PRO-LC, my local affiliate, had an eye-opening presentation in November 2003
by Diane Spatz, PhD, RNC, who shared the results of her (as-yet-unpublished)
study, “Strategies to Improve Breastfeeding Outcomes in Low Birth Weight
(LBW) Infants with Short Hospital Length of Stay (LOS).”

Her surprising finding: it takes *6 to 8 weeks* for baby to nurse
effectively enough that all caloric needs are met at breast!  Until then,
Mom needs to be doing extensive pumping to protect her supply, and needs to
be monitoring her baby’s improving transfer capabilities with pre- and
post-feed weighs on an accurate scale.

In Dr. Spatz’s work, the intervention (study)  group breastfed longer, and
was significantly more satisfied with the breastfeeding care it received.
So what did they get that the control group did not?

1.  Early breast stimulation.  The study group moms *went home* with a
hospital-grade pump, and were instructed to use it 6 times/day, in addition
to whatever nursing was occurring.  (The control group moms also got a pump
and instructions – but not the intensive follow-up support.)

2.  Accurate baby scale.  This helped the study group moms accurately assess
baby’s improving transfer rates ... and to reduce their pumping accordingly.
  The moms liked the no-doubt-about-it information the scale could provide.

3.  Nipple shields.  Many in the study group used a nipple shield after milk
had come in ... and for the babies who needed them, it often took until 42
weeks gestational age until it could be eliminated.  This is longer than
most of us like to recommend for a “transitional device” like a shield –
some babies in the study group were using a shield for six weeks!  But
because these moms were also using the scale so frequently, it was easy to
see that transfer was increasing, and adequate.

Nipple shields were helpful in diminishing that “latch-fall off” scenario
that tire near-termers, making BF inefficient.  The Moms liked them because
the babies were feeding at breast.

4.  Intensive follow-up care.

A.  These Moms got a home visit within 24 hours of discharge.  This was a
critical juncture:  Moms had left the hospital before milk had come in;
babies had done little or no breastfeeding in the hospital; the family could
easily “fall apart” that first day home.

B.  Lactation support was available to Moms via beepers.

C.  Telephone outreach and follow-up was conducted.

D.  Home visits were continued as often as needed.

The intensive level of support is noteworthy.  Even the control group got
better-than-average lactation support while in the hospital: for everyone in
this study of LBW babies with short LOS, there was: physician care, advanced
practice nursing care, lactation care AND pump provision with instruction.
Skin-to-skin was part of the protocol.

This is a vulnerable population of moms and babes.  It is very easy for them
to abandon breastfeeding, and turn to the bottle, when baby isn’t feeding
well in the early days.  Indeed, the study group moms who got the pumps and
scales and shields and visits and calls still needed 6-8 weeks to get their
babies fully to breast.

In Dr. Spatz’s study, 14% of the study group stopped BF at less than 30 days
... and none of these moms stated BF-related reasons.  The study group that
continued to BF went on to do so for a median of 145 days.  In the control
group, 27% stopped in that first month, ALL (save one) for stated BF-related
reasons.  Those that continued to BF in the control group did so for a
median of 75 days.  The take-home message:  as difficult as the first month
or so can be, there are huge pay-offs for the overall breastfeeding
experience.  Moms who understood the “whys” were able to stick with the
labor-intensive care plan, and nurse their babies longer.


Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA

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