrilled to see how easy it is. Sometimes baby will wake up and then nurse.
A teaspoon is 5 ml, mas o menos, so I let the mom know that 2 teaspoons is a
biologically normal feeding.
Colostrum contains approximately 67 kcal/dl (18.76 kcal/oz). In the
first 24 hours, total infant intake has been shown to range from 3 to 32
ml/kg of weight, or 10.2 to 108.8 ml based on a 7.5 pound baby (Casey,
1986). This corresponds with the newborn’s tiny stomach. Volume increases
over the next few days until production typically ranges from 556-705 ml
(14-19 oz) in a 24-hour period by day six (Hartmann, 2003).
If the mom is unable to hand express, I ask her if I may try. Usually, but
not always, I have pretty good fortune in finding that 'spot' that works.
Usually, the mom has pinched right at the base of the nipple vs. a few cm
back. I joke about the spoon being a low tech tool, and to use it if the
nurse says the "S-word," which is "supplement." I also praise the mom a
lot, even if she gets less than a teaspoon, and tell her she is awesome,
that her colostrum is really concentrated and "a little dab will do ya" (old
haircream advertising slogan).
I like hand expression and spoon feeding because it puts the mom in charge
and not a single drop is wasted.
Anna Swisher, MBA, IBCLC
Abundant Blessings
Austin, TX
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