Karen writes:

<However, someone mentioned expressing when preterm (including late or near
term) birth was a risk factor, which would include ALL twin/higher multiple
pregnancies. I'd suggest extreme caution in such situations. I can't imagine
any of us may want to suggest an intervention with the potential to
jeopardize the fetus's/fetuses' length of stay in mother's uterus.

Initially, this started with a discussion who was leaking a lot of colostrum
and also at risk for preterm birth. (I think someone mentioned there had
been been cervical change.) Makes sense to "catch" some colostrum to store
if possible, but this is different than actual expression and inducing
let-down.

So, I'm calling for clarification of terms and situations. Thanks.>


Good idea. Once again, (thanks, Diane;-), "Watching our Language" is in
order here.


We need to remember that the subject originally came up in regard to leakage
in a mother on bedrest due to placenta previa, which is a separate
classification of very high risk. (Since Rachel was away at a conference and
didn't see Nikki's question about placenta previa, I am at least going to
interject that there are degrees. Complete placenta previa is a totally
different, much riskier situation, different from marginal placenta previa,
where the lower part of the placenta is implanted close enough to the
opening of the cervix to begin tearing away from the cervical tissues
if/when they begin early effacement. Even this implantation site presents
potential for hemorrhage of unpredictable amount, often precipitating
imminent danger for mother and baby, and need for emergency C.S., hoping
there is time to save both, or at least, one. Calculating relative risk is
totally the province of high-risk OB.)



Secondly, I note that this subject has elicited a very high degree of
interest here, and may perhaps be a reflection of increased interest among
parents. Or possibly an effect of Dr. Jack's suggestions, too.



I think that says something about the current hospital climate and the
parent's feeling of lack of control of the risks inherent in using formula.
This is whether it is used indiscriminately, or with discretion, for
forseeable or unforseeable hypoglycemia, etc. because labor interventions or
other factors often make milk/colostrum transfer such a challenging matter
during the hours/days right after birth. (I agree with the comments re: hand
expression versus pumping prenatally or early in the perinatal/postpartum
period.)


Perhaps a noticeable increase in the number of mothers arriving with
advance,
"home-banked" colostrum might give a message, and perhaps a "wake-up" call
to hospital staffs, neonatologists, etc.


Does this observation occur to anyone else???


Jean
*****************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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