Pat says,
 
 
I think  pumping initially is sending the wrong message.  Gently teaching 
hand  expression and catching the drops in a spoon, which can be fed to baby 
or  stored in a sterile syringe for later use (baby  NPO for some reason) is 
 probably the best way to go, IMHO. This surely needs to be done in first  
hour  if baby won't or can't latch.     Those golden drops  get all caught 
up in pump apparatus, smeared on mom's breast,  etc.   and are lost.  
Remember it is liquid gold.  Pat in  SNJ>>

 
Pat, I have to disagree with you here.  That pumping within the first  hour 
garners a whole lot more than drops in a spoon.  There is a bolus of  
colostrum available to the baby -- if not to the baby because of immediate  
transfer to the NICU, then to the pump.  Just talked to one LC that did it  for a 
mom of a VLBW baby and they got 14 ml!  People who have done this  
generally find that they get anywhere from 10-20 ml -- in the collection  container. 
 This can be sent to the NICU for the baby.  If you wait  the 6 hours you 
do get the drops on the flange and smeared around the breast,  etc etc, and I 
totally agree that hand expression from then on may be a better  way to go 
than pumping.  But that first hour -- the message to the mom is  that you 
have colostrum there for your baby, and we want to be able to send it  to the 
NICU so it will be available for his first feed.
 
OK -- I am talking about babies going immediately to the  NICU.  I am not 
talking about the baby that can't or won't latch and can  stay w/ mom who 
may, if we leave them together, latch in the next 10  minutes.   So we may be 
talking about two entirely different  populations here.
 
The colostrum is there because of the oxytocin related to the birth, and it 
 seems that if it isn't moved OUT, then it sort of shunts back up in the  
breast....Geddes did a study on that, I believe, and then later -- at 6 hours 
--  you only get drops.
 
That said, we really do need a study and we need some comparisons.  I  
think in a mom that is induced or has a repeat C/Section and doesn't go into  
labor on her own at all, we may not see that bolus because Pitocin suppresses  
the mom's own oxytocin, and of course w/ no labor there is no oxytocin  
surge.  And it may be true to a degree in a mom who is stimulated for a  long 
period of time.  
 
I'd like to see a study done comparing pumping in the first hour with hand  
expression.  Realistically speaking, very few L&D nurses know how to  hand 
express or how to teach mothers hand expression.  It's almost  impossible to 
get them to have mom pump in that first hour if the baby is in the  NICU, 
never mind hand expressing.  And moms, unless it is a second time mom  who is 
proficient at hand expression may not do it long enough or effectively  
enough to get all the colostrum that is available.  
 
Short of doing ac/pc weights on babies with that very first feed, I don't  
know how else to get a better picture of it.  And try as I might, I can't  
figure out how to do ac/pc weights without taking the baby away from the 
mother  before that first feed is accomplished!
 
Jean, I'm still thinking about your post -- wondering how soon the extra  
fluid in the tissue is manifested as we don't *see* edema, as you've pointed  
out, until there is a real 30% overload of fluid.  So I'm wondering if  
pumping within that first hour after birth is still an issue. 
 
Lots of questions, and not very many answers.  But in the Parker  article I 
cited before -- even though it was a pilot project and only 20 moms of  
VLBW babies participated, the results over SIX weeks were astounding in terms 
of  milk production.  The only difference being 10 moms started pumping at 6  
hours and 10 pumped w/in the first hour and at every measure, the moms  who 
started pumping within the first hour had 2 to 3 times MORE milk than  the 
moms who started pumping at 6 hours.  
 
It is certainly something we need to be looking at.   
 
Jan Barger, RN, MA, IBCLC, FILCA
Lactation Education Consultants
Wheaton IL



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