I have been reading the posts on the guidelines and satisfaction of different
breast pumps and wanted to throw out some questions.
I also just read the 2 articles in the May 2004 JHL on areola edema by Jan
Riordan/Voni Miller and Jean Cotterman.  They are a must read for all in the
field.  IMHO.
According to research by Barbara Ackerman and Paula Meier they recommend that
mothers with babies separated from them due to medical problems should start
pumping at 6 hours postpartum and then to pump 10-12x/day for 20 minutes with
a hospital grade double electric pump.
Now I understand the rationale here but for many a mother in the first 24+
hours PP the pumping is mainly stimulating the breast and maybe the flanges will
be wet with colostrum but very little volume is seen.  Now add the
possibility of edema to the areola and there is even less seen.  This is very
discouraging for many a mother no matter how much you tell them that the amount is small
and the importance is the stimulation for a future milk supply.  Then
compound this with NICU practices that supplement babies with hefty amounts and the
mothers just don't see that their milk will ever get to what their babies are
eating.
Here are my questions.  Has there been any comparative studies to only hand
expressing Vs ele breast pumps, especially in the first 48 hours?  If mothers
need Reverse Pressure Softening to reduce the edema in the areola, doesn't it
make sense to just continue on with hand expressing and collect in a cup?  With
a mother hand expressing into a cup, it appears easier to collect the
precious colostrum this way than trying to separate the flange once the milk starts
to pool and pull it out with a syringe, doesn't it?
Any thoughts and feedback welcomed.
Ann Perry RN, IBCLC
Boston, MA

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