No offense intended to any previous posters, and perhaps I am being really
naive here, but "proof" and "data" and "evidence" seem like such laughable
concepts for anyone to try to generalize so as to automatically apply
routinely to the manner of feeding of a premature, or a normal newborn for
that matter.
It depends!!!!
It depends on the individual situation. It depends on the person who is
feeding the baby, as well as the individual baby. Specifically, it depends
on the balance between the ease of milk transfer and the individual baby's
ability to coordinate suck/swallow/breathing, regardless of whether the baby
is being breastfed or bottle fed.
The following are typically big "ifs" for a sleep-deprived, hormonally and
perhaps "anesthetically" and surgically recuperating mother, but I will
hypothesize anyway.
If we can assist the mother in
1) as natural an onset of Lactogenesis II as possible, plus
2) help her notice feeding cues and stress cues, and
3) explain to her how to use her breast as a feeding tool,
4) teaching her how important the pliability of the areola is in milk
transfer, and
5) how to achieve that pliability, and
6) help her appreciate the miracle of the milk ejection reflex and
7) how to trigger it in advance of feeding, and
8) how to use alternate massage appropriately,
it seems to me that feedings need not necessarily be prolonged, and the
breast need not necessarily always be thought of as a source of "work" for
even a tiny baby to transfer milk. OTOH, if breast swelling, either edema,
normal engorgement or edema superimposed on normal engorgement is
interfering with easy access to subareolar ducts and the stimulation of the
MER, even the most robust baby is going to have to expend "work" to
transfer even a little milk at a feeding, in the meantime endangering the
integrity of the nipple.
"Work", or energy of a different kind is expended if the adult feeding the
baby a bottle is unaware of the importance of pacing and allows the baby to
continue to suck and swallow rapidly (sometimes desperately to keep from
choking). There is very good evidence that in prematures at least, this can
cause episodes of bradycardia. How many calories does it take the poor baby
to recuperate from any such cardiorespiratory distress?? To say nothing of
the stressful body memories and psychological associations it attaches to
the process of eating! Not to mention the complications associated with
overfeeding. GERD, the diagnosis de jour, to hazard a guess about one!
I certainly hope this rapid feeding is no longer going on in hospital
nurseries as it did back in the decades when I worked in them, but I know
for a fact that many young parents, and for that matter, many grandmothers
and aunts are still totally unaware of this issue, because so many are still
interpreting the speed at which their baby may drink as proof that the baby
was "really hungry, because he took 2-3 ounces down, just like that!!!" I
have seen no evidence as yet that young parents in our town are routinely
being taught about pacing the flow rate of bottles. When a mother has opted
to use a bottle, such as in supplementing, or even when she may have decided
to "give up" on breastfeeding, I try to explain "pacing" to her in such a
way that she can interpret the baby's stress cues and identify with the
baby's feelings, and help her realize how pacing may be very important in
preserving the baby's willingness to breastfeed.
Thus, she has some chance of explaining it in such a way as to persuade her
boyfriend, or her mother, or her daycare provider to pace the flow. It's
hard enough to be a new mother without having to try to teach your own
mother, or an experienced day care provider a new way to bottle feed a
baby!
Being an advocate for the new mother and baby will continue to be one of our
most important roles.
Even with their physicians at times.
Jean
***************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA
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