Lynn Shea asks: "I'd like to take this discussion one step further......what
are typical
indications for pump usage in the first couple of weeks?"

Here are my indications:

1. Mom and baby are separated and baby can't nurse
2. Baby unable to latch
3. Baby needs to be supplemented:
    a. near term baby who lacks stamina to breastfeed totally
    b. low supply which has not been corrected by improved latch and
breastfeeding                 management
    c. baby unable to effectively transfer milk for whatever reason
4. Initial engorgement which baby cannot even partially relieve
5. Insurance pumping for moms at risk for low supply--e.g. breast reduction,
widely spaced tubular breasts--not sure, however, that the extra pumping works
in these cases but I like to maximize stimulation to whatever glandular
tissue is present.
6. Delayed lactogenisis

I do not have mothers pump to relieve overfull breasts as long as baby is
able to transfer milk well. I may have her hand express a bit for comfort and
then after the first week or so start measures to bring down supply. I don't like
to do this too early since I'm afraid to overshoot the mark.

I also tell mothers that, unless there is a need, it is better if they don't
pump and bottle feed in the first three weeks--stressing, of course, that if
there is a need the pump is available. I tell them that I like baby to master
Breastfeeding 101 and regulate supply before mom starts pumping and  bottle
feeding. I can see how this might be misinterpreted, but I don't know of any
cases where it has been.

Kathy Boggs, RN, IBCLC

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