Casey Very good question! I see the problem. I usually use your standard suggestion too, breastfeed first, then pump and save the milk for the top-up after the _next_ breastfeed. But in the special situation you describe of feeding sick/prem babies in the first few days of life, then personally, I'd recommend your second option - have mom pump _before_ the breastfeed, and then put the baby to the breast afterwards, even if it means that baby nurses at a comparatively "empty" breast. Why? Because it will likely lead to the least use of formula. There will be a time in the first 2-3-4 days when the mother is producing enough milk to pump sufficient first, and then have the baby nurse, and then be able to pump again before the next scheduled breastfeed. Then she can make the switch to nursing first, topping up with previously pumped EBM, and pumping immediately afterwards, ready for next time. In the NICU where I used to do consults in Harare, the moms would always hand-express rather than pump, especially in the first few days after birth, when the milk is quite scanty. Too many precious drops become lost on the inside of the pump ..... Also when the paediatricians started calling for mom's milk (and yes, they really did "order" it!) then the mom would often be expressing just a few drops every hour or even at shorter intervals, in a superhuman effort to add all the precious tiny quantities together to make enough milk for the baby's next nasogastric feed. Formula top-ups were seen as a regrettable, but sometimes necessary last-resort for _some_ of the feeds for some of the bigger babies (who needed more milk due to their size) and then usually only in the first 24 - 36 hours of life. Pamela Morrison IBCLC Rustington, England --------------------------------------- Date: Wed, 10 Feb 2010 14:14:43 -0500 From: "[log in to unmask]" <[log in to unmask]> Subject: Catching up with breastmilk supplementation Hello everyone! I have a question about supplementation in the first 24hrs or so. Assuming a baby has a legitimate need for supplementation, my first recommendation is always to have mom pump so that we can use her milk for supplementation, and, hopefully not need to add formula. For babies that will need continued supplementation - like a late preterm baby with low blood sugars, or a weak suck - I usually recommend a feeding routine where baby breastfeeds, then receives their supplement, and THEN mom pumps. Whatever mom pumps is saved to use as supplementation for the next feeding. I prefer baby to have the entire feed (breast and supplement) before mom pumps. However, the problem with this is - the very first supplementation - I have mom pump, she feeds baby whatever she has pumped. Great, baby gets breastmilk, hopefully no formula, and life is good! However, at the next feeding, there is no breastmilk available to use for supplement (because it was given at the last feed). The only way forward I've seen is (again, I am only talking about circumstances where baby meets criteria for continued supplementation, and NOT supplementing is not an option) to use formula for supplementation that feed, have mom pump, and save that milk for the next supplementation. However, this makes it almost impossible to strive not to give formula. Would you consider having mom pump BEFORE breastfeeding in order that the supplement can be breastmilk? I don't like that idea because then baby goes to an empty (or emptier) breast for the feed. On the other hand, it would prevent or reduce formula. For the most part, I'm talking about my late preterm babies and my hypoglycemic babies, and usually in the first 24hrs. Any tips or suggestions? Thanks, Casey Clubb, RN, IBCLC West Linn, OR USA *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome