Dear Laurie,
I used to believe that if everything was going well, meaning that baby is
nursing well and transferring milk well and so on, that there was no reason
to pump and that if you did encourage it, you might set them up for
oversupply problems down the road...
But, I had a case with a 37 weeker, in which everything was going well,
except that mom's engorgement was lingering and she was wondering if she
should pump her breasts to empty to get rid of the engorgement. Her baby
was transferring 2 - 2 1/2 oz at each feed (for a 5 pounder that was great)
at each feed. I was hesitant to have her totally empty her breasts since I
figured that it would make it worse. I was just encouraging her to pump or
express to comfort. (That was 15 minutes in her case).
I emailed a respected Lactnetter to get her opinion and she reminded me and
sent me research citations to show that milk production is generally set in
the first couple of weeks and remains the same through the first 5-6 months.
This was Peter Hartman research I believe. Anyway, her reasoning, and it
makes sense to me, is that we should be encouraging the moms of near
term'ers to pump and get that milk production going full speed. Because the
average 5 pounder is not going to bring in a production that a 7-8 pounder
would. A 5 pounder just doesn't take that much in the beginning. If we
leave it up the the wee little one to set the production, then when that wee
one is a 8-9 pounder, there is many times a struggle to have enough milk.
The production was set to say 16 oz - 20oz per day instead of 24 - 32oz/day.
The other issue is that a near termer sometimes coasts on the mother's
initial milk surge and good let-down. And doesn't really regulate. When
they do finally start sucking, there may not be enough because what is being
produced is only what was removed with a good let down.
Well, with my client I did encourage her to pump finally and she has been
able to keep her supply up with a lot of work. I wish I had encouraged her
to pump sooner.
Regards,
Cindi Swisher, RN, IBCLC
Colorado Springs, CO
-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]]On Behalf Of laurie wheeler
Sent: Tuesday, November 16, 2004 11:11 PM
To: [log in to unmask]
Subject: Re: 37 weekers
Would you recommend "insurance pumping" in this situation? :
37 wk healthy infant, birthweight 5 lbs 0 oz. Assessed to be breastfeeding
effectively w/ great latch and +++ swallows in hospital. 4 lbs 12.6 oz at
discharge on day 2 which is about 4% loss.
Follow up call reveals milk in, good feeding behaviors, abundant
wets/dirties, no problems identified , infant weighs 4 lbs 15 oz on day 5.
Knowing all the problems and challenges that *can* occur w/ near term
infants, I really don't feel she needs to pump to "insure a good supply". Do
any of you?
Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA
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