Catherine writes: Again, many premies have immature ability to coordinate
swallowing and breathing, and that might make even a normal supply
difficult to handle initially.

This is very true, Catherine, but if we let supply regulate to baby's need
before s/he is fully breastfeeding many premies are unable to transfer milk well
at all. It's certainly a dilemma. The way we handle it in the hospital is to
have mother partially pump before putting baby to breast. The Catch 22 is if
we lower supply to what baby needs, he is unable to transfer milk and if we
keep supply high for all the reasons I outlined in a previous post, baby can
choke and have bradycardia. I must say that some of these babies cannot even
coordinate a very slow flow on bottle or breast. It can be the only thing keeping
them in the hospital.  We watch babies very carefully to make sure they can
pace themselves and we teach moms the signs that milk is coming to fast--wide
eyes, paleness, gulping without stopping to breathe and have her take the baby
off the breast before he bradys. The problem with this, of course, is that once
a premie is removed from the breast he often will not relatch. I

As I wrote previously, with very high supply we do emloy measures to lower
it, but otherwise we usually need a cushion for these babies to be able to
breastfeed. We also make sure mothers do not stop pumping cold turkey when the baby
is discharged. Too many times we've seen this result in a precipitous drop in
supply. Instead we wean the pumping and in the best of worlds these mothers
and babies have close lactation follow up.

When our babies first go to breast they may only take 10 ml or less. We can't
lower supply to this level. And they usually only get that 10 ml if supply is
high. If we don't get them breatfeeding early, however, the spector of the
bottle hovers. Once these babies become established on a bottle many can never
get back to breast.

It's pretty labor intensive  to get this population breastfeeding--but oh so
important and worth it.

Kathy Boggs, RN, IBCLC

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