Patients may be instructed to exclusively pump for 24 hours to “see how much they are making.” Unfortunately, this approach is fraught with problems.
First, moms provided this directive are often making less milk than their baby needs, or there is some concern about the baby’s weight gain. Unless a baby is behind in calories or weak for another reason, a pump is never going to remove milk as well as a baby will. So a mom could be pumping volumes that are lower than her true gland function, and feel falsely defeated. This inevitably worsens anxiety and stress.
The other issue is that anytime you decouple mom and baby, you risk problems. This can include pump trauma for mom, or a baby not being interested in going back to the breast after a strict interruption.
The more ideal way to approach this scenario is to do this:
- Perform a weighted feed at the breast to understand how much baby is transferring.
- Closely follow baby’s weight (i.e. may even need daily weights early in life) with appropriate plan for supplementation based on weighted feed and overall picture of mom and baby.
If a baby is truly behind in calories and mom’s milk is clearly not being stimulated or not coming in, then you do need to de-couple (“divide and conquer”).
At this point, mom needs to stimulate breasts with a pump for a reasonable period of time (10-15 mins every few hours), and baby needs supplement in a bottle (get rid of the syringe — the baby needs efficient calories and parents need their sanity).
But mom and baby can also latch as they are able (i.e. not regimented, but when mom is feeling more rested and/or when her milk may be higher in volume during early morning hours). The idea is you still keep mom and baby in sync without strict rules. And the goal in this scenario with pumping isn’t to ascertain an “exact number” of volume (which is impossible with breastfeeding, unlike formula feeding). The goal is to stimulate mom’s breasts until a baby is able to do so efficiently herself.
