Breast feeding

Breast-Feeding Your Premature Baby
Giving birth to a premature baby can be a worrying experience, and your baby may be unwell and need the special care of doctors and nurses, but sooner or later, he or she will need your milk.

Your milk is the best milk for your baby.  It will have more fat, protein and sodium than it would have had if baby had been born on time.  It will be ‘tailor-made’ for a premature baby.  Breast milk is better th an formula milk when babies are starting to have milk feeds because it is easier to digest and absorb.  It also contains antibodies and other factors that help protect against infection, to which premature babies are especially vulnerable.

At first your baby may have to take milk through a tube that goes into the nose and down into the stomach.  Before your baby is able to suck effectively, it is helpful to cuddle him or her close to your breast to stimulate your milk supply. We will help you to breast-feed when the baby is ready to do so.

In the meantime, electric breast pumps are kept on the Neonatal Unit. A member of staff will show you how to use the pump, which is easy and very comfortable to use.

Expressing Milk

• The sooner you start expressing milk after the birth, the better chance you have of producing a good supply. If a pump is not available, you can hand-express, which may help stimulate your milk supply better than a pump.
• Start pumping each breast on a minimum setting and gradually increase the suction. If it becomes uncomfortable, reduce the setting.
• Use the pump regularly and often, starting early in the morning and expressing at least every four hours until you go to bed. Expressing once during the night may help ensure a good milk supply.
• For the first two or three days, express for three to four minutes each side, increasing the time according to how the milk is flowing. Do not continue expressing for very long after the milk has stopped flowing. You will probably get more milk if you switch from side to side, pumping for three to four minutes before changing sides, up to a total of approximately 10 minutes on each side.
• The first milk, called colostrum, is clear or yellow. It changes gradually over the next 10 days to the blue/white mature milk.
• Pour the milk into a sterile bottle. Then write your name, date and the time of expression on a label and attach it to the bottle. Refrigerate immediately.
• If the baby is not yet taking milk, or if you are producing more than is needed, we will freeze it for your baby to use later. It can be stored frozen for up to three months.

Expressing Room

For those mothers who wish to breastfeed, we have a special area where they can express milk. You may hire a breast-pump; details are available from staff. We are also one of only thirteen hospitals in the United Kingdom who have a Milk Bank, where donated breastmilk is kept and can be given to your baby if you so wish. You will be given help with all aspects of breastfeeding.

Minimalising bacterial contamination of breast milk

• Have a daily bath or shower, preferably in the mornings.
• Avoid using soap on your breasts, as this can cause dry, cracked nipples that are more likely to become colonised with bacteria.
• Use paper towels or tissues, not a towel, to dry breasts after washing.
• Wash and rinse hands very thoroughly,  and either remove rings or wash carefully under them.

More milk than your baby needs?
Please ask to see Anna or Sue on the Neonatal Unit.

Storage and transportation of breast milk
As soon as you have expressed your milk, transfer it to a sterile bottle and label it with your n ame, hospital number and the date and time it was expressed. You can store up to three times expression in one bottle, but refrigerate it in between. Do not fill above 80mls.  If your refrigerator maintains a temperature of 40°C or less, you can store it there, but it must be fed to your baby within 24 hours. If you want to store it for longer or are unsure, place it in the freezer as soon as possible. Once frozen, it can be transferred to the Neonatal Unit freezer. When transporting your expressed breast milk, whether refrigerated or frozen, place it in a cool bag with ice packs to ensure that the temperature of the milk does not increase.

Thawing expressed breast milk
Frozen breast milk may be thawed at room temperature or in a refrigerator. If you thaw expressed breast milk at room temperature, ensure that it is placed in the refrigerator as soon as it is thawed, and always use frozen breast milk within 24 hours of thawing.  Do not use a microwave oven to thaw frozen breast milk.

Remember, breast-feeding your baby is one thing that you can do that no one else can do, and it is very important for your baby.

A good supply of milk
Do not be discouraged if you obtain very little or even nothing for the first day or two.  Even a teaspoonful of colostrum is valuable to your baby. Regular and frequent expressing will encourage your breasts to produce milk. Your breasts may become very full and hard at three to five days after birth. This may last two days, but regular pumping will relieve it. Expressing near to your baby can help your milk supply. Have a rest and relax at least once each day. Hand-expressing is a useful skill.  First massage your breasts with firm strokes toward the nipple. Then place your finger and thumb approximately one to one and a half inches behind the nipples and squeeze, at the same time rolling the finger and thumb toward the nipple. Do this gently but firmly, with a slow rhythm, avoiding excessive skin friction.

If you have found the right place, your milk will begin to drop, then spurt. If not, move your finger and thumb a little further forward or back and try again. Rotate the thumb and finger positions so that you empty all the ducts. If you need help, please ask your midwife.  You have skin-to-skin contact when you hand-express, and this helps stimulate your milk supply better than a pump.

All the nutrients needed to make your milk are supplied by your body. To ensure that you take in enough foo d and d rink to provide these nutrients, there is usually a noticeable increase in your appetite and thirst. You may not be so aware of these signals if you are under stress, so it is a good idea to make a point of eating three meals, plus snacks, each day.
This should include something from each of the following groups:
meat / fish / egg / pulses
plenty of fresh fruit and vegetables
bread / potatoes / rice / pasta
milk / yoghurt / fromage frais / cheese

An easy way to keep up with fluid requirements is to take one to two drinks with you each time you express. Well-balanced snacks can be as nutritious as a cooked meal, e.g. fresh fruit and sandwiches. Avoid having just biscuits or sweets or chocolate instead of a meal. If your milk supply is declining, go through this checklist:

• Are you expressing four hourly throughout the day and maybe once at night?
• Have you tried hand-expressing?
• Are you taking time to relax and put your feet up at least once a day?
• Are you eating and drinking enough?

If you are doing all these things and are still having problems, please do not hesitate to tell the nurse on the Neonatal Unit.

Before you go home
If your baby is to remain in hospital, you will need to make some arrangements for sterilising pump equipment and expressing and storing your milk.

Breast pump hire
You can obtain details about hiring a breast pump from the Neonatal Unit.  The Unit requires a cheque deposit of £35.00, made payable to Born Too Soon.  The cheque will be returned to you when the pump is returned in good working order.  It will have to be returned on the day your baby is discharged.  A breast pump set, which is not returnable, costs £10, and payment is required when you take the pump home.  Cheques should be made out to Kingston Hospital NHS Trust.

Book on Breastfeeding

Fit to Bust - a comic treasure chest  

Alison Blenkinsop (nee Fookes), a former Kingston Hospital midwife and International Board Certified Lactation Consultant, has written a book to celebrate the lighter side of breastfeeding and motherhood.

See more here >