During the plenary session re: *Is Pumping Out of Hand* at this year's
(July 2011) presented by neonatologist Jane Morton, MD, FAAP, FABM, she
spoke of others' and her own research on this topic. She noted that Furman,
Minich & Hack (2002;
http://pediatrics.aappublications.org/content/109/4/e57.full.pdf) found
increased volumes via milk expression when expression was initiated within
6 hours of birth; done more than 5x/24 hours; a mother kept a log of milk
expression; and mom and baby engaged in skin-to-skin contact. (I don't like
milk expression "schedules," e.g. "pump every 3 hours around the clock" --
a specific schedule no more fits all mothers' lives than "a baby should BF
only X# of hours" fits all babies' lives! Whether number of times/24 hours
or # minutes/24 hours, it's more likely to happen when there is flexibility
and sessions are logged to keep all "honest" as it's easy for a mother to
think she's expressing milk more often than she actually is.)

Dr. Morton then discussed her own research (abstract at
http://www.nature.com/jp/journal/v29/n11/full/jp200987a.html) and the
results re: including "hands-on pumping"/HOP (massage, stripping,
compression and manual expression) of colostrum/mature milk
during/following mechanical pumping. She also said they found that 7 or
more sessions/24 hours made a positive difference in milk volumes obtained
at 2 weeks but not at 6 weeks. HOP sessions averaged 20 min/session in the
1st weeks (so 7[+] x 20 min = 140[+] min/24 hr) and 25 min at 6-8 weeks
(but averaged 6 sessions x 25 min = approx 150-155 min) -- so fewer
sessions, which meant many moms could get a greater period of uninterrupted
sleep, but similar amount of total time. BTW, I found this # minutes
fascinating because it fit more closely with the number of minutes the
"average" newborn BF in the 1982 study by de Carvalho, Robertson, Merkatz &
Klaus vs the notion of 100 min/24 hr. (If anyone has an evidence base for
the 100 min thing, which I read somewhere from the 1980s or early 90s but
not via Chris M, please share the ref!)

Use of hand expression for more than 5 sessions during the 1st 3 days
postpartum resulted in significantly more milk by day 14:
-- Group I: hand expressed <2x/24 hr those 1st days obtained 443 ml/24 hr
(+/- 217 ml) by day 14
-- Group II: hand expressed 2-5x/24 hr during the 1st 3 days obtained 488
ml (+/- 352 ml) by day 14
-- Group III: those who hand expressed >5x/24 hr during the 1st 3 days
obtained 780 ml (+/- 496 ml) by day 14.
At 8 weeks the mothers in Group III continued to obtain greater volumes
(close to 1000 ml/24 hr) than those in the other 2 groups, although all
were averaging more than 600 ml/24 hr.

Being instructed on and adding HOP techniques resulted in significant
increases in volume obtained.

Morton did not find a correlation with maternal type of delivery, her BMI,
history of previous BF, IVF or multiples and she asked if the techniques
supporting effective and frequent milk removal may have mitigated these
factors? She is not the only one to report in the last few years that
mothers obtained more colostrum via hand expression and then obtained
better volumes later, so Morton wonders if the milk removal in these 1st
days "programs" the breasts for the future.

I'd suggest anyone not yet familiar with her video "Maximizing milk
production with HOP," give it a trial. I've also suggested these techniques
(plus a discussion of Nancy Mohrbacher's "magic number") to mothers who
contact with a dip in volume obtained after weeks to months of BF + pumping
at work (after assessing for other possible factors), and most report a
rise in volume obtained again.

(Dr. Morton, please accept my apologies if I've goofed up any aspect re:
your sharing of this really helpful info this summer!)

-- 
Karen Gromada
www.karengromada.com/

Date:    Mon, 19 Dec 2011 21:39:41 +1300
> From:    J Nicholls <[log in to unmask]>
> Subject: pumping preemies
>
> Hello Wise Ones
>
> I have been trying to find research around the pumping times that =
> recommend mothers who's babies are unwell and in special care baby =
> units.
>
> I thought there was research that recommends " 100 minutes " per 24 hrs or
> something to that effect , rather than the "10 minutes every 3 hrly"
> ..
>
> Can someone please help me.
>
>
>
> Sincerely
> June Nicholls
> IBCLC
>
>             ***********************************************
>
>

             ***********************************************

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