Premature birth, breastfeeding and maintaining breast milk
Having a baby prematurely is a unique, different and often more stressful birth.
An intense period is expected for the parents, with more challenges compared to parents of a baby born on time.
The road to establishing breastfeeding is also longer. There are mothers who do not have enough time to establish breastfeeding during the stay in the hospital, But there are many directions to take before the release, and many premature babies can breastfeed successfully and for a long time.
Thoughts on premature breastfeeding among parents and staff members
Premature birth can be very overwhelming, scary, stressful and even a little disappointing (birth is a little different than you imagined) and there are mothers who will take some time to recover and start acting.
A premature baby sometimes looks very small and delicate, and the feeling among the parents and the medical staff is that he cannot breastfeed effectively.
Sometimes they think that it is better to feed him well in order for him to grow and get stronger and wait with breastfeeding to continue. In cases of very premature birth, there are medical conditions that require treatment and nutrition in other ways.
Breastfeeding is often postponed to a later stage, but it is important to know that healthy premature babies born in relatively late weeks can breastfeed partially/fully, with professional guidance and support.
Breast milk for premature babies
Breast milk is the best nutrition for a premature baby, and even the closest to what he would have received as a fetus in the womb during this period. And therefore, this is an amazing opportunity for the mother to allow this for her baby and it is better as early as possible.
The production of breast milk is a natural process of the body that starts from the 16th week of pregnancy and continues immediately after birth.
In a premature birth, the colostrum phase (the initial fluid) may appear several days until the milk arrives, the colostrum is extremely important and comes in small amounts. With precise work, with an emphasis on regular pumping, the milk will come and its quantity will increase.
Since the little premature baby needs very small amounts at the beginning, usually the amount of mother's milk will be suitable for him.
The breast milk of premature babies has unique ingredients, which are most impressively adapted to the needs of premature babies. More calories, proteins, fats, enzymes, vitamins, minerals and a unique amino acid profile that helps digestion and absorption of substances.
In some cases, according to the prematurity order, a substance called "human milk fortifier" will be added to the mother's milk to enrich the milk with minerals and energy required for a very small prematurity.
First steps after premature birth
- Understand what the current nutritional options are for your baby.
- start acting early. It is advisable to breastfeed/squeeze and pump already in the first hours after birth and certainly in the first day.
- If the baby can breastfeed, it is recommended to get good training and consider pumping in addition until you know that the baby is effective at breastfeeding.
- If the baby is not breastfeeding, it is important to start expressing milk in an orderly manner even if the baby is not eating yet.
- Organize pump parts in the hospital and at home.
So how do you do it??
In the first day, there are small amounts of milk called colostrum. This is primary milk, rich and adapted especially for newborn babies, it is important to note that it comes in small quantities to every mother.
Manual squeezing may sometimes be less pleasant, but the operation is important and effective. You should learn the operation before the due date if you know you will give birth early, or immediately after the birth, with the help of the lactation consultants or nurses.
In a premature birth, it is recommended to start pumping as early as possible, but it is important to take into account that the collection of the colostrum is expected to be easier with manual squeezing during the first hours and even the first day.
If there is difficulty with manual squeezing, you can work with pumping only, even if not much comes out yet, and the main thing is to start signaling to the body as soon as possible that it should produce milk.
Combining pumping and squeezing is a good tool for expressing milk, especially at the beginning and whenever it is needed.
And of course, take care to transfer every drop that comes out to the baby. Consult the preemie regarding a vessel in which the milk can be stored.
There are cases when the baby cannot eat in the first hours and even the first days. Therefore, it is very important that the mother starts to express the milk. Only in this way, the body knew that it needed to produce and increase quantities.
מומלץ שחלקי המשאבה יעברו ניקוי וחיטוי לפני כל שאיבה. חשוב במיוחד עבור שאיבה המיועדת לאחסון. במידה וזה לא אפשרי, אפשר לא לחטא לפני שאיבה המיועדת לחלב לשימוש מיידי ואז לחטא לפחות פעם ביממה. חשוב לשטוף היטב ידיים ולדאוג לסביבה נקיה. הוראות מפורטות יינתנו בפגיה, ותמיד רצוי לברר את ההנחיות ולפעול לפיהן.
הנחיות הבנק הלאומי לחלב אם לשאיבה:
It is recommended to pump at least 8 times a day, or more depending on the need (for example if there is congestion in the chest, if the mother needs to increase the amount of milk).
It is recommended to receive organized training on how to pump, to know the pump and its parts in the hospital. Sometimes, it is necessary to adjust the size of the funnels in order to pump efficiently (funnel/flange, the part that connects to the breast).
I should note that in Israel there is a breast milk bank donated by mothers who pump. The milk is monitored throughout, and is given prematurely to babies born with a very small weight and in situations where the mother does not have enough milk.
Towards the release of the mother to her home, it is recommended to take care of a quality double-sided pump (multiple user pumps) at the hospital level. You can rent hospital level pumps from private places (information on the internet) or purchase a high level bilateral pump from the health funds/private places.
And what about breastfeeding? ?
If the baby is healthy, and can start nursing, it is highly recommended to start experimenting with breastfeeding while still premature. In most cases, premature babies in good health will be able to synchronize breathing, swallowing and sucking. That is, when breastfeeding it is easier for babies to do all the necessary actions while eating with high success compared to other ways of feeding.
It is recommended to experiment with breastfeeding in relaxed conditions, while you are relatively calm, without tiring the baby with many procedures before trying to breastfeed.
In premature babies, you can ask to weigh the baby before and after breastfeeding some times. It is important to look at the baby and see how he is doing, what good swallows look like and thus gain confidence even in the preterm if possible.
Recommends allowing the baby many opportunities for skin-to-skin contact in the nursery and at home. Skin-to-skin contact can greatly help promote the health of the baby and its mother, and will also help milk production and breastfeeding success. If there are other family members who are allowed to enter the prematurity and have skin-to-skin contact, of course it is blessed.
In some cases, a baby will partially breastfeed already at term, and sometimes there will be single feeds at term and the establishment of breastfeeding will be done at home.
Achieving full breastfeeding with a premature baby may take more time and require more monitoring and professional support, but it is definitely possible.
Even if the baby is not mature and strong enough for full breastfeeding, the opportunity, experience and closeness to the breast are extremely important.
And of course, it is important to maintain breast milk by pumping throughout the period when the baby is not yet fully breastfed and/or the milk is not balanced (the mother has more than the baby needs or less).
Sometimes, premature babies will breastfeed and receive breast/other milk supplements, depending on their ability. Sometimes a baby born on time will be breastfed longer. Additional breast/other milk can be given to babies in different ways and it is recommended to consult about this.
The transition to breastfeeding may take days or even weeks. Very much depends on the week of birth and the condition of the baby. Willingness, patience, training and professional guidance are required, And as mentioned preserving the milk!
It is very important to use the professional support of a lactation consultant during hospitalization and after discharge home. Professional guidance is very helpful in assessing the baby's abilities, and in building a plan to successfully establish breastfeeding at an appropriate and safe pace for mother and baby.
You can find lactation consultants in your area on the website of the Israeli Association for the Nursing Professions https://ialp.org.il/ as well as in the community and the health funds.
***During the entire stay in the hospital, it is important to obey the instructions of the prenatal team, who knows the baby's needs and abilities***
The author of the article: Ariela Levy, certified lactation consultant IBCLC and organizational sociologist, owner of a private clinic in Tel Mond.
Mother of three children who were born prematurely, accompanies premature mothers and teaches and lectures in the field among professional women in Israel and around the world.