Regarding the idea that hands-on pumping should begin later. I disgree with that. In Jane Morton's video, she states that the study was on participants during the first couple weeks of initiating pumping for preterm infants. One group was pumping only, the next was hands-on pumping and the final was x 8 hands-on pumping plus x 5 hand expression per 24 hours and there was a significant difference in those groups. Early initiation of hands-on pumping stimulates oxytocin release and provides more effective and efficient milk removal. I do think it is best started in the hospital, as much as the mother can do. It's not best to have them wait until after discharge to begin hands-on pumping. Thanks everyone for the suggestions of the fetal monitor straps and abdominal binder. Can't wait to try those. I know some feel that it's too overwhelming to share this suggestion with mom. Some women are critically ill during this time. However, I think that it's only our job to provide the information. The mom has to decide what to do with it. It's not too overwhelming for mothers to discuss pumping regimens, target goals, pumping times, etc. Most appreciate a plan of care and having a specific goal makes it more likely they will acheive it. If a mom can't do it physically just support her efforts. I think the debate we were having was which would produce more milk single pumping one breast at a time with hands-on pumping, or double-pumping without any hands-on pumping. I see that my patients usually about twice as much colostrum when they use their hands either during pumping or by hand expressing, so I have to believe that's beneficial to long-term milk production. Here is a quote from Jane Morton:
   
   - What happens in the first 3 days is critical to future milk production.
   - There is a risk when mothers are taught to rely solely on breast pumps to establish and maintain their breast milk supply.
   - Even low producing mothers can become high producers—not by expressing more frequently, but by expressing more effectively. This involves learning a simple technique called hands-on-pumping.
   - So-called “risk factors” for insufficient milk production such as preterm birth, obesity, cesarean birth, advanced maternal age, first-time mother, and mother of multiples (twins, triplets or more) seem to be of little consequence when effective expression techniques are utilized.

Tricia Shamblin, RN, IBCLC

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