Pat writes: "I do wish the word would get out to mothers of premies that
pumping
excessive amounts milk is not of benefit to the baby. Most of the medical
support persons just cheer them on and exclaim about their vast stores in
the freezer."

I have to disagree here Pat. We  have to remember that some of these mothers
are spending literally months feeding the freezer before the baby is taking
any quantiity of milk at all.  A tiny premie may start out taking only 1 ml per
hour and over weeks build up to 30 ml per feeding or only 8 oz. per day. At
discharge these small babies are often only taking 16 oz. per 24 hr.
Never-the-less, we are happy when mom is making at least 25-30 oz. per day--way more than
baby can take. This is for a couple of very important reasons:

1. Some of these moms never achieve effective breastfeeding. Maintaining an
adequate supply while caring for a high needs baby can be difficult. Believe me
in those situations that freezer stock can significantly lengthen the
duration of baby receiving breastmilk. And it's amazing, as the baby's intake
increases, how fast the stock gets used up.

2. We know it's important to calibrate the breasts high. If we can reach an
ample supply early it is much easier to maintain it. For those mothers who
don't reach that 21-24 oz. (the minimum we like them to aim for) by the end of 2-3
weeks, it is very difficult to bring it up later.

3. Many mothers have inevitable dips in supply as they navigate the stressful
NICU stay. An ample supply is a cushion for this.

4. Finally, premies just plain do better if mother has a bit of over supply.
This translates into a faster flow and makes it easier for the baby to drink
the milk. We are always careful to make sure the baby can handle the flow. When
they are smaller we have mom partially empty before putting the baby to
breast. And many of these babies can only bf with a shield--an easier flow helps
with a shield.

5. After discharge we find that most mothers experience a dip in supply--an
ample milk supply provides a cushion for that as well.

With all that said, however, there are certainly times when we help a mother
of a premie to adjust her supply. We see moms who get 8 oz, per breast, per
expression. Reducing supply is very difficult for them but important. We start
with stretching out their interval and then having them take off a little less
each time. Even that doesn't work with some of these biological high
producers. We have had some good success with using Sudafed to decrease supply. And
some people put mothers on one week of estrogen containing birth
control pills to bring down supply.

In my experience the strongest correlate of a premie finally breastfeeding
effectively is a mother with an ample milk supply. It's one of the hardest hills
we climb in getting these babies to nurse.

Kathy Boggs, RN, IBCLC
Mountain View, CA

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