Debbie was asking how much I would expect to get from hand expressing and
using a hospital grade pump in the first 24 hours or so postpartum.  We
NEVER use a hospital grade pump or even a hand pump until lactogenesis
II.  Hand expressing is the recommended technique.  How much do we get...

This is really variable Debbie.  But I do have all the midwives trained to
jump up and down excited and tell every other midwife who is within earshot
of the mother how WONDERFUL it is if we get 1cc or more - and the reaction
if they get 5cc can be downright embarrassing.  This dispells mothers fears
of 'only' 2ml - that's not a bottle full.  Certainly in those first 24
hours I'm delighted to get 2 - 5 ml each time.  I read somewhere - i
suspect it was Breastfeeding Matters by Maureen Minchin, though don't quote
me - that the average amount of breastmilk the baby gets in the whole of
the first 24 hours is 38ml.  I make sure I tell mothers this too, and about
how small their stomach is when first born.

Hand expressing is gentle, minimally invasive, stimulates the hormone
response very effectively, is the best way when small volumes are expected,
doesn't cause any nipple trauma and Jean's 'reverse pressure' technique can
be used to improve an oedematous areola where pumping would make it
worse.  I really do encourage you to try it.

The other night we had a baby born by em c/s who went into nicu and was npo
(the term in Australia is NBM - nil by mouth).  Anyway I hand expressed her
and only got something like 0.3ml which I'd been sucking into a syringe as
each drop appeared - so I took it into the nursery and put it into baby's
mouth.  It was lovely to see the baby licking and tasting and it's the
beginning of forming the baby's immunity. (Baby was on a drip)
This mother I then recommended be hand expressed every 2 to 3 hours
(allowing for sleep) because of her minimal volumes, something we would
never have known about if baby had been well enough to go to the breast.

Can I just add that if the baby does the normal thing which is to
breastfeed several times in the first couple of hours after birth, then
have a long deep sleep I wouldn't dream of interfering with either mum or
baby - that's normal.  It's only when the baby has had NOTHING for 12 hours
and consequently the mother's breasts have had no stimulation that I would
do something.

Denise

*************************************************
Denise Fisher BN, RN, RM, IBCLC
BreastEd Online Lactation Studies
++++++ earn 120 L CERPs +++++++++
mailto:[log in to unmask]
http://www.BreastEd.com.au

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