I love to get some discussion on how often LCs tend to recommend
prenatal expression. Do you bring up the idea in general when dealing
with pregnant mothers, as in a class, or just in special "red flag" cases?
In a related question, how much of a red flag is waved by a mother being
significantly overweight? I've read some articles discussing that
lactogenesis 2 may be slower, and even about ongoing difficulties with
milk production, because of lower prolactin spikes. . I met with a
mother recently prenatally in a mini-consult (she was worried about the
effect of a nipple ring), who was a very large woman. We discussed,
using a doll, some positioning ideas, since the average-size women shown
in most breastfeeding pictures aren't much help. And of course, I
really stressed early and often, how to tell baby is getting
enough,etc. I also asked carefully about other health issues -- no
problems with thyroid, very regular menstrual cycles, no problems with
blood sugar issues, no difficulty getting pregnant, healthy pregnancy,
blood pressure fine -- because surely some of the production issues in
the studies might stem from the same factors that cause weight problems.
I know we've had discussions along these lines before. How do we bring
up potential problems without undermining the confidence that's needed
in those early days when the baby (hopefully) is on a feeding frenzy.
Would getting this person pumping prenatally make her feel proactive, or
make her lose confidence? And how much of a risk factor is the excess
weight minus any other health problems?
Her baby isn't due for a few months, so I figured I'd have time to get
back to her after I'd pondered this a little. But I'm thinking now that
just because of the likelihood of a c-section, it might be worth her
having those little syringes.
Margaret Wills, LLLL, IBCLC
Maryland
> Sue Cox published on this in Breastfeeding Review.
>
> Hand expressing is THE way to go - small volumes (ie drops) will get
> stuck on pump tubing and be lost.
> Start from 36 weeks, twice a day. Following a nice warm shower with some
> breast stimulation will get the best results. Have a sterile syringe to
> 'suck up' the drops expressed as she expresses them. Return the syringe
> to the sterile packet it came out of and put it into the fridge for the
> next expressing time. Some say to freeze the syringe after the second
> collection, but if hygiene is good I can't see why it can't be kept for
> 48 hours before freezing. Supplementing isn't usually needed in the
> first 24 - 48 hours, and if she is likely to be home by then she could
> keep the milk to use when baby is home. However, if necessary take it to
> hospital to use.
>
> I hope she does well with your help and supervision.
> Denise
>
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