Why is it important to feed the premature baby breast milk??

It is worthwhile and important to pump milk. This is the most suitable food for babies in general and for premature babies in particular. The mother's body knows how to produce milk according to the gestational age, so only mothers can provide the perfect food for the needs of our little ones. The many benefits of breast milk include improved immune protection, appropriate nutritional composition, and stimulation of optimal intestinal function, while providing a psychological and developmental advantage to the mother and her baby. Breast milk is also rich in factors that help protect against infections. Most of the properties of breast milk are present, even if it is only sufficient for part of the diet. Breast milk feeding reduces the risk of NEC (see glossary) and sepsis, and can thus significantly shorten the duration of hospitalization. Since the ability to suckle does not mature until the 34th week of pregnancy, most small and immature premature babies require feeding by tube through a gastric catheter. As they mature, premature babies are gradually taught to suckle. It is usually easier for premature babies to suckle from a bottle nipple, and only later do they gradually learn to suckle from the breast. Therefore, the way to feed a premature baby requires pumping breast milk and making sure it is stored properly until the time of feeding. If your premature baby is still small and in an incubator, it may be a long time before he attaches to the nipple and sucks directly from it. Until this happy moment arrives, you will have to be connected to an annoying, cool, plastic and sometimes noisy breast pump. This robotic substitute, called a breast pump, is going to be next to you every day at least eight times a day, every three hours (in any case, it is not a good idea to open intervals of more than 4 hours between pumping during the day and 5-6 hours at night). This is not an easy task – especially for mothers of premature babies whose hospitalization is going to be long. What can make this task easier for you is the knowledge that the milk given to your premature baby is essential for his health and the best thing you can give him as a mother. We strongly recommend consulting with the lactation consultant in the maternity department at the hospital or at the maternity hospital regarding pumping methods, frequency, etc. The first few days after birth

In the first few days after birth, the body produces a yellowish, thick milk called colostrum. Colostrum provides the baby with the nutrients it needs in a concentrated form in a small volume. Colostrum is tailored to the baby's needs: Compared to the white mature milk, which arrives two to three days after birth, colostrum contains less fat and lactose (and is therefore easier to digest) and is richer in carbohydrates and protein. It has a mild laxative effect, which helps the baby excrete meconium (the first stool) and excess bilirubin, thus helping to prevent jaundice. Colostrum contains many antibodies and white blood cells, which protect against viruses, bacteria and other infections. It helps establish the good bacteria in the baby's digestive system, and also contains growth factors, which help the baby's digestive system mature. It is important to start expressing colostrum from the breast as early as possible, as close to birth as possible. Since colostrum is viscous and sticky (sometimes resembling honey in texture), it is possible and even advisable to begin expressing it manually (without a pump) into a sterile container. Expressing colostrum from the breast as close to birth as possible can prevent problems with milk supply later on. Manual expression of colostrum is done as follows:

Before expressing milk, it is essential to wash your hands with soap or alcohol gel and massage both breasts for about a minute in total. The massage facilitates the release of milk.

Place your finger and thumb parallel to each other, each about two centimeters from the nipple.

Press with your fingers inward toward the ribs (into the breast).

Continue pressing while trying to connect the fingers inside the breast and pulling the fingers forward (down towards the nipple).

Ultimately, it is a circular shape - inward: one finger to the other and towards the nipple. It is important to emphasize that the work is done on the internal tissue and not on the skin. When pumping colostrum, it is important to give it to the baby in the way it is fed (tube / bottle). When the milk amounts increase (a few days after birth), you can start using a breast pump.

So how do you actually start pumping?

Pumping breast milk is different from breastfeeding. In order to be successful in pumping breast milk, perseverance is important. Sometimes in the first few pumpings, no milk comes out at all or very little milk comes out, 10 ml, 20 ml. The most sophisticated pump does not completely simulate the sucking action as it is performed by the baby, and the mother's body needs to get used to secreting the hormone oxytocin, which causes the release of milk - for a pump and not for a real breast. Starting pumping is not easy. The body that has not yet had time to recover from childbirth needs to learn to perform a new action that is unfamiliar to it, and in addition, you constantly feel like you are being tested. Unlike a mother whose baby was born on time and breastfeeds him as she pleases, you are measured for every CC.

Which pumps should be used?

Pumping with a double-sided pump (which pumps from both sides at the same time) increases the volume and saves valuable time. Double-sided pumping is especially helpful if you are a mother of twins and want to achieve an adequate milk supply for both of them.

It is recommended to rent/borrow a double-sided pump with a closed system. You can get it from pharmacies, rental companies, buy it on the private market, or through health funds. Many of the funds today have subsidies for breast pumps. It is advisable to check with a lactation consultant which pump is suitable for your needs. When borrowing from "Yad Sara", it is advisable to have a letter from the midwife confirming that you did indeed have a premature baby and to borrow a suitable pump.

Tips for increasing milk supply:

• It is very important to believe in your body that it is capable of nourishing your baby with the best nutrition.
• Look at a picture of the baby(s) while pumping milk – this action activates the milk release reflex.
• Smell a cloth diaper with your premature baby's body odor while pumping milk.
• Pump after kangaroo care and breastfeeding.
• Pump in a comfortable position and in a relaxed atmosphere.
• If milk production is still insufficient, it is worth consulting with a lactation consultant and obstetrician about using milk boosters.
• It is important to avoid mint and sage, which may cause a decrease in milk production.
• You can also use the power pump method - pumping for 10 minutes and resting for 10 minutes, several rounds in total, for an hour once a day.

And some more general advice:

In most maternity hospitals in Israel, most nurses take courses on breastfeeding and are called breastfeeding advocates or lactation consultants. Naturally, they are the most available and accessible, use them.

Even if your premature baby is still small and can't breastfeed on his own, you can let him experience nipple contact even when he's small, during kangaroo care. During kangaroo care, it's a good idea to bring the premature baby closer to the breast, and you can even squeeze a few drops and apply them to the breast so he can taste the taste.

The way to wake a baby who has fallen asleep at the breast is to press on the breast (like the squeezing action you did in the early days), and in this way, flow delicious milk into his mouth. This way, sometimes the baby will wake up and continue to nurse - during hospitalization, it is important to do this only after consulting with the lactation consultants/supporters in the hospital.

It is very important to drink and eat healthily and sufficiently. It is equally important to rest. Don't forget that you have just given birth to a baby(s), and you must regain the strength you have lost.

Try to get two sets of vacuum cleaners and cleaning brushes, one at home and one in a bag or locker in the nursery.

It is recommended not to clean the pumping tool with "Septal Scrub" (the hand cleaning liquid used in baby bottles) but with dish soap. The Septal Scrub may leave a residue.

The pumping routine can become very tiring and boring. It is recommended to combine pumping with other activities such as reading, phone calls, and more.

Do not compare or discourage other mothers who are pumping with you during your preterm delivery. Milk production varies from mother to mother and there is no point in comparisons that can be frustrating.

In any case of fever, illness, or taking medication, a qualified lactation consultant should be consulted regarding continued breastfeeding/pumping. The medical team should be informed that sometimes the effects of illness or medication can also be passed on to the baby.

The transition from pumping to cleaning

Breastfeeding attempts can begin from 30-32 weeks, but it depends mainly on the baby's condition and not on the week of maturity. Therefore, it is recommended to consult with the team to know when to begin breastfeeding attempts.

It is recommended to receive guidance from a nurse/lactation consultant on a bottle feeding method that supports and promotes breastfeeding.

In your first steps in breastfeeding, what matters is not the quantity, but the quality of your and your baby's experience.

And what do you do if there is still not enough milk?

It is a good idea to contact an IBCLC (International Board Certified Lactation Consultant) as soon as possible (details can be found on the La Leche League website). In cases of a sharp decrease in milk production, there is medication that may help. Ask your doctor about it, but it is important to remember that without increasing breast stimulation by sucking or pumping frequently, the medication will not be effective.

If there is too little milk, it is worth adding a few more pumpings: While you are in the hospital, add intermediate pumpings, say a long pumping when you arrive and another short pumping every two hours. Within two days, the amount of milk may increase.

How to store pumped milk?

• Before storing the milk, make sure to clean the storage container.
• The recommended storage containers are glass containers, hard plastic containers, or plastic bags designed for storing breast milk.
• It is advisable to use a separate storage tank for each pumping.
• You can mix milk pumped at different times only after it has cooled in the refrigerator.
• You can add milk that has been cooled in the refrigerator to frozen milk, as long as the amount added is less than the amount of frozen milk present to prevent the milk from thawing.
• It is recommended to store milk in small quantities of 60-120 ml, in order to avoid waste.
• The date should be written on a sticker and attached to the storage container.
• Storing pumped breast milk (from the Ministry of Health website)
• The Ministry of Health guidelines are for a baby born at term. That is, after discharge, they can be followed. As long as the baby is premature, the postnatal procedures must be followed.
• Expressed breast milk can be stored at room temperatures of 16 – 29 degrees Celsius for up to 6 hours.
• Expressed breast milk can be stored in the refrigerator for 5 to 8 days.
• Breast milk can be stored in a freezer with a separate door from the refrigerator or in a separate freezer for up to 12 months.

Thawing and heating milk

• Expressed breast milk that has been in the refrigerator should be warmed to room temperature in a container with warm water.
• Frozen breast milk can be taken out an hour before use and warmed in a container with hot water, or thawed at room temperature.
• You can take the milk out of the freezer and into the refrigerator and use it within 24 hours of removing it from the refrigerator.
• Leftover milk that has been thawed can be used within 4 hours of thawing. After that, it should be discarded.
• Do not heat breast milk in boiling water or in a microwave.
• Milk fat has a tendency to separate and float to the top, so thawed breast milk should be gently stirred and its temperature checked before feeding.
• Chilled milk contains more anti-inflammatory factors than frozen milk. Therefore, the chilled milk should be used first and then the frozen milk.

Additional breastfeeding support

You can get more information and support on the following websites:

La Leche League website in Israel http//:www.lllisrael.org.ilLa Leche League is a registered non-profit organization whose member instructors provide support and information on a voluntary basis on the subject of breastfeeding.

On the website of the Israeli Association of Nursing Professions: https://ialp.org.il/

Breast milk bank

Information about the milk bank, eligibility, and more can be found here. here.

previous