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Breast Milk for the Fragile Baby

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The benefits of breastfeeding healthy infants are well known, but the advantages for premature infants are sometimes overlooked. Nursing is occasionally considered too challenging for an already stressed new mother and a fragile baby. The truth is, breastfeeding the premature infant has significant health benefits and often helps parents deal with the challenges of the neonatal care unit.

 

Studies have shown that human breast milk carries antibodies or natural infection-fighting proteins that prevent or decrease the severity of life-threatening infections in the premature infant. In addition, the natural proteins, fats, and sugars found in breast milk are easier for premature babies to digest than commercial formulas. In other studies, premature babies fed breast milk were shown to have significantly better intellectual and motor development and better vision than babies fed commercial formulas.


  Getting Started

  Equipment

  Pumping

  Storing and Transporting Breast Milk

  Feeding Sessions

  Transition to Direct Breastfeeding

  Your Nutrition



Getting Started

 

The most important key to success is your own commitment to provide breast milk for your newborn. After that you'll need some equipment, instruction, and lots of support from family, friends, and nursing staff. In most cases, a very premature baby or a seriously ill full-term baby won't be strong enough to breastfeed initially. So you will need to start stimulating your breasts mechanically to start the flow of milk. Even if you can breastfeed your baby initially, you may still need to pump breast milk to leave for your baby when you go home from the hospital and your baby stays.

 

Equipment

 

    • Breast pump. A double-port "medical grade" mechanical breast pump is best. Rent one from your hospital, from a Women, Infants and Children (WIC) office, or from a local chapter of La Leche League. Or purchase a lightweight portable model if you'll need it later when you return to work. The double-port pump stimulates your breasts simultaneously and is more efficient at extracting milk than a single-port system.
    • Breast pump accessory kit with double cups and tubing to fit the pump
    • Lots of small, sterile bottles with screw-on tops/nipples supplied by the hospital. Every hospital has a system for transporting and receiving breast milk -- —just ask!
    • Small, clean towel or cloth diaper
    • Small cooler to transport frozen milk
    • Nursing bras
    • Nursing pads (disposable or washable)
    • Healthy snacks and drinks such as fruit, a sandwich, milk or juice
    • Water, water, water
    • A picture of your baby and/or soothing music
 

 

Pumping

 

You should start pumping as soon as possible, even if you're lying down recovering from a C-section. Ask a nurse or lactation consultant to help you. You won't get much at first, but what you will get is colostrum, a very high-quality milk.

 

Your breasts will get very large in the first few days and then diminish somewhat in size. Wear a comfortable nursing bra with pads to absorb leakage. Pump about every three hours (you can go as long as five hours once during the night). When your milk supply is established, in one to two weeks, you should produce about 25 ounces of milk a day. This will be plenty to start feeding your baby, when your baby's doctor gives the okay.

 

How to Pump

    • Find a regular place to pump that is private, clean, comfortable, and preferably near a sink. The hospital nursery usually has a designated room, or find a quiet place in your home.
    • Wash your hands thoroughly.
    • Use the baby's picture and soothing music to relax.
    • Massage your breasts to help get the milk flow started.
    • Connect the machine, tubing, double cups, and sterile bottles. Place a cup on each breast and pump both breasts simultaneously for 10 to 15 minutes. Start at low power and then move up to full power when the milk is flowing well. You'll feel a tingle or brief burning as the milk starts to "let down" and really flow.
    • Remove the bottles from the tubing. You should divide the milk into separate sterile bottles of one ounce each until your baby is taking larger feedings.
    • Label all the bottles with your baby's name or hospital record number. In order to prevent breast milk from one mother being fed to the wrong infant, the nursery may have strict rules regarding labeling and storage. Milk that is not labeled or stored correctly will have to be discarded.
    • Clean the pump cups, and wash your hands again.
 

 

Storing and Transporting Breast Milk

 

Give the nurses fresh milk whenever possible for your baby's feedings. The immune components are best when the milk is fresh. You can keep the rest of the milk in sealed bottles in a cooler with ice or in the refrigerator. Place the extra milk into the freezer as soon as convenient.

 

Milk Storage Guidelines

  • You can store breast milk at room temperature for three to four hours.

 

  • You can store breast milk in a refrigerator for 24 to 48 hours.

 

  • You can keep breast milk frozen for up to three months.

 

Feeding Sessions

 

For the very small baby, the first feedings will be by a small tube leading from the mouth or nose into the stomach or bowel. The first feedings may be only a few milliliters—less than a teaspoon—in some cases, as doctors observe how the milk is tolerated. During tube feeds, it is important for the baby to have some oral stimulation with a rubber nipple or finger and some skin-to-skin contact with a parent or a nurse, as tolerated. The closer the situation is to a regular feeding, the easier it will be to make the transition to direct breastfeeding later.

 

The first feedings will consist of breast milk with a special fortifier added to accommodate a premature infant's specialized nutritional needs. Nurses may want to skim off the upper layer of milk, which contains the most fat, in order to get the richest milk into the infant first (human milk isn't naturally homogenized).

 

Parents can certainly assist with feedings even if the milk is simply pushed through a tube. Be there. Do as much as you can. Your baby is learning about your smell, touch, and voice as part of the feeding. It's important to stay calm and quiet during this time, because it takes all your baby's concentration and energy to get this feeding thing started.

 

Transition to Direct Breastfeeding

 

The medical staff of the hospital will decide when you should begin direct nursing. This decision is based on several factors, including the baby's ability to suck effectively without tiring and his ability to maintain his body temperature out of the incubator or isolette. Many babies are ready to nurse directly when they weigh about 1,500 grams or are about 32 to 34 weeks in gestational age. This varies a lot, however, and will depend on your infant's specific condition.

 

When you are ready for the first direct breastfeeding, have a nurse or lactation consultant help you. The nurse can create a semiprivate area around your baby's incubator. You may want to do some breastmassage at first to get the milk flow started. Have the nurse or lactation consultant help you the first few times to get the baby latched on to your nipple. Be aware that too rapid a flow may overwhelm a small infant, causing him to sputter and the milk to roll out of his mouth. If that happens, pump a little off first so the milk flow is at a rate he can handle.

 

At first, you may nurse directly one to two times a day, increasing as the baby tolerates the additional feeds. If your baby stops sucking quickly, you may want to pump the rest of the milk from your breasts in order to maintain your production. Keep pumping between feeds until your infant is a full-timer. Remember that skin-to-skin contact helps maintain your baby's temperature and improves your milk production.

 

The medical staff may check on the volume of milk the baby drinks by weighing him before and after a feeding. The amount will be small at first but will increase as he grows in strength, experience, and familiarity.

 

Your Nutrition

 

Continue the same healthy diet you had when you were pregnant, but drink twice as much fluid. After a few weeks of lactation your appetite will increase, and you may need to add an additional healthy snack or meal. This is not the time to diet! You should limit your intake of caffeine and alcohol and refrain from smoking.

 

This may seem challenging just when you and your partner are already dealing with the demands of an unexpectedly fragile newborn. But making the choice to breastfeed and following through with a pumping and feeding routine will be rewarded. Because of your commitment to breastfeeding, your baby will soon gain weight and grow strong and healthy right before your eyes! By spending more time at the baby's side and in the neonatal unit, you'll quickly become more at ease with the environment, the medical staff, and other parents who can be a great support.

 

 
 
 
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