Hi Amy,

The longer I do this, the more I wonder about the whats, whys, and hows of
milk production. The issue with the late preterm infant is: will this
baby's demands drive this mother's supply?

As you know, some mothers seem to produce lots of milk with seemingly
little effort (but what really is she or baby doing differently? or maybe
nothing unusual at all). Some mothers seem to try "everything" and do not
produce nearly enough.

Therefore, I err on the side of caution, and until proven otherwise, I
advise mother to express post-feed and comp the baby, or at least store for
a later comp if needed. If most feeds seem to be going well, and the
"numbers" look good, mother can skip the night expressions or whatever. Or
you can take the tactic that mother express only for the feeds that were
"poor" or she attempted but baby did not feed. This is the ART as well as
the science.

I do seem to see, anecdotally, that mothers who start expressing (say
around a month postpartum) and get in a pattern of expressing maybe once a
day (extra besides feeding baby) seem to have plenty of milk later on.
These are mothers I work with who are returning to outside employment.

I think if a mother is a true "kangaroo care" mother, and her premie is
feeding "well" then I would respect her choice to feed very very often,
with monitoring. I still would worry though.

As far as small term babies, I do worry a bit more with them, because when
they lose weight they are so small. I don't really see any harm in
post-feed expressing (I favor hand expressing in the early days), but
rather I see a benefit. I think if the mother is a primipara or the birth
was via C-section, I worry more. But some of the small term infants are
ready feeders and do quite well, of course.

Laurie Wheeler RN MN IBCLC
Mississippi Gulf Coast USA

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