Premature baby & breastfeeding

B

Bubbly

Registered User
I just had my baby girl on Saturday and she was only 33 weeks and 5 days then. Her birth weight was only 1.89kg hence is now being taken care of in the IC unit of the hospital.

The hospital encourages breastmilk for the baby, but as I cannot breastfeed the baby directly, I have no choice but to express (by hand and pump). So far (this being day 3) I am managing to get around 45 ml per pumping session. At the moment, this amount is find since she can only take 20ml each time. However, I worry that when the time comes for the amount to increase, I will not have enough for her.

I have a few questions about all this:

1. Am I getting enough milk from pumping? Anything I can do to increase this amount since there will be no way for the baby to stimulate the production of milk.

2. Since premature babies tend to have weaker digestive systems and intestines, what food should I avoid so as not to cause any irritation to the baby?

3. I also found that one breast is giving much more milk than the other (35 ml vs 10 ml). Anything I can do to improve this?

Would really appreciate some help as my baby is likely to be in hospital for another month, so will be needing to deliver the milk everyday to her.
 
Dear Bubbly,

When you are pumping/expressing instead of feeding the baby directly it is important to pump as many times as the baby would be feeding. That is between 8 and 12 times in 24 hours. I would suggest making a chart with 12 boxes on it for each day and filling in how much you manage to pump each time. This way you?ll know exactly how things are going and if you are making the minimum of 8 pumping sessions a day.

Mothers who pump their milk for their babies sometimes mistakenly cut back too far on their number of pumping sessions, because even with fewer sessions at first they get the same amount of milk per day. However, as time goes on their breasts stay full for longer stretches, milk production tends to go down.

You are looking for the amount of milk you can get to increase to around 750 mls in 24 hours by the two week mark. This is the amount of milk a full term baby needs and the amount you should aim for.

You may find the kellymom web site useful:

Establishing and maintaining milk supply when baby is not nursing
http://www.kellymom.com/bf/supply/maintainsupply-pump.html

Breastfeeding your Premature Infant
http://www.kellymom.com/bf/preemie/preemie-links.html

If you or the baby?s father are allergic to any foods. It would be best to avoid these.

It is very common for one breast to give more milk than the other. Prof. Peter Hartmann?s research has shown that usually it is the right breast which gives more milk but in about 10% of women it is the left breast. This is nothing to worry about ? just keep going. It is the total amount you get over 24 hours which is important ? not how much each time or from which breast.

Best wishes,
SARAH
 
Thank you very much for the advice. I will follow them and update you all on how it goes. Fingers crossed.
:thanks
 
Hi Bubbly, congrats on yr newborn. My son was born at 31wks & was also taken care of by the NICU for a month. The up side to this, I found, was that I had all my attention on expressing breastmilk & recovering frm my C-section op at home.

With that, I diligently express breastmilk at regular intervals that is similar to how a newborn will consume, i.e. every 2-3hrs, except for the night, which I omitted. Despite this, I had more than sufficient breastmilk to be delivered to the hospital everyday.

Breastmilk will somehow increase in quantity to what yr baby will consume, at the different stages of their development. Therefore, at this early point, tho you may find you have little to express, with continued regular expressing, you shld have no problem receiving a continued and even an increased supply.

Invest in a good breast pump, and this doesn't have to be an electric one. I used the Avent manual pump & had found it to be useful thoughout my son's 1st 6mths and even used it for my 2nd child.

At the hospital, I was taught several good techniques which may help you too. For one, massaging your breasts before each expressing will help stimulate flow. Another is to use a hot wet towel and place it over yr breasts before expressing, this also stimulate the letdown. Thirdly, alternate expressing yr breasts every few minutes or so and increase the length you spend on each breast, ie start expressing w/yr right breast for abt 4mins, then proceed to the other breast for same length of time. Then return to the right breast and increase expressing for 5mins, returning to the other for the same time. Repeat again for 6-7mins each breast. I kept each pumping session to abt 30mins in total.

The foods to avoid, I was told, is ginger cos it tends to cause jaundice in the baby. You still have to eat well inorder to maintain a good enuf weight and also to supply nutrients in your breastmilk. Of course stay away from alcohol & caffeine.

One thing I'd like to share w/you is that, having been tube-fed and then bottle-fed for a whole month, my baby had lost its instinct/ability to suckle from my breast even after he was home. That meant I had to continue w/expressing breastmilk & feeding him from the bottle. Again there are up & down sides to this.

Lastly, I'm not sure if you've heard of Kangaroo Care, which came highly recommended by the hospital staff. It entails putting your baby (clad only in diapers) on your bare chest, and draping the both of you to keep warm, for a session of about half hr. It is beneficial to both premie baby & mother as it helps create bond, keeps baby warm, stimulate breastmilk production, helps baby grow/heal faster. I enjoyed these sessions w/my son when I visited him at the hospital.

Above all these, steer clear from worries. Instead, focus on getting yrself healthy & well again, in good preparation for your baby's return home. It will be totally different, and more tiring for you, once you have a baby requiring yr full attention day & night. Get yr hubby to give his total support too.

My son is now 2half yrs. He's healthy, has no complications and is now within the 75 percentile in terms of growth.

I hope this is useful to you, and best of luck! Let me know if you need more help.







Bubbly said:
I just had my baby girl on Saturday and she was only 33 weeks and 5 days then. Her birth weight was only 1.89kg hence is now being taken care of in the IC unit of the hospital.

The hospital encourages breastmilk for the baby, but as I cannot breastfeed the baby directly, I have no choice but to express (by hand and pump). So far (this being day 3) I am managing to get around 45 ml per pumping session. At the moment, this amount is find since she can only take 20ml each time. However, I worry that when the time comes for the amount to increase, I will not have enough for her.

I have a few questions about all this:

1. Am I getting enough milk from pumping? Anything I can do to increase this amount since there will be no way for the baby to stimulate the production of milk.

2. Since premature babies tend to have weaker digestive systems and intestines, what food should I avoid so as not to cause any irritation to the baby?

3. I also found that one breast is giving much more milk than the other (35 ml vs 10 ml). Anything I can do to improve this?

Would really appreciate some help as my baby is likely to be in hospital for another month, so will be needing to deliver the milk everyday to her.
Click to expand...
 
Ahglad,

Thank you so much for your advice. It is definitely comforting to read them. I have been trying to get more rest yesterday and the supply seemed to have improved. Will see what happens over the next few days.

Just wondering, you mentioned the Kangaroo Care, did the hospital suggest this? Which hospital were you in? Just wondering whether the hospital (Queen Elizabeth) will let me do that. So I just bring a blanket for the visit and place the baby on my bare chest? Not sure if the nurses will let me do that since there will be other dads in the unit during visiting hours. Will see. Sounds like a lovely suggestion to me.
Thanks again!
 
Hi Bubbly, it was in S'pore that I gave birth to my son then. Thus I can't advise you on the hospital situation here. But I'm sure the HK NICU is aware of kangaroo care. You could approach them & ask for private time/space with your baby. I was given a private room within NICU to do kangaroo care w/my son. Sometimes when this room was occupied, the nurses pushed a movable partition around my son's crib & this provided privacy too.

A big enough towel to cover yr chest & son will suffice. Also recommended that you wear a front-buttoned up shirt (rather than a t-shirt) as it'll be easier.

One more thing, my son had to be in a stable condition before I started on this, ie. able to be taken off machine/drips inorder that you can carry him out of his crib & onto yr chest.

If you want more info on this (& other issues concerning preemies), take a read at http://www.prematurity.org/baby/kangaroo.html

Gd luck. Send me a PM if you need further info.
 
Hi Bubbly

I'm also another mother of a preemie - born at 34 weeks exactly, and my boy weighed in at 1.77kg. He's now coming to 9 months and doing well!

My milk supply was also very low in the beginning, and they had to tube feed formula initially. I was pumping every 3 hours, even in the night. One breast was producing less milk as it was engorged/had very big lumps. I had to place hot towels on my breasts and massage them before each pump and over time, both breasts are producing similar amounts and more milk. I use Avent duo electric pump to save time pumping both at once. My boy is still on total breastmilk now and will feed direct from me unless I am away at work.

Many people say that eating fish will help increase supply, which you can try.

Breastfeeding a preemie is definitely tougher compared to a full term baby.... Hang in there during this difficult initial period, as it will definitely get better!

Rest well and take care!
 
Another good site which explains about kangaroo care is Kangaroo Mother Care at http://www.kangaroomothercare.com/
This site was made by Dr. Nils Bergman, who is one of the doctors who pioneered this type of care.

In fact I would suggest kangaroo care and lots of skin-to-skin contact for any babies who are having problems breastfeeding, whether they are premature or full term.

LLL in Hong Kong has a copy of the video tape Rediscover the Natural Way, which is advertised on his web site. If you?d like to borrow it please contact me on 2548-7636 or at [email protected]

Best wishes,
SARAH
 
(written from my husband's account)
hi
you have gotten some very good advice from the pp's regarding breast feeding.
my children were born at 26 weeks and as i didn't get to hold them for one month, direct breast feeding was impossible, so i expressed. after i could hold them, breast feeding was still too tiring.

having a baby in the nicu is very stressful, but if you can (and if you cannot, please do not berate yourself), do keep expressing.

in regards to kangaroo care, even if your sweet baby is on nasal canula (basically anything besides a vent) you can make the request for kangaroo care. the benefits of kangaroo care are proven and massive and government hospitals are aware of this (my children were at queen mary at they were quite pro-kangaroo care).

speaking to your baby is also good, singing...she has been listening to your voice for so many months, what a comfort to hear it now.

is your babe on a ng feeding tube or feeding independently?

good luck to you. the nicu is a tango, one step forward, two steps back...feel free to send me a pm to vent or ask any questions if you so wish.

all best.
 
Thank you for all your advice and support. Yes, having a baby in NICU is very stressful. Everyday, before I go, I always have a funny feeling (hard to describe this but I am excited yet anxious at the same time is closest to the feeling I guess). When I arrive, if I see her condition has improved, I am over the moon, but if it is the same, I feel a little sad (luckily so far, it has not gotten worse!!)

My baby is feeding independently now and is not wired up anymore, so I will speak to the nurses about the kangaroo care (may have to wait till the nice nurse is on duty, some of them make me feel as if I am in the principal's office, always telling me off for doing this and that!)

My husband is probably the noisiest in the ward when he gets in there as he talks to our baby and sings to her as well. I am not quite as good as I always go blank and don't know what to talk to her about!

Milk supply has gone up slightly, and I am pumping religiously every 2 - 3 hours (getting in around 9 bottles a day). Would like to do more but energy level is getting lower and hospital visits take up a few hours, but one positive aspect is I always manage to pump more as soon as I get home from the hospital. Contact with my daughter must be increasing the volume, so I am hopeful.

Thanks once again all for the encouragement. It really helps me get through everyday and encourages me to keep going.:thanks :woman
 
Just wanted to let you all know that my milk supply has increased, I am managing an average of 50ml a session, sometimes going up to 90ml! It is ample for my baby now as she is only drinking 40ml each time, but I am sure when her appetite increases, so will my milk supply. Although I am not sure whether it's the mother's milk tea, the chinese fish soup, the sleep, the massaging or pumping every 2 hours which has helped, but it doesn't matter as long as something is happening :)

She has also gained back all the weight she lost from losing water in a week, which is a good sign the docs say. So all seem to be going well.

A truly big THANK YOU to you all for all your supportive words and advice. It really really helped.
 
(writing from husband's account)

that is really good news on many fronts.

hang in there. send me a pm if you have a bad day and need to vent. remember you have been through a lot too...be gentle with yourself.
 
New Challenge!

My baby girl finally came home last night and it goes without saying, we are over the moon! I tried to BF her directly but have found that my nipples seem to be too big for her little mouth. She would suck just the nipple part and not be able to get any of areola into her mouth. Subsequently, my nipple will fall out from her mouth. Hope I am explaining this well!!

Anyway, anyone had experience with this? I am going to try and let her BF directly for each feed, at least for a few minutes and then give her the bottle. It seems that she is taking so much effort to drink from me that I am worried she may not be getting enough for all the energy used.

Any suggestions are highly appreciated!
 
Hi Bubbly,

Fantastic news that you have your baby home already!

I've heard that preemies sometimes don't learn to breastfeed effectively until they are nearly full-term age. I would recommend that you give Sarah a ring directly (contact number posted earlier in this thread), as she is one of the foremost lactation experts in HK. There may be techniques which she can tell you about, to speed up the process of teaching your baby to breastfeed. Good luck!
 
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