Hi all,

I really appreciate everyone who took the time to respond to my post of a
couple of weeks ago in which I asked if you recommended use of a nipple shield,
did you also recommend insurance pumping -- why or why not?

Of course, as with all "questionnaires/surveys" as the answers came back in,
I began to realize I hadn't phrased my question adequately.  It was
interesting to note how often the term "insurance pumping" was misunderstood --
obviously not a term in common usage.  For that, I apologize.  I should have realized
it isn't that common a term yet, and defined exactly what I meant.

Anyway, I kept notes:  there were 22 specific responses -- most to Lactnet,
and a few to me privately.  Many of you said you would recommend pumping if
there was a low milk supply.  I concur -- though I wouldn't call that "insurance"
pumping -- that's pumping because there is a low milk supply and you want to
bring it up.  A few said that you would not recommend pumping because if the
baby didn't transfer milk with the shield when they were with you, you'd
abandon it and go to plan B, C, or D -- whatever was next.  Some said pumping would
depend on test weights, some depend on the feed that is observed, some said
only if mom can handle the pumping, and some said if good feed, no, if poor feed
yes.  A few said yes, they would recommend insurance pumping several times a
day until an ample and robust supply is demonstrated.

I see moms both in the hospital and in my office if problems arise after the
hospitalization.  I'd rather not use shields in the hospital basically because
we have no clue as to whether or not mom has an ample supply, but my choices
are limited if baby simply won't/can't latch.  We can pump & cup feed; we can
pump & finger feed; we can pump and bottle feed.  If we are going to do any of
the above, I'd rather have the baby on the breast, albeit with a shield so
they at least get accustomed to assuming the position.  Of course, all of *my*
plans depend on what *mom* can cope with!   Then if the pump is started in the
hospital, I absolutely recommend pumping as a backup until mom has
demonstrated that supply is robust and baby is feeding well with the shield -- at which
point we begin weaning the baby from the shield.

I define "insurance pumping" as pumping "just in case" when there is a
potential problem -- i.e. we are using a shield (we wouldn't be if there wasn't some
sort of issue), the baby is "just a little early" or a baby with some sort of
problem that precludes a stellar attachment and suckling -- such as Down
Sydrome or a cleft.  It seems to take the burden of initiating and maintaing the
supply off the shoulders of the baby totally and puts part of it on the mother.
 Now she doesn't have to use a pump, she can hand express -- that is
certainly a great idea.  And as I said, once she has demonstrated a consistent robust
supply, then we begin to commence to start to eliminate pumping.

So that's what I do -- thank you again for all of you who wrote, and for all
your varying responses.  It's great to see how different LCs practice around
the world.

Jan Barger, RN, MA, IBCLC, RLC
Wheaton, Illinois
www.lactationeducationconsultants.com

             ***********************************************

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