After 35 years of caring for premies, I would just like to comment about the "exhaustion" issue. It isn't breastfeeding that stresses premies - it's eating --period...and a lot of other things including the overstimulation of handling, too much light, too much noise, painful procedures, poor positioning, etc. etc. Paula Meier's study showed quite clearly that premies do better and have fewer stress cues with breastfeeding than with bottle feeding, but, depending on the degree of prematurity, both are difficult. It's a lot like asking a 9 month old baby to walk - some can do it, but most can't. We are pushing these babies to get them to eat before they may be ready. Developmentally, the baby is not supposed to have to coordinate suck,swallow and breathe at 28 or 30 weeks gestational age. He/she is supposed to be floating in water, practicing a little while still attached to a placenta which does all the real feeding, excreting, breathing, etc. Everything is unfinished - gastric system, lungs, immune system, brain, eyes, kidneys - you name it....but at birth, even when that birth is premature, everything tries to work. What we do in an intensive care nursery is support those immature systems and try to keep the baby physiologically stable until maturity takes place. It isn't easy. That's why they call it "intensive care." Babies can suck very early, but to coordinate suck/swallow/breathe requires a fair amount of maturity. Not all mothers have nice, easy MER's. Some have Niagara Falls letdowns, while others take forever to let down even with massage. It requires patience and skill to help a premie learn to breastfeed. When they hit about 35 - 36 weeks gestational age, it is like somebody turns on the switch and the baby says "OH! THAT is what I am supposed to do," and begins to breastfeed. Some require 40 - 42 weeks to do well, depending a lot on how sick they were. Like the analogy of the 9 month-old - some can do it sooner than others. It is a very individual thing and is sometimes related to the mother's anatomy and lactation physiology as much as to the baby's capability and health status. What we don't want to do is allow the baby to burn so many calories trying to eat that he loses weight. Call it "exhaustion", call it "stress" call it "developmental immaturity' or whatever. The point is, getting a premie to breast is a lot different than getting a full-term baby to breast, and the infant's responses are quite different. Hope this helps. Deanne RN IBCLC NICU *********************************************** 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