Thank you for your reply, Laurie. I value your insight. 
Take care,
Amy

Sent from my iPad

> On Oct 30, 2016, at 11:19 PM, Laurie Wheeler <[log in to unmask]> wrote:
> 
> 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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