Hi Karen,

I have been a 'lurker' for a while, and this is just my opinion from 
observations with clinical work and understandings I have gleaned from 
conferences, especially from Hartmann reserach.  It can be a bit daunting 
posting here, with so many worldwide experts!

 I often note that many mothers of prems (and twins in partcular), start out 
well with a good supply but then  3 months later may be struggling with 
their supply and have introduced more and more formula to maintain 
satisfactory weight gains.  I feel there may be a couple of common reasons 
for this.  Firstly, lack of support transitioning the prem/prems from 
'managed' feeding to baby led feeding when the baby/babies are mature enough 
and secondly, I observe their milk supply may not have reached and 
maintained its full potential in the first 6 weeks.

To this end, I employ a little maths and encourage mothers to try and 
achieve a full term milk supply (for singleton or twin) as soon as possible 
and keep it pitched there until the babies are mature enough and strong 
enough to take care of it themselves.  This may often be around due date 
plus a week or two.  In other words aim for about 700 mls/24 hours for a 
singleton prem and approx 1200 - 1400 for twins.  If the babies go home with 
an average volume of around 350 mls/24 hours (160mls/kg for 2kgm baby), then 
mum needs to pump about another 300 mls per day over and above her baby's 
feeding, with decreasing amounts each week as the baby is growing.  Same for 
twins, only double.  Often this can be achieved with just 4 pumpings a day, 
less in time till eventually, none.

I counsel mothers that this extra work may be challenging for a while, but 
will give less work and stress in the long run. The pumpings need only be 
quick and best done straight after a feed when perhaps the baby/babies are 
being changed by her helper or just propped beside her (filling their nappy 
no doubt!) while she takes  5 - 10 minutes to do a quick double pump. There 
should be flexibility in this too - pumpings may be missed at the end of the 
day when the household is especially busy, but picked up more in the early 
morning.  The mum will work it out.

Karen Palmer
New Zealand




----- Original Message ----- 
From: "Karen Foard" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, March 20, 2011 9:49 AM
Subject: Twins/34 weekers/supply

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