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Subject:
From:
Becky Krumwiede <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 17 Mar 2000 13:01:50 EST
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I have lots of questions about this, too.  The longer I'm in practice the
more sure I am that I don't know much.  We developed a flow chart at our
hospital so the nurses would have something to follow since the LC's aren't
there all the time.  If baby has not latched on and fed well by 12 hours, mom
is to start pumping about every 3 hours.  If she gets something, we feed it
to the baby (if only drops, we add a few drops D5 to wash it off the sides of
the bottle).  If she gets nothing and baby isn't grumbling to be fed, we
don't start feeding baby until 24 hrs.  We start with D5 (based mostly on Dr.
Jack's writings and our hope to not have to introduce foreign proteins), but
if still no colostrum or only tiny amounts by 48 hrs. we start a
protein-hydrolysate formula.  Despite the fact that we have Medela Classics
and Ameda-Egnell "big pumps," like Jan B. we often have mothers pumping
absolutely nothing for many pumpings.  For the life of me I can't figure out
why so many moms get nothing, but others get a half ounce (15 mls) on the
first pumping!

If there were research to support it, I would be *really* happy to have the
babies hanging out on moms chest licking and nuzzling for the first 24-48
hours, but I guess I'm fearful that would compromise the milk supply.  We
really don't know, do we?

Denise wrote:  <<My other point is preventing engorgement.  We all know that
frequent,
effective breastfeeding from birth will prevent engorgement and that not
draining those breasts often enough in the first 48 hours will cause
engorgement.>>

I don't think we know that at all!  I see moms with very bad engorgement
whose babies have nursed wonderfully all along.  And about a month ago I
wrote into Lactnet about a Hmong mother with very bad engorgement and never
got a response to my question on that one, so I'll ask again:  This mother
had been nursing some, but topping baby off with bottles of formula.  I made
a home visit and chatted with her recently emigrated mother-in-law, who had
nursed 4-5 children in Laos or Thailand, who had never seen anyone with hard,
tight breasts like that!  In their homeland the practice is to not nurse at
all until the milk comes in; someone else wet-nurses the baby until the mom
"has milk."  So why, with this practice, do mothers not get engorged?  I
wondered whether our Hmong mothers would be better off not nursing at all
until the milk comes in if they're only going to do it sporadically.  Perhaps
occasional emptying is more conducive to engorgement than no emptying.  Do we
really know?  By what we believe to be true, that older Hmong woman should
have seen plenty of engorged breasts in Laos and Thailand!


Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin

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