I have also seen premies have a spell (apnea and bradycardia) when their
mothers have tremendous let downs or just a fast flow all of the time. Mothers
like these act like a bottle to a premie. Breastfeeding allows the baby to
control flow better because it is a feeding that the baby controls to a far
greater degree than a free flowing bottle. It is about flow and the baby
having the ability to coordinate suck, swallow and breathe. Nobody can swallow
and breathe at the same time. When a baby is immature, you will see that the
baby will suck, suck, suck, swallow and breathe, breathe, breathe. Full term
mature babies will suck, swallow and breathe. Try swallowing some water and
taking a breath at the same time. It can't be done--adults even have to do
one or the other. We try to have the baby use a slower flowing bottle before
they go home to see if it is comfortable for them, taking 20 min or so for a
feeding.
Babies are far more stable cardiovascularly with breastfeeding, but the flow
is slower with most women (remember many mothers of premies have low or
borderline milk supply) and they may tire out before taking in the full amount
(remember 180++cc/kg/d) of breast milk at the assumed 20-22 cal/oz. With
bottle feeding, we can add things or lactoengineer with hindmilk the breastmilk to
a higher calorie concentration, so that they don't have to take in the
180++cc/kg/d to grow well. They simply have to take in less volume to grow. As
the baby matures and mother and baby become more comfortable and competent and
CONSISTENT with breastfeeding, they should be doing more and more
breastfeeding as the baby shows good growth.
These are not smaller full term babies and making the same generalizations
about what "should" be done is unrealistic and grossly unfair. Every baby sh
ould be evaluated over a long period of time after discharge, not a single,
solitary visit. I have had mothers call me crying and upset because an LC came
to their house and told them that they should be fully breastfeeding,
because the baby performed beautifully while they were there (how much of that was
from subtle help from the LC??). Either they took this person's advice and
then went to the pedi for a routine visit where the baby did not grow or lost
weight, so the pedi ordered heavier supplementation (how can you blame him?),
or that they stopped breastfeeding and just pumped and bottled or switched
to formula, because they couldn't handle the inconsistent information (who
could?).
Let's give these people a break and give them some time to adjust to being
home without monitoring, 24 hour/day nursing and medical care, and I and Os.
If a mother is patient and persistent, she will breastfeed, no matter how
long it takes them to figure it out.
Maureen Allen RN, BSN, IBCLC
Brigham and Women's Hospital
Boston, MA
PS
180cc/kg/d for a 2 KG (4 lb, 6 oz. roughly) baby equals about 1 1/2 oz eight
times a day.
***********************************************
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(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
