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Subject:
From:
Pamela Morrison <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 10 Feb 2010 22:09:31 +0000
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Casey

Very good question!  I see the problem.

I usually use your standard suggestion too, breastfeed first, then
pump and save the milk for the top-up after the _next_
breastfeed.  But in the special situation you describe of feeding
sick/prem babies in the first few days of life, then personally, I'd
recommend your second option - have mom pump _before_ the breastfeed,
and then put the baby to the breast afterwards, even if it means that
baby nurses at a comparatively "empty" breast.  Why?  Because it will
likely lead to the least use of formula.  There will be a time in the
first 2-3-4 days when the mother is producing enough milk to pump
sufficient first, and then have the baby nurse, and then be able to
pump again before the next scheduled breastfeed.  Then she can make
the switch to nursing first, topping up with previously pumped EBM,
and pumping immediately afterwards, ready for next time.

In the NICU where I used to do consults in Harare, the moms would
always hand-express rather than pump, especially in the first few
days after birth, when the milk is quite scanty.  Too many precious
drops become lost on the inside of the pump ..... Also when the
paediatricians started calling for mom's milk (and yes, they really
did "order" it!) then the mom would often be expressing just a few
drops every hour or even at shorter intervals, in a superhuman effort
to add all the precious tiny quantities together to make enough milk
for the baby's next nasogastric feed.  Formula top-ups were seen as a
regrettable, but sometimes necessary last-resort for _some_ of the
feeds for some of the bigger babies (who needed more milk due to
their size) and then usually only in the first 24 - 36 hours of life.

Pamela Morrison IBCLC
Rustington, England
---------------------------------------
Date:    Wed, 10 Feb 2010 14:14:43 -0500
From:    "[log in to unmask]" <[log in to unmask]>
Subject: Catching up with breastmilk supplementation

Hello everyone!

I have a question about supplementation in the first 24hrs or so.

Assuming a baby has a legitimate need for supplementation, my first
recommendation is always to have mom pump so that we can use her milk
for supplementation, and, hopefully not need to add formula.

For babies that will need continued supplementation - like a late
preterm baby with low blood sugars, or a weak suck - I usually
recommend a feeding routine where baby breastfeeds, then receives
their supplement, and THEN mom pumps.  Whatever mom pumps is saved to
use as supplementation for the next feeding.
I prefer baby to have the entire feed (breast and supplement) before mom pumps.

However, the problem with this is - the very first supplementation -
I have mom pump, she feeds baby whatever she has pumped.  Great, baby
gets breastmilk, hopefully no formula, and life is good!
However, at the next feeding, there is no breastmilk available to use
for supplement (because it was given at the last feed).

The only way forward I've seen is (again, I am only talking about
circumstances where baby meets criteria for continued
supplementation, and NOT supplementing is not an option) to use
formula for supplementation that feed, have mom pump, and save that
milk for the next supplementation.

However, this makes it almost impossible to strive not to give formula.

Would you consider having mom pump BEFORE breastfeeding in order that
the supplement can be breastmilk?  I don't like that idea because
then baby goes to an empty (or emptier) breast for the feed.  On the
other hand, it would prevent or reduce formula.

For the most part, I'm talking about my late preterm babies and my
hypoglycemic babies, and usually in the first 24hrs.

Any tips or suggestions?

Thanks,

Casey Clubb, RN, IBCLC
West Linn, OR USA

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