Grace writes:" The length of stay patrol would like to see more breastfeeding babies bottling earlier in an attempt to get them home sooner. If there are any studies that show that the babies that then do not go on to breastfeed will get breastmilk for a shorter duration than their breastfeeding peers, it may help." The length of stay police are alive and well in the NICU where I work as well. I am not aware of research that proves that the duration of breastfeeding is different between NICU graduates who receive breast milk by bottle v directly from breast, but I can tell you what I've experienced with many of the mothers I work with. Before breastfeeding is fully or even mostly established bottles are introduced and then pushed. The mother is made to feel guilty if she asks to limit bottles. "Don't you want your baby to get out of here?" The LC tells her one thing, the nurse something else and the neonatologist something else again. All except the strongest mothers capitulate and so baby often leaves the hospital without breastfeeding fully established. Mom may have had a great milk supply in the hospital but now she's home with a fragile baby with special needs. She knows he can take the bottle--after all the nurses have proven that they can feed the baby better than she can. Now she's on her own. Baby may be on oxygen, needs breast milk mixed with fortifier, needs meds. She's overwhelmed. She used to pump 8 times per day but now she's lucky if she can fit in 5 or 6. That once wonderful milk supply dwindles. Baby's not nursing and she panics as she uses up the store in the freezer. Most mothers can't keep up with caring for a high needs baby and pumping. When they see their babies gain wt. well on the bottle, they are reluctant to rock the boat and go back to breast. And as their milk supplies rapidly diminish the chance of successful breastfeeding declines, because premies do better when supply is high with resultant faster flow. I saw just such a mother today. Her baby born at 25 weeks gestation (1 lb-10 oz.) left the hospital 2 weeks ago at 41 weeks adjusted age. Milk supply when she left was 30 oz./ 24 hr. This baby could take a full feeding from breast (by test wt.) but not consistently on the schedule his caretakers wanted. He left the hospital on breast and bottle and because mom, even with a scale at home, was so afraid he would not get enough to eat he was transitioned totally to bottled breast milk pretty quickly. Supply is now 18 oz. in 24 hr. and baby fights the breast. Her day is a round of pumping, feeding, giving meds, and watching the nasal cannula oxygen. She's running out of steam on the pumping. I think with a few more days and a lot of good support this baby could have been fully breastfeeding. I did get him on the breast today but it was a struggle. I don't know if even this very dedicated mom can keep it up. I'm realistic--I know hospitals aren't the best place for anybody to live--but if a few more days and some really consistent support can facilitate the baby feeding at the breast, then I know we can lengthen the duration of babies receiving breast milk. Bottles are often pushed to get babies out of the hospital when other issues are still keeping them there. I find often that when bottles are pushed baby is still not ready to go home or to take all of the feeds orally and so we've jeopardized breastfeeding and baby is still in the NICU. If the inability to breastfeed is the only thing keeping a baby in the hospital and it becomes clear that it can't be quickly accomplished, then we need to support the mother and baby at home. So many times, though, this is not the scenario I see. We are currently working on a protocol in my hospital where we will at least have some consistent guidelines for when to introduce a bottle and how often. I'm anxious to see if it facilitates breastfeeding for premies and gives mothers fewer mixed messages and more confidence. And finally my hope is that these mothers who have dedicatedly pumped for weeks on end will have the reward of feeding their babies at breast. Kathy Boggs, RN, IBCLC *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html