Dear all:

I have one of those brain storms going on, and even though I know I have no
time to implement these ideas I can't help myself.  My colleague and I have
been having this continuing dialogue about suck vs. supply and in reality
we have seen that supply can concur many initial minor suck problems.  This
is playing out in terms of the choices of feeding methods early on.

For those of you who think that babies just suck on the tube, I've been
tracking enough cases that I can concretely say that this is not the case
for most babies.  I have documented milk transfer from the breast itself,
while using the tube and sometimes it is quite substantial.  For those of
you who think that babies never suck on the tube alone, I have concrete
evidence that some babies really do just figure out how to suck on the tube
despite a good deep latch.  In fact, I've followed up on a couple of cases
where there has been no progress at all on the SNS (either my own cases or
other LCs) and with use of the Haberman bottle they have gone back to the
breast quickly.  I was quite amazed the first time this happened because I
was so scared of using a bottle.

We all have our alternative feeding device preferences. Many of you who
have been on Lactnet for a while may know that my supervisors had trained
me well in the use of the SNS.  I feel like I know all of the little tricks
and foibles and am completely unafraid of this relatively tricky device.
It does work, but most moms hate it and often if they have acquired low
supply they find it tricky to pump at the same time. BUT as I've been
tracking women through supplementation (with EBM as 1st choice) back to the
breast, I've been finding that many times mothers can achieve the same
results with Haberman bottles rather than the SNS. We all have our own
criteria about when to use the SNS and when not to. I think it would be
useful to start defining some criteria for when to use the SNS vs. when to
use the bottle in a concrete evidence-based way.

I was thinking of randomizing moms who need to offer supplement (with EBM
as 1st choice) to either the Haberman group or the SNS group for one week.
The criteria for needing to offer supplement would be clearly defined.  The
outcome measure would be increased milk transfer by the baby from the
breast (without assistance from the SNS). At the end of the week (and
study), the LCs involved would reassess the situation and provide an
individualized care plan for each participating dyad. Infants that clearly
need other feeding devices (e.g. cup or finger feeding) would be ruled out
of the study and we'd define criteria to determine this.

I am also thinking of the reality of how women use the SNS and wondering
whether nighttime suppements from the Haberman would mess up the design.
Really, it is tough for women to start with round the clock SNS use.

Also, I would have a clear plan for withdrawing infants from this study -
e.g. infants that start to retract their tongues, infants that stop opening
wide for the breast, infants who start reducing the effective feeding on
breast alone, etc.

What do you think of this basic idea?  Any ethical concerns here?  Since
this would not be comparing one brand against another, what ethical
concerns would there be in seeking funding to do something like this.

OK.  Waiting for the debate.

Best, Susan

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

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