Dwindling milk supply is unfortunatly a common problem for preterm mothers.
Much of it is avoidable when things start out right and we use the evidence
we have to guide our practice. See the article in the December issue of the
Journal of Human Lactation by Hill, Aldag, and Chatterton for a good look at
how to predict milk supply after two weeks. Their data shows that a mother
needs to be producing more than 3500g by week two if she is to be expected to
produce sufficient amounts at weeks 4 and 5. If she is producing more than
1700g by week two she has a 50% likelihood of reaching the minimum amount of
3500g by week 5 postpartum. A mother producing less than 1700g at week 2 is
in trouble. A mother needs to pump like crazy during those first 14 days.

We know that the first 14 days are critical for calibrating the breasts to
make the most milk they can. Frequent milk expression, which means more than
8 times a day is needed. Data shows us that 10-12 times each 24 hours during
the first 14 days maximizes what the breasts will produce throughout the
entire lactation. We know that the degree of drainage of each breast at each
pumping also regulates the amount subsequently produced.

Even knowing all this, we still see mothers being told to start pumping a few
days after delivery, pump only the amount that the baby needs at the time,
don't pump at night, pump 6-8 times a day, etc. This type of guidance
contributes directly to insufficient milk by 6 weeks down the line.

I would refer some of my mothers with exceptionally low production to have
accupuncture that would increase their milk supply. This usually worked, but
not always. A mother who is pumping only 6 times a day and experiencing
supply problems needs intensive help and needs to be pumping much more than
that. I also have mothers massage and compress their breasts while they are
pumping to both make the pumping go faster and drain as much milk out as
possible.

Marsha Walker, RN, IBCLC
Weston, MA

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