In a message dated 00-01-08 18:44:37 EST, you write:
<< I would sincerely appreciate any information or opinions you could share
concerning how often and for how many minutes mothers need to pump for a
single infant, twins, triplets and quads. Any references? >>
For some actual suggested parameters, see:
Gromada, KK & Spangler, AK (1998). Breastfeeding twins and higher-order
multiples. JOGNN, 27(4), 441-449 (esp. p. 443).
Gromada, KK (1992). Breastfeeding more than one: Multiples and tandem
breastfeeding. NAACOG's (AWHONN's) Clinical Issues in Perinatal and Women's
Health Nursing, 3(4), 656-666 (esp. p. 659).
Gromada, KK (1999). Mothering multiples: Breastfeeding and caring for twins
or more! Chapter 11: Multiples in the newborn intensive care unit (rev. ed.).
Schaumburg, IL: La Leche League International.
I know policy makers hate to take too many factors into consideration, but
those factors do affect new mothers' of multiples (MOM) abilities to pump. If
babies are closer to term, larger in size and will be receiving enteral feeds
soon/today via tube or by mouth, initial volume will be more of an issue than
if babies are more preterm and VLBW. The MOM with the closer to term and
larger premies probably will want to pump more often than the ones whose
babies are more preterm and will be taking smaller amounts initially, but
still needs to establish adequate production that can be increased via
additional pumping sessions (or occasionaly by somewhat longer pumping
sessions) as babies' need for EBM increases.
Policy also needs to take into account that MOM are more likely to be
recovering from complications of pregnancy, L&D or postpartum that can affect
a mother's ability to pump, e.g. effects of prolonged bed rest, surgicaln
delivery, PIH-HELLP, postpartum hemorrhage, etc. (BTW, 1998 and 1999 refs
include note that nurse or LC can pump or show family member how to pump a
MOM who is physically unable in the first day[s] after birth.) Add to that
the need to spend time with babies in the NICU or staggered discharge of
multiples and having to meet the needs of one or more at home while spending
time with one or more in the hospital, and it complicates the picture.
IMHO, I wonder if many mothers of higher-order multiples stop if recommended
to pump as much as 30-40 minutes every 3 hours during the day because it is
too overwhelming to continue. I find when mothers increase the length of
sessions, they often decrease the number. Although this works for some, it
seems to result in decreased production and discouragement for many.
Bottom line--The best pumping routine for a MOM is one that establishes and
maintains adequate milk production yet is one the mother finds realistic and
adaptable for her changing situation.
Karen (who confesses conflict with Mothering Multiples, but don't think other
refs should be a conflict)
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