Some very interesting thoughts on this subject.
Rachel, thank you for the discussion of hand expressing in the first 2 days.
This is where I see the need for more research.
Nancy, when you sighted the Pediatrics study (Correlates of Lactation in
Mothers of VLWI, Furman L, Minich N, Hack M.) it did not appear to have used a
comparison of mothers only hand expressing as opposed to pumping or not pumping
in the first 48 hours.  I just wonder if mothers follow the same protocol as
with the pumping but instead use hand expression, what the out comes would be?
Jan, you wrote that there is a large bolus of colostrum in the first 2 hours
postpartum.  Do you have the actual numbers of mls these mothers are able to
obtain?  Are these moms multips, primrps or both?  How many mothers have been
observed in this study?
Now, I want to share a story that prompted my questions.
       There was a mother who delivered vaginally, 38 weeks with PIH.  She
was kept in the L&D unit on Mag Sulfate for 2 days and her baby ended up in the
Special Care Nursery because of hypoglycemia.  The baby was treated with IV
and 24 cal formula.  The mother did not see her baby for >24 hours and did not
start pumping until she was 48 hours.  She was set up with a double electric
pump and pumped 6-8x/day but never got any milk.  When I saw her she was 72
hours PP.  Her breast had some fullness, breast small with very small nipples,
firm areola.  I observed her pumping and there was no let down after 10 minutes.
I then had her use RPS and then hand express, she got milk!  The plan was
then to use the RPS and hand expressing instead of pumping along with
breastfeeding the baby.  I also had her use the RPS prior to nursings.  It was 2 days
before I saw her again and she was getting ready to be discharged.  Her breast
were very full and the evening before she had gone back to the pump and was
getting 1-2 oz (each pumping she was getting more).  The baby was not latching or
sustaining a latch during the day so we used a small shield with good results
and in the evening baby handled the bare breast.  The mother thanked me at
discharge for helping her through all this.  She said if she had not done the
hand expressing and saw her milk she would have quit.  I am trying to reach her
now to see how things are at home.
Food for thought.
Ann Perry RN, IBCLC
Boston, MA

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