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From:
Cathy Bargar <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 4 Jan 1999 08:24:08 -0500
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Can't round up the research data for it at this hour - extremely impressed
with Chris Mulford's (I think it was) command of minutes of effective
pumping per day, etc - but a couple of things come to mind from my
experience in working with moms pumping for a NICU baby:
1) If I'm remembering the beginning of this thread correctly, the woman with
the really huge pumped supply was a teen mom, and it was in the early days
post-birth. In my experience, young women (teens especially!) really
commonly have huge supplies at first. Can't cite the physiology on why, but
in evolutionary terms it makes sense to me - nature seems to really like us
to produce our babies early, and ensuring an easy and ample supply goes
along with that. I haven't seen this "oversupply" be a problem in the long
run, though; I would take care to tell the mom not to panic when it/if it
goes to a more commonly-seen (trying not to use the word "normal" here, as
obviously this is normal for some moms) volume of expressed milk. OR
hopefully she'll be able to get to nursing directly ASAP and won't have to
measure!

2) Women pumping long-term: again, this is strictly my observation and
clinical experience, not research-based, but in the moms I've worked with
who've pumped long-term most have had better supplies if they pump on the
less-often (3-4 times/day) side, rather than more often as of course we
usually tell them to do. Worked with one mom who had a 24-wk baby (1#4 oz
BW), baby had cerebral palsy and big-time respiratory problems and was never
able to develop an effective latch-on-and-nurse-effectively pattern
(although would nurse briefly occasionally, and frequently went to breast
for comfort). This was a great mom - willing and able to try every
intervention in the book; she pumped for over six months (the baby never had
any GI problems, BTW!). She noticed lots of fluctuations with supply, but
definitely found that when her supply started to drop, if she pumped more
often than every 4 hours it would drop even further, pretty drastically.
(Not to even go into the stresses this mom was facing - just coping with the
needs of this baby and her 4-yr.old was a huge task, and I'm sure her life
wasn't enhanced by having to pump!) We found that fenugreek and a
"relaxation" tea did help, but only when she pumped LESS frequently (q 4 hrs
or longer vs. q 2 hrs, which she would try every time her supply dipped).
Other women I've worked with have found a similar thing - I always attribute
it to the fact that pumping can be pretty time-consuming and stressful, and
these women frequently have lots of time constraints (traveling to visit the
NICU, hanging around the NICU for hours at a time without any place they
really could settle in and feel like "home", coping with other young kids at
the same time, worries about how the baby is doing, etc., etc...)

Leads me to my current practice, which is to quote them chapter and verse on
all the "right" ways to "manage" pumping, and then help them experiment with
what works for them. And share with them what I think most of us have seen
about expected "dips" at specific times: 2-3 wks., again at 4-6 wks., often
again after about 3 months. Have others noticed these kind of "routine"
fluctuations? Thank God for direct nursing, when we don't have to fret over
every cc that comes out!

Cathy Bargar, RN, IBCLC, with gratitude for the wide variety of mothers and
babies I've been privileged to work with and learn from!

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