Dear all:

I really think that on a practical basis, one has to examine the approach on a case by case basis, rather than on a theoretical basis.  I've dumped all sorts of ideas that are good in theory for what works. 

As for milk extraction before and after pumping, with and without tubes, I have seen all sorts of different patterns!

There are the babies that "wake up" and feed more vigorously if they get a little supplemental milk from an artificial device first, just as there are some babies who "calm down" if they get a little supplemental milk first and can then attach and feed more vigorously.  

Most babies tend to extract more milk from a fuller breast and tend to decline in their milk removal as the breast softens, but there are those that only feed vigorously when the breast is softened first.

There are babies that make you certain that they are eating nothing at all -- and they aren't, until you simply wait them out and let them eat when they are good and ready to do so.

There are babies who need the flow from a tube to get started and get enough suction to remove milk from the breast.  Just as there are those babies who will figure out how to just suck from the tube without removing a single drop from the breast.

Most babies will slow down in their milk removal over time on the breast, but I've also seen babies who start out slow and speed up as they go.

I do not think you can make any blanket recommendations without actually observing the particular baby and mother -- preferably over time and not just one feed.

Best, 

Susan E. Burger, MHS, PhD, IBCLC

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