Ann Perry raises questions touching on a hot topic at my workplace these days, namely how to start milk production, not to mention collection, when baby is unable to come to breast. I am pushing for our standard of care to be manual expression from the start, collecting in medicine cups, moving on to a hospital-grade pump (more specifically our 50 year old Egnells) as volume goes up and viscosity down, around the second or third post partum day. Currently we advise women to start pumping 10 minutes per side, 6-8 times in 24 hours. For the first 36 hours it is extremely rare for milk yields to be collectable, as they end up barely coating the flange or just getting caught in the rubber valve between flange and bottle. Hand expressing into a cup allows the baby to get the first colostrum, it allows mother to see how much there is and how easy it is to get out as she learns manual expression, and it saves staff an enormous amount of work collecting, washing, sterilizing and re-distributing collection sets. We have enough pumps, but they are large and noisy and clumsy. A stack of medicine cups on mother's nightstand takes no space at all, and she can express a few ml. every hour or so without disturbing her neighbor or having to go find all the parts she needs. She can express lying on her side, so it is more conducive to rest, and as many of our mothers of babies in the NICU have had cesareans, this is yet another advantage. My clinical impression (that unknown quantity by which so much bad practice is justified, I know!) is that this is a more effective way of getting things started. Milk comes in in copious amounts around 48-60 hours if mother is eager and willing to express frequently. If baby is able to be held skin-to-skin there is usually a noticeable increase in milk yield after a STS session. Surprise surprise. Putting this procedure into place will require all staff to learn manual expression, but I find they learn it readily and there is virtually no objection among mothers, to being shown how to do it. Rachel Myr Kristiansand, Norway *********************************************** 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(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html