Breast milk - pumping, storage and breastfeeding

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

It is worthwhile and important to express 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 the mothers can provide the perfect food for the needs of our little ones. The multiple benefits of breast milk include improved immune protection, appropriate nutritional composition and stimulation for optimal bowel function, while providing a psychological-developmental advantage to the mother and baby. Breast milk is also rich in factors that help protect against infections. Most of the virtues of breast milk exist, even if it Only enough for part of the diet. Breastfeeding reduces the risk ofNEC (see glossary) and sepsis, thus it can significantly shorten the duration of hospitalization. Since the sucking ability matures only towards the 34th week of pregnancy, most small and immature premature babies need to be fed by tube through a gastric tube. As they mature, the premature babies are gradually taught to suckle.

It is usually easier for premature babies to suck from a bottle nipple, and only later do they gradually learn to suck from the breast. Therefore, the form of feeding the premature infant requires pumping breast milk and ensuring its proper storage until the time of feeding. If your premature baby is still small and in the incubator, it may be a long time before he attaches to the nipple and suckles directly from it. Until that happy moment arrives, you will have to be connected to an annoying, cool, plastic and sometimes noisy breast pump. This robotic replacement, 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, you should not 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 that you consult with the lactation consultant of the maternity department at the hospital or at the maternity ward regarding the method of pumping, its frequency, etc.

The first days after birth

In the first few days after birth, the body produces a yellowish, thick milk called colostrum. The colostrum provides the nutrients necessary for the baby in a concentrated form in a small volume. Colostrum is adapted 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 thus is easier to digest) and is richer in carbohydrates and protein. It has a mild laxative effect, which helps the baby excrete the meconium (the first stool) and the excess bilirubin and thus helps 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 to mature the baby's digestive system. It is important to start and squeeze the colostrum from the breast at the earliest stage, as close to birth as possible. Since the colostrum is viscous and sticky (sometimes reminiscent of honey in texture), it is possible and even desirable to start squeezing it manually (without a pump) into a sterile vessel. Squeezing the colostrum from the breast as close as possible to birth can prevent problems with the milk supply down the road. Manual squeezing of the colostrum is carried out as follows:

Before you approach to express milk, you must disinfect your hands with soap or alcohol gel and massage both breasts for about a minute in total. The massage facilitates the release of milk.

The finger and thumb should be placed parallel to each other, each about two cm from the nipple.

Press with your fingers in towards the ribs (into the breast).

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

In the end it's 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 colostrum is pumped, it is important to let it mature in the way it is fed (tube / bottle). When the amounts of milk increase (several days after birth), you can start using a breast pump.

So how do you actually start pumping?

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

Which pumps should be used?

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

It is recommended to rent/borrow a double-sided pump with a closed system. It can be obtained from GAMs, rental companies, buying in a private market or through the health insurance funds. Many of the insurance funds today have a subsidy for breast pumps. It is advisable to find out with a lactation consultant which pump is suitable for your needs. You were indeed born premature and borrow a suitable pump.

Tips for increasing the amount of milk:

• It is very important to believe in your body that it is capable of feeding the baby with the best nutrition.
• Look at a picture of the baby while pumping the milk - this action activates the milk release reflex.
• Smell a cloth diaper with your premature baby's body odor while pumping.
• Pump after kangaroo and breastfeed.
• Pump in a comfortable position and in a relaxed atmosphere.
• If, nevertheless, the milk yield is not sufficient, it is worth consulting with a lactation consultant and obstetricians regarding the use of milk enhancers.
• It is important to avoid mint and sage that may cause a decrease in milk yield.
• You can also use the method power pump - Pumping for 10 minutes and resting for 10 minutes, several rounds in total, for an hour once a day.

And some general advice:

In most preemies in Israel, most of the nurses go through breastfeeding courses and are called breastfeeding supporters, or breastfeeding consultants. Naturally, they are the most available and the most accessible, use them.

Even if your premature baby is still small and cannot nurse by himself, you can let him experience contact with the nipple even when he is small, during the kangaroo. During the kangaroo, you should bring the baby closer to the breast, and you can even squeeze a few drops and apply it on the breast so that it feels the taste.

The way to wake up a baby who fell asleep on the breast is to press the breast (like the squeezing action you did in the first days), and in this way pour delicious milk into his mouth. In this way, sometimes the baby will wake up and continue to breastfeed - during hospitalization, it is important to do this only after consulting with the breastfeeding advisors/supporters at Fegia.

It is very important to drink and eat healthy and enough. Equally important, rest. Don't forget that you have just given birth to a baby(s), and you must regain your lost strength.

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

It is recommended not to clean the suction tool with "Spetal Scrub" (premature hand cleaning liquid) but with dish soap. The spatula scrub may leave a residue.

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

Do not compare and do not be discouraged by the other mothers who pump with you in Fegia. 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 the continuation of breastfeeding/pumping. The medical staff should be informed that sometimes the effect of a disease or medication can also be transferred to the premature.

The transition from pumps to breastfeeding

The beginning of breastfeeding attempts is possible starting from week 30-32, but it depends mainly on the condition of the baby and not on the week of maturity. Therefore, it is recommended to consult with the staff to know when to start trying to breastfeed.

It is recommended to receive guidance from a nurse/lactation consultant on the form of giving a bottle that supports and promotes breastfeeding.

In your first steps in breastfeeding what is important 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?

You should contact a certified lactation consultant IBCLC As soon as possible (details can be obtained on the "La Leche League" website). In cases of a sharp decrease in milk production, there is a drug treatment that may help, ask the doctors in Fegia, but it is important that you remember, without increasing the stimulation of the breast by sucking or pumping multiple times, the drug will not be useful.

If there is too little milk, you should add several more pumps: during the stay in the nursing home, add intermediate pumps, let's say a long pump when you arrive and another short pump every two hours. Within two days there may be an increase in the amount of milk.

How do you store expressed milk?

• Before storing the milk, take care to clean the storage vessels.
• 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 container for each pumping.
• You can mix pumped milk at different times, only after it has cooled in the refrigerator.
• You can add milk that is cooling in the refrigerator to the frozen milk, as long as the amount added is less than the amount of frozen milk available in order to prevent the milk from thawing.
• It is recommended to keep milk in small amounts of 60-120 ml, in order not to cause waste.
• The date must be written on a sticker and attached to the storage tool.
• Storing pumped breast milk (from the Ministry of Health website)
• The Ministry of Health guidelines are for a baby born on time. That is, after the release you can follow them. As long as the baby is in the carrier, follow the procedures of the carrier.
• Pumped breast milk can be stored at room temperatures of 16-29 degrees Celsius for up to 6 hours.
• Expressed breast milk can be kept 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.

Defrosting and heating milk

• Expressed breast milk, which was in the refrigerator, should be warmed to room temperature in a container with hot water.
• Frozen breast milk can be removed an hour before use and warmed in a dish with hot water, or thawed at room temperature.
• You can take the milk out of the freezer into the refrigerator and use it within 24 hours of taking it out into the refrigerator.
• It is possible to use leftover milk that has been thawed within 4 hours of thawing. Then throw it away.
• Do not heat the breast milk in boiling water or in the microwave.
• Milk fat has a tendency to separate and float to the top, so thawed breast milk should be gently mixed and its temperature checked before feeding.
• Chilled milk contains more anti-inflammatory factors than frozen milk. Therefore, the cooled milk should be used first and then the frozen.

Additional breastfeeding support

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

La Leche League website in Israel http//:www.lllisrael.org.il. The La Leche League is a registered association, whose member guides provide support and information on a voluntary basis, on the topic of breastfeeding.

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

Breast milk bank

Information about the milk bank, entitlements and more... can be found Here.