Breast milk and NICU

A

Aquarian

Registered User
Hello. I'm trying to get sorted for the inevitably early arrival of my baby. It's likely he'll be early enough to need time in NICU (I hope not, but I want to be prepared). Can anyone share their experiences with feeding?

If he's too small to feed normally, will the nurses let me pump milk for him or will they insist on formula? Is there a fridge or somewhere to store milk? Are they quick to bring a pump after birth or should I bring my own? Will I need to bring my own storage bags?

I'll be going in for a check up on thursday so i'll try to get an 'official' answer then but i'd like to hear the reality too.

Thanks.
 
depends on the hospital i think...

QMH has a pump, they brought it to my bed when my son was in special care. but i don't think they would be able to let you use it all the time as there would likely be other mums needing it, too.

not sure about storing the breast milk. i would think not, but don't quote me on that.
 
Hi Aquarian,

I'm sorry to hear that you baby may need time in the NICU and that you'll need to get your milk going by yourself. Generally while you have colostrum hand expressing is more productive than pumping. Colostrum only coming in drops at the beginning and we usually collect in in syringes. In fact, many of the NICUs in Hong Kong will only accept milk from mothers in syringes but each one has different regulations so it is best to find out the rules from your NICU.

There is a very useful website http://newborns.stanford.edu/Breastfeeding/ which shows how to do the hand expressing and then later on as your milk increases how to do hands on pumping to increase you milk supply.

Remember that if your baby was healthy he would be feeding between 8 and 12 times every 24 hours so this is how often you will need to hand express or pump - it will be a lot of work - as expressing and pump are more tiring than direct breastfeeding.

Try to get your full supply (about 750mls a day) in by two to three weeks, even if you are producing a lot more than your baby can drink. As the first couple of weeks are a time that your body is expecting to increase the milk every day and so it will happen naturally. Trying to increase the milk later is, of course, still possible but is generally harder work.

La Leche League - Hong Kong has a library with a number of books about having a premature baby you can see a list at http://www.lllhk.org/Library/Special.html

Best wishes,
SARAH

Sarah Hung IBCLC
www.lotuslactation.com
 
At QMH stored EBM must be in a bottle and not a plastic storage bag for milk, they don't take storage bags. So when you do it, make sure to ask how much to store in each bottle so that you don't waste any milk. Another thing is, you will need to completely freeze it...no sign of melting, and they will happily store for you. Just need to make sure it's labeled correctly, with your name, babies name, bed number, from my experience they don't give formula without asking you first, and they are very pro breast milk. You'd most likely have to do everything at home and bring it ti the hospital, they have the facilities but it will just be more relaxing to do at home. All the best! The nurses are great there...helpful and supportive" :)
 
That's really helpful, thank you. I'll definitely check with them what they'll want from me. It all seems very complicated! I hope he'll be strong enough to feed directly.
 
At QMH, they do accept the milk in the Avent Via cups - this is what I used. Definitely no storage bags allowed. And as Leslie mentioned, it must be 100% frozen for them to accept it. Either that, or pumped AT the hospital and still warm. They only allow enough milk for one day worth of feeding so you must bring it each day. Take note to a) how frequently and b) what volume the feedings will be. This can change from time to time, but you must provide a) the right NUMBER of bottles, and b) the right VOLUME in each bottles to ensure that your child gets breast milk. For NICU, feeding the baby is more of a priority than what is being fed - and if they have changed the feeding schedules and you don't have enough bottles/enough in each bottle, they will add formula without specifically asking you. My daughter was in there for 4 months and was fed formula multiple times, mainly due to them changing the feeding schedule without informing me. There were a couple of times when she was fed formula for no apparent reason and I got quite upset with them because I was going to all the effort of pumping. The thing is, accidents happen. Nurses forget to take a bottle out of the freezer and then it's not ready when the baby needs it.

My advice would be to make sure you're doing everything that you can to ensure that your child gets as much breast milk as possible - BUT don't stress about it if and when there's some kind of mix-up and the baby gets formula instead. If you have a child in there for a while, it is bound to happen sooner or later.

Oh another thing - when the baby is born, the first few days, you will only be producing colostrum so it is best/easiest to hand express and collect it with a syringe. You don't really need to start pumping until your milk comes in, I think I started pumping around day 3 or so.

I wrote about my experience of pumping here: http://madeline-hope.blogspot.hk/2010/10/exclusive-pumping.html and here: http://madeline-hope.blogspot.hk/2011/07/one-year-of-pumping.html if you are interested in reading it. My main point is that IF you want to pump/breastfeed, it takes a lot of work in the first 4-8 weeks. If you manage to "follow all the rules" in those initial few weeks, you can avoid many of the issues later on. It is hard, particular if you have a little one in NICU - but the people I knew who followed a strict pumping regime in the first few weeks had a lot more success than those who didn't. Not that breast milk is the be all and end all - but just know that it DOES take work...

Oh and at QMH - if you can, try to breastfeed directly. This has more benefits than you know: a) it is so much easier than pumping, and b) it means that you will be allowed into NICU at ANY TIME for feeding, rather than having to abide by the 3-8pm visiting hours. Try as soon as medically possible, and keep trying and keep trying, even if it is not likely to be successful. My little one had a cleft palate and I always knew she wouldn't have enough suction to feed directly - but as long as she was allowed, I kept trying mainly so I could come and see her outside of "visiting hours" ;) As soon as she was home, I didn't even try any more because I knew for her, it was futile...

If you have other questions, feel free to PM me as well.

All the best!
 
Breast Milk & NICU

Hi Aquarian,

Congratulations on the upcoming arrival of your baby. Sorry to hear your little one may have to spend time in the NICU, although no doubt he?ll be very well cared for.

As the other mothers above have said, QMH is quite supportive of breastfeeding, so if you supply them with your milk, portioned and frozen, they will store this and feed to your baby in the event he cannot immediately feed at the breast.

A newborn baby generally nurses 8-12+ times in a 24-hour period. If you are expressing, you can set a timer or reminder to express every two to three hours. To maximize rest, you could aim for every two hours during the day, and perhaps every three hours overnight, this is up to you.

Then each day you would take your milk into the NICU. Freezing it into say 60-80ml portions is a good idea, as if you were to store it in say 120ml portions and your baby took less than this, the remaining milk which has been defrosted will likely be wasted.

As Sarah said above, in the early days when your breasts are producing colostrum, expressing by hand usually yields more, as colostrum is sticky and can stick to the inside of a pump. Once your milk comes in then a good double electric pump is a good option. They are available for sale in most baby shops, or can be rented or borrowed from friends (sterilized first of course).

A few tips:

- For storing milk, add cold to cold. You can combine milk from different pumping sessions, however just cool the freshly pumped milk first before adding it to already stored milk.

- Breastmilk storage guidelines can be found at http://kellymom.com/bf/pumpingmoms/milkstorage/milkstorage/ although be aware this is for a full term baby. The guidelines for premature or unwell babies are more conservative.

- As Sarah said above, even if your baby only takes a tiny bit in the early days (his milk intake will increase as he gets bigger and his tummy can take more) it?s important to pump regularly to build up a full supply. You?ll start by getting just a few drops, don't be discouraged it will increase!

- There are lots of methods for feeding a baby breastmilk which can help minimize the chance of baby developing a preference for a bottle, such as cup / spoon / syringe feeding. You can discuss this with the NICU staff, but don't be disheartened, many babies who receive bottles in the beginning can be encouraged back to the breast when discharged from the NICU.

Some mothers find a written breastfeeding plan is helpful, especially if it seems like information overload. Feel free to get in touch with one of us at La Leche League if you?d like some more help or info with this.

All the best and kind regards,

La Leche League - DB Team
[email protected]
 
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