Irish Premature Babies just recently ran an workshop on Breastfeeding & expressing for the premature baby. The course was paid for by the charity and open to the public and medical professionals. Nicola O' Byrne from breastfeeding support ran the course for us. Due to the success of the course we will be running it again in a few months. We are in the middle of setting up breastfeeding buddies so parents can talk to other mums who have successfully breastfeed or expressed for their preterm baby. We are also working on producing a booklet on breastfeeding.
If you have any expressing or breastfeeding problems and would like to talk to either an experienced mother or a professional lactational consultant, please contact the helpline and we will put you in touch with somebody. Our charity works with the help of a wonderful lactation specialist who has ample experience of helping prem mums. If you are not in a position to finance this, we will try to cover the costs of one visit and some follow up phone calls.
Tips for Breastfeeding Your Premature Baby
By Azza Ahmed, DNS, RN, IBCLC, CPNP
Bringing Your Premature or Ill Breastfeeding Baby Home
By Kathleen S. Kuhn, RN, BSN, IBCLC, and Megen J. Kuhn, RN, BSN
Real mums' stories
Two mums have kindly shared their experience of getting their premature baby to breastfeed. We hope it will help any mums who are in a position to consider breastfeeding their baby.
Debra's experience of breastfeeding her son.
My failure & success at breastfeeding my premature babies
Information sheet - Breastfeeding your premature baby
Justine Diamond & Anne Casey courtesy of www.preemie-l.org have produced an informative and helpful sheet called "Breastfeeding your premature baby"
Article - Early attainment of breastfeeding competence in very preterm infants
The article "Early attainment of breastfeeding competence in very preterm infants" by KH Nyqvist of the Department of Women's and Children's Health, Uppsala University, Sweden is available. It explores the development of breastfeeding capacity in very preterm infants, as an immature sucking behaviour is often mentioned as a barrier in the establishment of breastfeeding.
Tips for Breastfeeding Your Premature Baby
By Azza Ahmed, DNS, RN, IBCLC, CPNP
Your(“premie”) baby. Breastfeeding a premie baby takes time and patience. It may be easier if you know why your baby acts the way he does.
When will my premature baby be ready for breastfeeding?
Your premie is ready to breastfeed when he can suck, swallow, and breathe on his own. Your premie will have a good heart beat,easy breathing, and good skin color. Babies have 6 different ways of acting,from deep sleep to crying.
1. Deep sleep: No eye movement, no bodymovement, steady breathing
2. Light sleep: Some eye and body movement 3. Drowsy: Heavy eyelids that open andclose, some body movement
4. Quiet alert: Wide open eyes that look around. Breastfeeding may work best when your baby is “quiet alert”
5. Active alert: Eyes open, more body move- ment, fussing
6. Crying: Awake and upset
Watch your premie when he is just waking up (drowsy). When your baby is “quiet alert” and ready to breastfeed, he might:
1. Smack his lips
2. Stick out his tongue
3. Put his hands up to his mouth.
How do I know that my baby is getting enough milk?
While your baby is in the hospital, you can weigh him before and after breastfeeding
to see how much he drank. After your baby is 1 week old, look for:
1. A gain of about 1/2 to 1 ounce (14 to 28
grams) every day at 34 to 36 weeks.
2. Six or more wet diapers each day
3. Three or more poopy diapers each day
How will I know my baby is good at breastfeeding?
Lots of practice will help your premie learn how to breastfeed.
1. He will start out sucking 1 or 2 times, then stop to rest.
2. He may need to practice over many feeds to get strong and use a nice pattern to suck,
swallow, and breathe.
3. Babies love to practice!
Good sucking means your baby can keep sucking for more than 10 seconds before pausing. Some premies may be home before they can suck well. Good sucking may not happen in the hospital.
1. A wide-open mouth as big as a yawn. Baby’s mouth will take in all of your nipple
and some of the darker colored areola.
2. A good sucking rhythm with 1 suck per second.
3. Baby swallows milk after every 1 or 2 sucks.
4. Baby stays on the breast.
5. Baby can suck and swallow several times in a row before he stops to rest.
How do I know my baby is drinking milk?
You may see milk at the corners of the baby’s mouth.
You may hear him swallow.
You can feel tugging when he sucks. The tug should feel like the breast pump.
How will I know if my babyis having a problem?
Watch your baby when you breastfeed. If your baby shows any of these Signs of stress, stop the feedingand give him a break.
Hiccupping or coughing
Gagging or choking
Spreading his fingers
Arching his back
Looking away from you or staring into space
If you think your baby is not getting enoughto eat, ask your health care provider or lactation consultant.
Bringing Your Premature or Ill Breastfeeding Baby Home
By Kathleen S. Kuhn, RN, BSN, IBCLC, and Megen J. Kuhn, RN, BSN
If your baby is born premature or ill they , he may start life in the the neonatal intensive care unit (NICU) of your hospital. He may stay only a day or two, or he may stay a few weeks or even months. Until he is able to breastfeed well, you will be expressing and storing milk. Once your baby starts to breastfeed, you will want to do it often. This will give him a lot of practice before going home. You will also want to continue to express your milk after each feed while your baby is learning to breastfeed. The lactation consultant will help you to know when you can stop expressing milk.
In the hospital, before your baby goes home
Ask the staff about your baby’s feeding routine when you go home.
Try to be at the hospital as much as you can so you can breastfeed often.
The more your baby practices, the faster he will learn to feed without any help or extra milk.
After your baby goes home
He may continue to need extra milk until he learns to breastfeed well.
Continue to feed your baby the same way he fed in the hospital for the first few days
at home. Make feeding changes slowly. Continue expressing your milk after feedings.
Continue to hold your baby skin to skin often
Gradually make feeding changes
For example: If your baby is breastfeeding 3 times per day and fed another way 5 times
per day, your first change might be to breastfeed 4 times per day and another way 4 times per day.
Continue to slowly increase the number of times your baby breastfeeds.
Gradually reduce the number of times you give expressed breast milk.
If your baby has been breastfeeding at each feeding and is also taking some extra milk
with each feed, slowly reduce the amount of extra milk you give after the feed.
Gradually decrease your pumping
Keep pumping until your baby is no longer given any extra milk.
Try to pump often enough so you can give the baby your milk when he needs extra milk.
Your baby’s doctor or lactation consultant will help you to slowly reduce the number of times you pump each day.
You can stop 1 or 2 of your pumps at first. Then, after a few days, you can stop another 1 or 2 pumps.
Do not keep dropping the number of times you pump if you feel engorged (breasts feel hard and painful) at any time.
It is important not to stop pumping all at once.
As you cut out pumps, continue to get your baby weighed weekly.
Your baby should keep gaining weight well before you stop pumping.
Continue to change the feedings slowly. Make changes only if your baby has enough wet or soiled diapers and is growing well.
Your baby should have at least 5 or 6 sopping wet diapers each day.
Your baby should make at least as many poops each day as when he was in the hospital.
Your baby’s doctor or nurse will tell you if the baby is growing well.
If your baby is growing well, that means he is getting enough milk.
Follow up care:
Take your baby to his doctor or nurse for all his appointments.
Remind your baby’s nurse or doctor that you are working toward full breastfeeding.
Your baby may need to be weighed often to be sure he is feeding well.
Call your lactation consultant anytime you are concerned about breastfeeding.
Signs your baby may not be getting enough milk:
Your baby will not wake up to feed.
Your baby will not stop crying.
Your baby is not making enough wet or poopy diapers.
Call your baby’s doctor right away if he has any of these signs.
Debra's experience of breastfeeding her son.
I'm not Irish, I'm Canadian (Though I do have Irish roots, my great grandfather came from Dublin) Anyways, I can understand the stress and worry of breastfeeding with a preemie. My second son came early at just over 34 weeks. They never knew why, as until then all had been uneventful. One weekend, the week before he came, I was feeling very unwell (but didn't worry that much, as I'd been unwell almost the whole pregnancy), and as I was on all fours, suddenly I felt a small pop..and I knew what it was. I went in to have the fluids tested, they said nope it's not amniotic, but I knew it was, and went back the day insisting they test gain. This time, it did test positive. Due to being very, very strongly strep b+, they induced me (I cringed when they said it, but had done my research and knew it was safer that way, especially since the waters had been broken for close to 48 hours at that time...)
Anyways, lo and behold, my little Alex was born seven hours later, 5 lb 4oz. He was whisked away to be taken care of immediately, and I tried to sleep (had him at 8 pm ish). The next morning, I was told he'd been put on CPAP, but had pulled it out. They laughed and said that was a good sign...and while he was in NICU one of the nurses said, oh, he's got a little temper! And the funny thing is he still does (he's now just turned four).
So, all in all he did quite well. He had no trouble with breathing or maintaining his body temp, just had to stay to in NICU to learn the suck/swallow/breathe and also to make sure he gained weight. In the weight dept, he didn't do all that well...but once I got him home, he gained better (though in all honesty, he's a real lightweight, STILL, he's about 5-10% for weight but 50% for height, so a real string bean). I remember them (the doctors going around from baby to baby with their clipboards and notes) giving me a bit of the third degree and asking questions about me breastfeeding etc, and I finally said, I breastfed my first son to 18 months and he was in the 90% for weight...they backed off after that ;)
I did a lot of kangaroo care with him, and went to the hospital twice a day for nursing when he started to be able to (hubby went once a day too, to do kangaroo care and to visit). The first latch he ever did, was so good that one of the nurses asked for permission to show another new nurse what a good latch looked like. I was very lucky that he took to breastfeeding like a duck to water. Had he not, I was still very determined. I was told that, when I got him home, I should increase his feedings from bottle to breast over about the span of two weeks. It was looking like he preferred breast to bottle even in NICU (one of the nurses commented on it), and sure enough, he took about five days before he was on breast only.
I feel very blessed to have had the prior breast feeding experience to give me confidence. It can be difficult enough to learn how to breastfeed a full term child (my first child, born full term, and I went through a LOT during the first six months, I hung on but at times it was so overwhelming and challenging I would cry). It's THAT much more daunting to learn to breastfeeding a preemie!
BUT - it can be done.
First, you need to make sure you surround yourself with plenty of positive support.
If you are determined to make it work, and at give it your best shot, having someone trying to pressure you to just give in and give formula isn't good. If you can be paired up with a preemie mom who is breastfeeding that would be terrific. Secondly, do your research! Know where to go for advice (many family doctors are NOT up to date on breastfeeding and will often just say to switch to formula rather than help overcome obstacles that can be overcome). Third, be careful with bottles! There are other ways that baby can be fed that will help avoid nipple confusion/preference. I was lucky that my baby liked the breast over the bottle and I hadn't really thought about nipple confusion (Though, it was a challenge later when he flat out refused bottles when I had a five day hospital stint due to pancreatitis and then a gallbladder surgery... but we figured it out...).
Dr. Jack Newman has been known to respond to emails within 24 hours...if you're in need of help, try that. It's by email, but sometimes it can help allay worries, or clue you into something that no one told you about. And, really important, keep up your supply! I started pumping before I went to sleep that first night, and had the nurses wake me over night so that I could pump. Yes, it's a pain to wake up, but if the full term baby were hungry, you'd be feeding baby anyways...sleep deprivation comes with the territory, as we all know.
I found the Medela Symphony worked really well for me, whereas other pumps had not (I make LOTS of milk but struggle with pumping...but I actually got a good supply of frozen milk, which ended up not being used as baby hated bottles).Drink well, eat well, rest as much as you can (HAHHAAA...I know, baby in NICU, who gets to rest??? But accept any offers of help, etc, or ask if you need to, in regards to other things, like cooking, cleaning, watching other children etc).Remember that milk comes in (mature milk) at differing rates. Give it a chance. You might be one of the women that takes a little longer, and that colostrum will do your baby a LOT of good!
It's absolutely a case of needing to teach yourself where to go for help/advice, and also educating yourself well.
That said, if you give it your all, and you only bf for five months, three months, or three weeks...don't beat yourself up. We do the best we can with what we know. And some breast milk is better than no breast milk. It's a really tough time when your baby is in NICU. I cried a lot, and he never had any real setbacks/problems! It's just emotionally difficult.
Do your best to give your baby your breast milk, as it is absolutely the best for him/her (I ended up breastfeeding Alex to around 19 months or so)...but don't harbour guilt if you did all you could and it didn't work.
My failure & success at breastfeeding my premature babies.
I had my first preterm baby at 30 weeks. He came home from hospital a bottle fed baby on bottles of expressed milk. I wanted to try get my son to breastfeed but I had no idea how to do it. I contacted several of the usual suspects and asked for some advice and most were unsure how best to get a preterm nipple confused baby to breastfeed. I was advised to contact a lactation specialist to get some help and I had arranged an appointment with one. However, events changed and my son was admitted into hospital seriously ill and fighting for his life. Unable to do anything for him, I thought at least I could continue pumping and give him some breast milk to help him. However under the stress of the situation and I know I was not eating, sleeping or drinking properly, my previously good milk supply started to dwindle and I had no idea how to rectify the problem and there was no one around to help me as I was staying in the hospital all the time. When my son recovered and was allowed home, he was close to six months and my milk supply was almost non-existent and I had to supplement some of his feeds. I finished expressing at six months and within a week or so, my freezer supply was gone. It was almost a relief to finish, it was so frustrating pumping tiny bits of milk, it made me feel so inadequate and I felt I had let down my son all over again, the first time I let him down. I failed to carry him to term and now I could not feed him the way I had wanted. I would have liked to either express longer or get him to breastfeed but neither worked out through a lack of knowledge or the right support.
When pregnant again, I decided to spend some time reading up on breastfeeding and expressing. I found the internet a brilliant source of information. It was only through research that I realised that I never got the advice, support or the correct information about expressing or breastfeeding and this, in conjunction with a very stressful situation, ended my hopes of ever breastfeeding and of expressing. I was determined to give myself the choice to choose the method of feeding I wanted for my baby whether it was a full term or another preterm. It ended up I went into labour at 31 weeks so it was another preterm. Only this time, while I was sent to HDU, my husband went to the NICU and told the staff to put a sign on the incubator that no bottles were to be given. The baby was doing really well and was tube fed for a while. I was allowed to hold him on day six and every day after that I did kangaroo care and put him to my breast. Most days he did nothing at the breast but the odd day, he gave me a little lick. The time came for him to be introduced to an independent method of feeding and in most cases this starts with the bottle in Ireland. I was really nervous of introducing a bottle because I had already come home with a nipple confused premature baby and really did not want to go down that route again. I tried to explain my fears to staff to the NICU and sadly on the whole it was not met with much empathy. In the end after a very tearful conversation with a doctor and senior nurse, I gave in and reluctantly agreed for the sake of son to allow him to be bottle fed. Without the NICU staff I would not have my two beautiful sons and for that I will eternally grateful, and I have met some amazing people in the medical profession, but I feel that many women like myself are being let down and not getting the right support in relation to breastfeeding. When you have a term baby, you see your baby first, you wash them first, you change their nappy first, you cuddle them first and you choose how to feed them, when you have a preterm baby, all your “firsts” are taken away and all you have is feeding and for me breastfeeding is the one thing that only I could do as my baby’s mammy.
When I brought my son home, he was bottle fed just like his brother, but I was absolutely adamant that I was going to get this one breastfed.
Within a day of coming home, I had hired a lactation specialist to work with us. She recommended we try nipple shields first, to make it easier for him to feed as he was only 35 weeks. We tried him on the nipple shields for almost every feed first but he got so tired he practically stopped feeding at all, so we amended it to alternate feeds, one feed at the breast using a nipple shield followed by a bottle feed. It was a little time consuming as after the” feed” on the nipple shield I ended up giving him top ups in the bottle and then had to express. He just seemed to show no interest and all he wanted to do was sleep. I tried every trick I could think of to keep him awake to feed but if he wanted to sleep that was it. He had problems with jaundice since he was born and still had, so this did not help matters at all. I was getting a bit frustrated but I had a very supportive husband, public health nurse and lactation specialist who helped me when I felt like throwing the pump & nipple shields out the window. A few more weeks followed like this and we decided to try a SNS system of feeding. In theory I loved what this machine could do but it was not for me. I found it a bit messy and the tubes kept falling out. It was around week 14 now and despite all our best efforts, breastfeeding was not happening. I was thinking of just expressing full time because I was wore out, my milk supply had dropped but thankfully I went on to motilium and it resumed within a few shorts days. My lactation specialist came over for a visit and as usual we tried to breastfeed. But this time, it was different, he opened his mouth wide enough so she could latch him on and miraculously he breastfed for the first time. I could not believe it, I was delighted, it was short lived as he refused for the next feed but he took it the feed after that. We started off it one or two breastfeeds a day, sometimes followed by a top up. Gradually over a period of about two weeks, he breastfed more than bottle fed, the tops were gone and he was gaining good weight. Still had to continue doing some expressing until he learnt to breastfeed more proficiently. When he eventually made the transition to full breastfeeding, it would take him an hour for each feed but as he got stronger, his feeding time reduced. I eventually managed to get him away from the set feeds and he was feeding on demand. He is almost a year now and we are both still enjoying breastfeeding and I am so glad I stuck with it even though I felt like stopping a few times. It’s so easy and I took great delight in sending back my pump. It took me a while but his jaundice was an issue and if my son learnt to breastfeed and if you have the right support and advice it can really makes the difference. I am glad, thanks to the support I received, that I got to breastfeed my prem.
Breastfeeding your premature baby
by Justine Diamond and Anne Casey
For most new mothers, breastfeeding is something you expect to happen as a natural result of childbirth. When a baby arrives prematurely, you are suddenly thrust into a critical life and death situation. Your baby will be rushed off to intensive care to be hooked up to breathing tubes, IVs and monitors. You may not be able to touch or hold her. The baby's immediate care seems to eclipse every other concern and thought you may have had. So now you may ask, with some concern "Can I still breastfeed my baby?"
Yes, you can. There are many good reasons for supplying your baby with breastmilk. It is something that only you can do, and it enables you to take a more active role in the baby's care. The breastmilk of mothers who deliver prematurely is ideally suited to the special needs of the premature baby. Colostrum and breastmilk contain white blood cells, antibodies and other valuable immune properties that may help a premature baby resist infection. Recent studies have shown that breast milk may improve the neurological development of premature infants.
It isn't easy. Supply can be very difficult to build up and maintain. You'll need to use a breastpump until your baby is mature enough for direct breastfeeding, and sometimes for longer. Here are some basic questions and answers to help get you started while your baby is still in hospital:
1. When can my premature baby begin to breastfeed?
If your baby is stable and relatively well, breastfeeding can be gradually introduced from about 32-33 weeks. Before this stage, expressed breastmilk can be given to your baby via a gavage tube, and baby's interest in breastfeeding encouraged by the skin-to-skin contact of kangaroo care.
2. How do I get started?
You'll need to begin expressing by the day after your baby's birth, and even earlier if possible. Some mothers prefer to begin with hand expressing. A nurse or lactation counsellor should show you the proper way to express either by hand or with a breastpump. Once your milk has come in, you'll need to begin using a good breastpump. The pump may feel uncomfortable at first, so try to use a low setting. In time, you will be able to increase the speed and the suction setting of the pump.
3. How often and for how long do I need to express?
For the first day or two, before your milk comes in, you'll should pump for about 5 minutes every three hours during the day, and once during the night. Once your milk comes in (no matter how small the amount produced), you should try to express at least 6-8 times in each 24 hour period, for as long as it takes to completely empty your breasts. You'll need to rent or buy a hospital grade electric breastpump to use at home.
Frequent pumping can be difficult to manage with a sick baby but will help to build and maintain your supply. If your baby is in hospital for a long time, you may decide that it would be better for you to sleep through the night, but try to never go longer than 8 hours without expressing. When you know your baby will soon be coming home, you can begin begin expressing during the night again.
4. What is the best way to store and freeze/thaw milk?
Some hospitals don't allow the use of frozen milk. Your NICU will be able to guide you on their practices and procedures, however these general guidelines should help:
Containers used for collection or storage of breastmilk should be clean and sterile. Most hospitals supply sterile containers or bottles, or small bottles of sterile water (discard water) which can be used to store breastmilk. Small plastic bags or disposable bottle liners (double bag) can be used to freeze milk. Some of the breastpump manufacturers make bags specifically for the purpose of storing milk though these can be expensive.
You need to label each collection with your name and the date, as the oldest milk will be used first. It is safest to refrigerate or freeze milk promptly after pumping. Fresh milk can be refrigerated and transported on ice to the NICU. Many NICUs have a refrigerator or freezer where you can store your milk. Make sure that you don't overfill any bag of milk that will be frozen as the milk will expand in the freezing process.
Storage times: Recommendations provided by The Nursing Mothers Association of Australia
Fresh milk(6 hours at room temperature), refrigerator (3-4 days, at the back of the fridge where it is coldest), freezer compartment of your refrigerator (2 weeks), if the refrigerator has a separate door (3 months), deep freezer (6-12 months).
Frozen milk : if thawed in the fridge but not warmed (4 hours or less at room temperature), thawed in the fridge (24 hours but don't refreeze), thawed in warm water (only for the duration of the feed, or back in the fridge for a maximum of 4 hours).
To defrost: Thaw under warm running water or in a tepid water bath. Do not use hot water, as this can destroy some of the milk's benefits. Do not thaw by leaving on the counter for a long period of time (the refrigerator is O.K. though). Do not microwave breastmilk to heat it or thaw it. Breast milk also separates, so gently swirl to remix
5. Is there anything I can do to increase my supply?
Maintaining a breastmilk supply without a nursing infant is very difficult. Here are some suggestions from Preemie-L mothers:
A. Fluids and rest
The stress and fatigue that come with having a premature baby can be counter-productive to your milk supply. A good diet and plenty of fluids are essential, and need to be planned for as best you can. If you find your supply is dwindling despite your best efforts, try to spend a day or two in bed, getting up only to eat and express.
B. Increase frequency of pumping
Most women find that frequent shorter pumping sessions work better than longer ones spaced further apart, for example, 10 minutes every three hours rather than 20 minutes every four hours. You need to experiment and find out what works and what is practical for you. If your baby is still in the hospital, you may not have the opportunity to express freqently.
C. Herbal and Medicinal preparations
There are various herbal remedies that are popular and worth trying (but not all at once!). These include brewer's yeast, fenugreek tea or capsules, blessed thistle (also called milk thistle) and mother's milk tea (a U.S. product). These are usually available at health food stores. A Guinness stout in the evening is also a popular remedy, at the very least it is nutritious and will help you sleep.
There are also medicines which can help your let-down such as Metoclopraminde, available as Reglan in the U.S.A. and as Maxalon or Pramin in Australia and England. The lactation consultant at your hospital can advise you on these. They aren't suitable or effective for everyone.
D. Expressing techniques
Many Preemie-L mothers have found that warm compresses and breast massage prior to pumping helped them to relax, and that this in turn resulted in a higher yield of milk. Stopping several times during pumping to reposition the pump cones can sometimes help. Alternating hand expression with machine pumping during a session may also provide a greater yield. If you are not using a double pump, this is something you should consider.
E. Have your breastpump checked
This is so obvious that many times it is overlooked. Make sure that your pump is working correctly and that the suction is correct and the gaskets are all tight. If there is a problem, you can usually return the pump or get new attachments.
F. Supplemental Nursing System [SNS] (only if you are actually Nursing)
A supplemental nursing system may help increase your supply because it allows your breasts to be stimulated while the baby is fed either expressed breast milk or formula. There are two widely available models the Lact_aid Nursing Trainer and the Medela Supplemental Nursing System. A SNS consists of a bag or bottle that hangs around your neck and is filled with formula or expressed milk. Thin tubes taped to your breasts with surgical tape deliver milk to the infant as he sucks. They can be fiddly to use but some mothers have found them to be a good solution for low supply.
6. What can I do if my baby fails to thrive?
If your baby fails to gain weight, it may be recommended that you supplement your nursing with formula or your milk may be enhanced with a fortifier. This does not mean that you have failed, and it does not necessarily mean that you must give up your efforts to breastfeed your baby.
7. Can I supplement breastfeeding with bottles?
If your milk supply remains low, you can continue to breastfeed with supplements of formula or EBM. Supplemental feedings can be given by bottle, supplemental nurser, cup or by one of the special feeding devices. Depending on the health of your baby, your neonatolgist may prescribe a higher calorie formula, or have a breastmilk fortifier added to your expressed milk. Remember that any milk you can supply, no matter how little, is a precious gift, one that only you are able to provide.
8. What can I do if my baby is unable suck well?
Some premature babies never learn to suck well, even though they may be growing and developing in other ways. You can continue to provide breastmilk for your baby by expressing and giving EBM in bottles. A good routine is to feed your baby EBM from a bottle, and then express for the next feed while your baby is close-by. It sounds awkward but it's actually nice (and time-saving) to combine feeding and expressing this way rather than separating the two activities.
9. Will my baby suffer if I give up trying to breastfeed?
No, your baby won't suffer if you are unable to provide breastmilk. Sometimes, even with the best of intentions and the best of efforts, supply just does not increase. It happens more frequently than the books and the lactation specialists would have you believe, and it is NOT an indication of failure. Milk supply is not a simple equation, especially with a premature baby. The stress of having a premature baby, your own physical condition as a result of the birth all come into play as well as how quickly you are able to actually nurse, and how soon after the birth you are given access to a pump.
While it is possible to build a supply through exclusive pumping, it is very difficult, and most women will experience a decrease in their supply after about 6 weeks of exclusive pumping. Sometimes this can be overcome, and sometimes it cannot.
10. Is there anything husbands can do to help?
For mothers struggling with the demands of pumping, a husband's support is very important. Husbands can help by encouraging rest, shopping for food and cooking, providing companionship during the endless breastpump sessions, offering backrubs, borrowing magazines and videos to help make the time spent expressing more tolerable.
And remember to praise. Expressing milk for months on end can feel like a thankless task. Husbands who nurture their wives through this long and demanding process are helping to provide their premature babies with a unique gift of love.
Sometimes it becomes clear that breastfeeding isn't working out. This can be devastating for a mother who has always hoped to breastfeed, and the love and support of a husband can be a great comfort.
11. When should I wean my baby?
The simple answer to this is when you are ready. It may be when the baby is several months old (or younger) or several years old. As your baby grows, breastfeeding continues to be a source of comfort as much as nutrition. This is part of a unique relationship which can continue as long as you and your child enjoy it, regardless of the amount of milk provided.
Neifert, Marianne, Dr. Mom's guide to breastfeeding Penguin Group, 1998. Excellent information on breastfeeding high risk infants. A good source for information on increasing supply. One of the only books to address the emotional concerns of not being able to supply an adequate amount of milk.
Eiger, Marvin S, and Olds, Sally Wendkos The complete book of breastfeeding Workman Publishing,1987. Excellent section on expressing and storing milk.
Expressings - Thoughts and advice on breastfeeding from The Early Edition newsletter
Getting started with pumping (moo)
Increasing your supply
Where to get help
Transition to nursing at the breast in NICU
Transition to nursing at home
Breastfeeding your premature baby This is a very helpful and informative page taken from the For Parents of Preemies web site.
The emotional side of breastfeeding a preemie by Preemie-L member Kerry Bone.
The more technical side of breastfeeding a preemie by Preemie-L member Kerry Bone.
Breastfeeding a premature baby supplied by Ameda/Egnell, a company that makes hospital grade pumps.
Breastpumps and breastfeeding solutions the home page of Medala, who make breastpumps and other nursing aids.
Pumping moms listserve provides information and support for breastfeeding mothers who are working, or who have premature babies.
Organisations like LaLeche League and Nursing Mothers' Association of Australia (NMAA) provide breastfeeding support, breastpump and SNS hire, regular social meetings and special information booklets (breastfeeding preemies, building supply, returning to work and so on).
Disclaimer: The writings and opinions contained in this FAQ are simply that, and are in no way meant to be considered as medical advice, nor are they meant to replace any medical advice. Always discuss concerns with your doctor.
This document is copyright to Preemie-L. It may be reproduced in any format so long as it is reproduced in its entirety, including the contact link to the Preemie-L home page at www.preemie-l.org