Thursday 14 July 2011

Express Yourself - Pumping for Your Premature Baby

Breast milk is the ideal first food for premature babies. It’s gentle on the stomach, its custom made, and it’s a special thing only you can do for your baby. No nurse or doctor can do this, only you, your baby’s mummy.
If you have never considered breast feeding, it’s really worthwhile giving it a try. You don’t have to go on to breastfeed your baby (and occasionally it doesn’t work out, and I think it’s a good idea to mentally prepare for this, I didn’t). Even if you only express the colostrum, the liquid gold that appears before your milk comes in, this is very valuable, and will help provide some protection against infection for your baby. 

When Joseph was tiny, and strung up to all manner of monitors and had iv lines in most of his limbs, it was so lovely to see him being given pipettes of my milk to give him comfort. It made me more determined than ever to express for him. Joseph had to be on Total Parental Nutrition (TPN) for the first couple of weeks of his life in order to build up his weight, and to protect his tummy from infection. This gave me a head start. Here are my tips.

Where do I start? It is recommended by most lactation consultants that you hand express only for the first few days, you should do this as soon as you are able. Your midwives on the delivery suite will be happy to show you how. There are also some very good clips on You Tube to show you how. You may find it beneficial to look at photos of your baby. This did not help me, Joseph's first photos were distressing, but I did find having a little hat he'd worn or a muslin he'd been wrapped in helped enormously.

When can I use a pump? You can use a pump once your milk comes in, which is normally day 3 but can be a bit longer. Don’t be alarmed (particularly if you have a later gestation premature baby) if they are put on formula for a couple of days. Unlike term babies, premature babies have no or little fat stores to keep them going until your milk comes in. It’s not a reflection on you, and you have not failed, it just takes time for your milk to come in.
What pump should I use? If you are expressing for any period of time, you need an electric pump, manual pumps might be ok for short periods of time, but for full time expressing you need an electric one. I personally used Medela, but there are many other brands now available. I do think, if you are pumping for any length of time, you need to double pump. I have been “test driving” a DVD for families of premature babies and have to share this tip with you. You can buy very expensive pumping systems so you can pump hands free. Or you can get a sports crop top, cut two “Madonna holes” in it, and stick your pumping cups through the holes, and away you go!
How often should I pump? This is the million dollar question and everyone will tell you something different. There are two standard responses to this question. The one given by our unit and most neo natal units, is to pump every 3 hours, and once your milk is established you can go up to six – eight hours at night. The other school of thought is that you should be expressing to a similar schedule that you would be feeding your newborn, that is 10-12 times a day.
I am going to be honest. I think the every 3 hours advice is the one that most people will be able to do and not go barking mad. Even the every 3 hours is hard, especially if you have other children. Expressing full stop is very difficult when stressed, and stress will not help your supply. So my advice is, if you can express 10 – 12 times in a day then that is wonderful and is going to give you a great start and a lovely supply for the future. If you can only manage every 3 hours, then there is plenty of evidence that that maybe sufficient. If you can’t manage that often, you will still have some milk for your baby and that’s wonderful.
How do I store my milk and how long for? Please be guided by your unit’s protocols, however this is the advice I was given. Milk can be stored in pots (provided by the unit) or in plastic bags. I had bags that hooked directly on the pumps. The bags take up a lot less room in the freezer. Make sure all your pots or bags are clearly labelled (some units provide ready printed sticky labels) and clearly dated. The unit will use the oldest milk first. Fresh milk is best, so I used to try and express into two containers and make sure they used some fresh and froze the rest.
Milk can be refrigerated for 24 hours for a special care baby (for a term baby its considered fine for 48 hours) and can be frozen for up to 3 months for a special care baby (up to 6 months for a term baby). When defrosting make sure it is well shaken, as it will separate on defrosting.
A word on massage – it is vital you gently massage your breasts before each expressing session. I did not do this religiously and still have pain now on occasion, and have not breast fed or expressed for almost two years now. The massage only needs to be gentle, and can be done in the bath or shower, or your partner can help. This helps get the ducts working.
My supply is dwindling and I don’t know what to do – the quick fix is domperidone also known as Motilium. This is a medication used for stomach upsets, to improve stomach motility (the transit of liquids and food), ironically many premature babies are on this medication for reflux. Domperidone improves the let down reflex. It is not licensed for this purpose, and some GPs may not prescribe it, however most units will have a “domperidone letter” you can give to your GP.
Herbal supplements can help, and the two most used ones are Fenugreek and Milk Thistle. You can buy these from most health food shops. You will need to tell the unit if you are using Fenugreek, as it does change the consistency and smell of your babies poo.

Ask the unit to show you Kangaroo care, if you are not doing this already. Skin to skin contact with your baby may help your supply and in particular the "let down" reflex to release more milk. Expressing by the cot side may help too. 
The longer fix are the following – drink plenty of water. I was advised to drink no fizzy drinks, as it is dehydrating. I would also go easy on tea and coffee. Fruit juices and smoothies are fine, and now is not the time to worry about calories. You need calories in order to have the energy to express. I was also advised to eat – a lot, and to supplement with chocolate in order to get enough calories. Oats are a really good food, and if you have a slow cooker you can cook porridge in there and keep it for a few days if you make it with water, and just add milk to it before you eat it.
Stress can impede supply. Worrying about getting stressed will make it worse. The best way to cope with a baby in special care is to use all the sources of support you can, to find what works for you, and to take time out. Go for a walk, go out for a meal with your partner, have a haircut or a massage or a pedicure, your baby is well looked after.
Ultimately, if you are trying to express, that is wonderful, and if you find that it is too hard, and you are getting too stressed, then be prepared to make some difficult decisions. I know the day I put my pump away was one of the saddest days of my life, but also one of the most freeing.  In my case I was finding that my milk had to be fortified to give Joseph what he needed, and then he had to have formula as well as my supply stopped meeting his needs.
Any breast milk you can provide will be beneficial to your baby.


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