Apropos of the discussion of when to initiate pumping, Pam Hill, et al.
Effects of Pumping Style, J Hum Lactation  1999, 15(3):209-216.

One of the variables of this study was hours from birth to initiation of
breast pumping.  "...milk weight group was inversely correlated with number
of hours from birth to intitiation of breast pumping and positively
correlated with both the overall mean weekly frequency (of pumping) and of
kangaroo care."  An important conclusion of this study with clinical
implications for those charged with helping moms of compromised infants is
that "...the level of milk production reached by 3 weeks is likely to be
maintained in subsequent weeks." pg 214.

 The authors caution that:  "For the mother who has made a commitment to
exclusive breastfeeding for several months and is producing <1700 g/week at
week 2, the outlook is grim.  Such mothers may need intensive nursing and
pharmacologic intervention."  I read this to suggest that getting the milk
supply established in the absence of a normally nursing baby requires prompt
attention in the early postpartum.  People have made excellent points in the
interesting discussion of this issue.  Mothers do need time to process their
situation emotionally, and we do need to allow the infant time to organize
feeding following birth.  However, when it becomes clear (by careful
assessment of the dyad) that the infant is NOT going to be feeding normally
for a while, then protection of the potential for full milk production
capacity becomes a priority second only to making decisions on how to feed
the baby in the meantime.

The study suggests that kangaroo care IS very effective in assisting milk
supply, and indicates that initiation of pumping at a MINIMUM of 6 times
daily --  8-12 is better (with careful evaluation of supply at week 2)  will
provide adequate protection for the mother who is maintaining milk supply
with mechanical expression.

I think it is fabulous that we are starting to have data by careful
researchers to help us make better clinical decisions on such matters.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html