Expressing & Feeding
Not too long after baby's birth you are likely to be visited by a Lactation Consultant or Midwife to discuss the possibility of expressing breast milk with a view to ultimately breastfeeding your baby when they are well enough.
Colostrum and breast milk are very important for sick or premature babies. In fact it is so important that a milk bank has been established at King Edward Memorial Hospital, PREM Bank to store and distribute donor milk for the sickest and most premature babies.
Initially you will hand express every 3 hours and a nurse or midwife will assist you to catch the small droplets of colostrum in a syringe to send to NICU/SCN for baby. Once your milk begins to flow, which may take many days, depending if you have lactated before, you will be able to use a pump which will make expressing more efficient. It is highly recommended to double pump with a hospital grade pump as this will be easier for you and more efficient. Pumps can be hired from the hospital or your local chemist may also have them for hire.
You will continue to express every 3 hours. If you are struggling, your milk isn't coming in, or your supply is very low, then your Lactation Consultant may provide you with information about medications which may help. If you have not had contact with a Lactation Consultant and are struggling or just require some support please speak to the nurses on your ward or caring for your baby to organise a chat.
Before discharge from King Edward Memorial Hospital it is recommended that you attend a talk about expressing presented by the milk room. An information booklet they distribute can be found here, Expressing Breast Milk for your Baby in the NICU. If you are at another hospital you may find the information in the booklet useful. You will need to speak with your hospital about the hire of a breast pump for use at home.
Some natural things you can do to encourage a good milk supply include:
- Drinking plenty of water
- Ensuring you pump every 3 hours
- Emptying your breasts when pumping
- Having a photo of baby with you when you pump
- Having an item that smells like baby with you when you pump
- Maintaining a healthy diet
When your baby is healthy enough it will be time to introduce baby to the idea of breastfeeding, this may be as early as 32 weeks. Initially baby will be encouraged to nuzzle on an empty breast. You will express off your milk first and then offer baby the empty breast. They may take a few sucks before tiring, breastfeeding is exhausting work!
Sometimes babies have trouble maintaining a good latch when they are born early or sick. This can often be overcome with the use of a nipple shield. The Lactation Consultants attached to the NICU/SCN can help you to determine if this is appropriate for you and your baby and what size shield to use. If you are struggling ask to speak with a Lactation Consultant. While nurses in NICU/SCN do have experience in this area Lactation Consultants are specially trained in all things lactation.
Once baby has got the hang of nuzzling and latching onto an empty breast nurses will often feed baby through their NGT while they are nuzzling. This is so that baby associates sucking with their tummy feeling full. Nurses will often use a dummy at feed times when you are not around. Once baby is coordinated enough to breathe, suck and swallow at the same time they will be allowed to try on a full breast, this may be around 34 weeks, but it's important to remember that all babies develop at their own rate. The earlier and sicker your baby was the longer they may take to get the hang of suck feeds.
Sometime during this transition period from all tube feeds to some suck feeds it may be appropriate for baby to have a bottle of expressed breast milk. Nurses will discuss this option with you as you will need to consent to bottles being used. If you do not want your baby to receive bottle feeds please have the nurses write clearly on babies chart that you do not provide consent.
Having baby suck all of their feeds is one of the criteria required for discharge. While expressing to bring in and maintain your milk supply is very hard work taking your baby home from NICU/SCN and being able to breastfeed them is one of the most rewarding experiences for a mother. After all this is one of the few things that no one else can do for you.
Should you feel that you need ongoing support in your breastfeeding journey or perhaps just to speak to someone outside of the NICU/SCN you will find information and a friendly ear through Australian Breastfeeding Association.
If you are unable to breastfeed or if you choose not to you will need to communicate that to the staff caring for you or your baby. Most hospital NICU's provide formula and bottles for use while baby is in NICU/SCN but you will need to check with them.
When getting ready to leave hospital you will need to make sure that you have all of the necessary equipment and formula at home to continue bottle feeding your baby.