Breastfeeding your premature baby

The first few days

Often one of the first things you can do for your baby it to provide breast milk. You should generally start trying to express some milk (or colostrum in the first few days) within 24 hours of the birth. Expressing can be quite challenging, especially in the first few days. You will generally start by expressing by hand, a nurse, midwife or lactation consultant should show you the correct procedure and fill you in on what you should do with the precious gold you manage to produce. If nobody asks you about expressing, please ask someone, breast milk is ideal for your baby, and although your tiny baby may not be ready for your milk just yet, you need to begin to establish a supply and expressing is about the only way to do this.

One of the most challenging aspects of expressing can be stimulating an effective let down reflex. A number of things can interfere with this process especially tension, fatigue, pain, shock and strong emotions like anxiety, embarrassment, grief, anger or depression can. Many of these feelings occur together when a premature birth happens and frustration at having to express rather than breastfeed often compounds these emotions.

To help your let down reflex you could try:

• Closing your eyes and visualising that it is the baby sucking;

• Expressing by baby's cotside if hospital policy allows this;

• Keeping a picture of baby in front of you while expressing so that you can keep your focus on baby;

• If baby is wearing clothes, hold and even smell a set that baby has recently worn;

• Stimulate the nipple (or have your partner do it) before you start expressing or start by hand expressing before using the pump;

• Massaging the breasts gently toward the nipple;

• Using a warm heat pad while expressing or have a warm shower before hand;

• Reading a book, watching television or listening to music are often quite relaxing;

• Swapping breasts frequently during expressing;

• Having someone massage your back and shoulders while you are expressing; and

• Following a set routine in a special place to relax can help the body associate the routine with expressing and then letting down.

After a couple of days, or when your milk comes in, you will probably start to use an electric pump to express your milk, this is far more efficient than doing it by hand, and will help to establish your supply. Most hospitals will rent you a pump when you leave, so that you can continue to express at home, others will put you in contact with the Australian Breastfeeding Association (ABA) who also rent out pumps. Many pharmacies also hire out breast pumps, however, the cost tends to be higher through a pharmacy. 

The ABA should also be able to help with advice if you need help to increase your supply. Hospitals have Lactation Consultants who should be able to help you with any breast feeding questions you may have. Hospitals have different guidelines as to the storage of milk, and how long it can be kept, so check with yours what you need to do. Although you may be producing more milk than your baby requires at first, babies often grow quickly and demand then outstrips supply so it is helpful to have a freezer stash somewhere to help you keep up. The ABA also has guidelines on how to store breast milk in your home freezer once your baby comes home with you.

Breastfeeding at last

When your baby is ready to start sucking on the breast, often around 34 weeks or so, you will need some help in positioning the baby and sitting comfortably. Again, the nurses should help you with this. Sucking a feed can be very tiring for your baby, so don't be discouraged if he or she only takes a couple of sucks (or licks) before nodding off - gradually those few sucks will increase until the baby is breastfeeding a whole feed. At first your baby may only be offered the breast once a day, but as they grow and get stronger they will be able to tolerate more feeds and will take more at each feed.

It is generally best if babies are not offered bottle feeds while you are trying to establish them on the breast. A different sucking action is required for each and babies can get attached to the bottle teat rather than to mum's nipple. When you are not around for a feed, babies will generally be gavage fed (tube fed), as they were before they began to learn to breast feed. Once feeding at the breast is going well, a few bottle feeds each day when you aren't available to breastfeed shouldn't cause any problems, but if you find that your baby is having trouble changing from bottle back to breast, request that no bottles be given. Cup feeding is another alternative - there is some information about this in the Internet Links below.

Increasing Supply

Although some mothers produce an adequate supply of breastmilk, and a few produce more than enough, others struggle to express sufficient for their baby's needs. Talk with the nurses and the lactation consultant available at the hospital about ways to increase supply. We asked some of the Austprem mothers for suggestions on increasing supply, and these are listed below. Some may work for you, others may not. Some you might like to try, others might not be right for you.

Please check with your doctor and/or the nursing staff before you take anything to be sure that it is safe for you and your baby (many substances taken by the mother are found in breast milk so your baby will be taking the substance as well).

Professional advice should be sought before taking therapeutic doses of either herbal or homeopathic treatments to ensure appropriateness and for best results.

• Drink lots of water- one cup per feed, however be careful not to drink too much water as a condition called hypersaturation can occur where the electrolyte levels are adversely thrown out of whack. Serious cases of hypersaturation require medical intervention to correct. 3 litres is a comfortable amount without risking hypersaturation.

• Eat almonds and cashews (so long as neither parent has an allergy to nuts)

• Drink a glass of stout a day (be wary of the alcohol content though)

• Don't drink coffee, tea or cola soft drinks, or anything else with caffeine (go easy on the chocolate too!)

• Express, express, express as nature will respond within a few days. Even if the milk supply has dried up completely, frequent expressing and allowing baby free access to the breasts will often return the milk supply within 10 days 
  OR
  Breast - Rest - Breast - Rest -Breast - this method involves putting baby to the breast 3 times per session with a rest break for you to play with baby for a few minutes between feeds. This can help baby relax and catch his/her breath as well as stimulate more milk production.

• Try expressing from both breasts at the same time (there are machines that do this)

• Try double-whammy expressing where you express for 15-20 minutes (10-15 minutes if double pumping) have a rest break for � and hour and then express for another 15-20 minutes.

• When feeding - attach baby to one side for about 3 mins or until the first let down is felt. Then swap sides until another let down and then swap back (lots of swapping in the first 5 - 6 mins) then let him finish one side completely. This will create extra let downs and then making sure he has finished one side helps to stimulate greater production.

• Sometimes stretching the baby out a bit between feeds may help as then the baby might feed better and will be more satisfied by the next feed. If you are lucky this will continue with the baby then going longer before the next feed, thus giving more time for the supply to increase and so will then get a better feed again. If baby is constantly draining the breast then the supply does not get much time to increase and Mum can just get exhausted. Rest is important, and sometimes it might help to have someone else take the baby out while the mother has a sleep; if he is not crying near Mum and she can have 1/2 an hour extra rest/sleep between feeds then her milk supply may increase for that next feed (1/2 an hour wont starve him!) If all else fails in settling him a one off top up bottle of formula or drink of boiled water won't hurt either - so long as it is ONCE and not regularly.

• There is a pressure spot on the shoulder about 3 fingers from the neck (a soft spot) in a straight line up from the nipple. On Mother - press on this gently but firmly towards the end of the feed to get one last "hind milk" let down. If someone else can press on this while she is feeding it is great and can help. You can also try massaging the reflex zones on the feet jest prior to expressing for the breasts (the curved fleshy part across the bottom of the foot just before the arch on the inside and up to just before the little toe on the outside), hypothalamus (reflex point in the middle of the bottom of the big toes) and pituitary (on the outside of the big toes just below and slightly back from the toe nail).

• Talk with a Lactation Consultant (LC) - it is a very valuable investment to identify what the problem is. The hospital should have someone available, or be able to put you in contact with someone. The Australian Breastfeeding Association should be able to help too.

• There are some prescription drugs, primarily anti-nausea medications, which have a side effect of increasing breast milk production. If you think you may benefit from something like this, check with your doctor as to which medication would be best for you and your baby. Do not take anything prescribed for someone else, or previously prescribed for you without discussing it with your doctor first.

• The roof of the baby's mouth might be highly arched (sometimes called "bubble mouth"). This can cause many sucking problems, you might need to consider expressing more and bottle feeding as the baby might be sucking, sucking, sucking...but not actually getting much milk. A peristaltic teat on a bottle (Pigeon have one which fits on many of the bottles including the Avent ones) may help to develop the baby's jaw muscles and tongue motion to overcome the arched palate. The tongue motion in particular is important as normal teats only require a straight suction not suction-compression action.

• Herbs believed to aid lactation are:
  * Alfalfa - contains phyto-oestrogens so use in moderation or reserve for when supply is threatened;
  * Aniseed - will also aid digestion and reduce wind in both mother and baby;
  * Catnip - useful for colic;
  * Chamomile - also very calming to nerves and digestion;
  * Chastetree - use a dosage at the lower end of therapeutic range as it will be more likely to increase prolactin levels than at the higher end of the range;
  * Dandelion - seek advice on this one as it can have a diuretic effect;
  * Dill - also useful for colic;
  * Fennel - similar to Dill;
  * Fenugreek - also good for the mucous membranes in the lungs;
  * Goat's Rue - particularly if there have been any blood sugar problems especially during pregnancy;
  * Hops (by itself not in beer LOL) - also a useful sedative;
  * Nettles - supportive for kidneys and uterus and very high in nutrients esp. iron;
  * Raspberry - also excellent for uterine recovery after birth;
  * Red Clover - also a blood cleanser / detoxifier containing phyto-oestogens
  * Squaw Vine - also a good general reproductive tonic. Can also be used on sore nipples;
  * St Mary's Thistle - also for liver and digestion.

• For homeopathic remedies there is a product called Formula FEM by BioResearch Pty Ltd which is available from many pharmacies or health food stores where they have a naturopath. The active ingredient that impacts on prolactin levels is Pulsatilla and any product with Pulsatilla in it will be beneficial. Products containing Lac defloratum may be used when the milk supply dries up all together.

• Also:
  * Kangaroo care is extremely helpful as it also stimulates prolactin and promotes a better let down.
  * Having a relaxing bath with baby for around 10 minutes where the focus is on being together, not washing baby is a good way of getting invaluable skin to skin contact.
  * Baby massage after a bath is another way of relaxing and bonding with baby.
  * Baby slings (once your baby is able to be in one) are a good way of letting baby have access to the breasts without exposing oneself to the whole world for extended periods of time.
  * Co-sleeping or bed sharing is also highly beneficial for prolactin production and can either be with baby in the same bed (to check safety precautions visit http://www.askdrsears.com/html/10/t102200.asp) or in a bassinet right next to mum (you will probably need to wait until your baby comes home for this one)
  * Protein consumption is critical to milk production. 3 serves of primary protein (meats, fish, eggs, etc) about the size of the palm of your hand is best, but watch that not too many eggs are eaten as this can cause problems with baby's digestion. Secondary (plant) proteins can be substituted for vegetarians and need to be carefully balanced to ensure adequate equivalent levels are consumed.

Internet Links

Australian Breastfeeding Association
Premies: Breastfeeding
Co-sleeping : yes, no, sometimes?

These tips were provided by families of Austprem, and are not necessarily the views of Austprem Inc. 

This information is intended as general background information only - please talk to your doctor or health care provider for more specific information and advice.

Please also read our disclaimer.