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 than 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.
Breast feeding/expressing is the one thing that you can do that no one else can do, and it is very important for your baby. It is like medicine for your baby.
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.
Please purchase a breast pump for use at home while your baby remains on the neonatal unit. The nurses can provide advice and guidance on breast pumps that are for sale or hire.
The sooner you start expressing milk after the birth, the better chance you have of producing a good supply. We recommend that you hand-express, which will help stimulate your milk supply and then use a breast pump when your ‘milk comes in’, this generally begins anywhere between 48 hours to 5 days.
Hand expressing is a useful skill. First massage your breasts with gentle touch/strokes towards the nipple. Then work your fingers back from the nipple to where the texture feels different to locate your milk ducts. You will need to push gently inside the breast to do this. Use your finger and thumb to make a ‘c’ shape over the ducts/around the dark area of the nipple and gently squeeze down. Release the finger and thumb and repeat action of squeezing down. If you have found the right place, after a few squeezes, you notice drops of colostrum begin to appear. This can be collected in a syringe, provided by the neonatal unit and in your colostrum pack, and given to you baby or stored in the fridge/freezer until baby is able to feed. If not, move your finger and thumb a little further forward or back and try again. Rotate the finger and thumb positions, so that you stimulate and empty all the milk ducts. If you need help, please ask your midwife or a neonatal nurse and refer to the leaflets provided in your colostrum pack.
Do not be discouraged if you obtain very little or even nothing in the first day or two. Even a teaspoon of colostrum is valuable to your baby. Regular and frequent expressing (8-10 times in 24 hours) will encourage your breasts to produce milk. Your breasts may become very full and hard three to five days after birth. This is your milk ‘coming in’. This may last a few days but regular pump expressing will relieve it. Expressing near to your baby can help your milk supply. Rest and relax as much as is possible with having a baby on the neonatal unit!
Start pumping each breast on a minimum setting and gradually increase the suction. If it becomes uncomfortable, reduce the setting.
Use the pump 8-10 times a day, not leaving it longer than 4 hours in the day and 6 hours at night. Expressing once during the night may help ensure a good milk supply, ideally between 2-5 am as this is when your milk producing hormones are at their highest.
For the first two or three days, hand express for three to four minutes each side, increasing the time according to how the milk is flowing. After the first 2-3 days, as the colostrum turns to milk, pump express each side until the breast feels empty or until the drops of milk have slowed right down. If the drops are still flowing, do not exceed much more than 30 mins on each side as you may over produce and this can lead to complications such as mastitis.
The first milk, called colostrum, is clear or yellow. It changes gradually over the next 10 days to the 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 3 months on the neonatal unit or for 6 months at home in a freezer at -18 degrees Celsius or below.
For those mothers who wish to breastfeed, we have a special area where you can express milk. We also recommend cot side expressing, as being close to your baby can help increase and sustain your milk supply. We have pumps on wheels for this purpose and you are also welcome to use your own by the cot side.
Double pumping is a good way to help increase your milk supply by stimulating a greater hormonal response and it also saves time. The pumps on the neonatal unit allow for double pumping, this may be something you consider also when purchasing your own pump.
Minimising bacterial contamination of breast milk
- Have a daily bath or shower
- Wash your hands well with soap and water prior to expressing
More milk than your baby needs?
You can donate breast milk if you have lots more than you need. You will need to fulfil certain criteria and will need to have some blood tests, this information can be found at www.ukamb.org. The nearest milk banks are St Georges and Queen Charlottes. You can also speak to Sue Bellamy or the baby friendly team at Kingston NNU for more information.
Storage and transportation of breast milk
As soon as you have expressed your breast milk, transfer it to a sterile bottle and label it with your name, date and time of expressing. Do not fill the bottle above 100mls. If your refrigerator maintains a temperature of 2-4 degrees Celsius or less, you can store it in there but it must be used or frozen within 48 hours. If frozen, it can be frozen for 3 months on the neonatal unit or 6 months at home in a freezer at -18 degrees Celsius or lower. 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 breast milk
Frozen breast milk may be thawed at room temperature or in a refrigerator. If you thaw frozen breast milk at room temperature, ensure that it is placed in the refrigerator as soon as it is thawed, and always use breast milk within 24 hours of thawing. Do not use a microwave to thaw frozen breast milk or warm up fresh milk.
All the nutrients needed to make your milk are supplied by your body. To ensure that you take in enough food and drink to provide these nutrients, there is a noticeable increase in your appetite and thirst. You may not be so aware of these signals if you are under a lot of stress, so it is important to make a point of having three meals a day and trying to snack in between. This should include meat/fish/eggs/pulses/fruit/vegetables/bread/potatoes/rice/pasta/milk/yoghurts/cheese etc. Ensure you keep up with regular fluid intake as well; a re-fillable water bottle is useful as there is a water fountain on the unit where you can regularly fill up.
If your milk is declining, go through the checklist:
- Are you expressing 8-10 times a day?
- Have you tried cot side and double expressing?
- Have you tried hand expressing/massage at the beginning/before using the pump. Skin to skin touch of your hand to the breast will encourage the release of oxytocin, which enable the ‘let down’ of the milk?
- Are you looking photos/videos of your baby or using muslin/miniboo’s/clothes that have been with your baby to smell them and stimulate the milk hormones?
- Are you allowing yourself to rest/sleep enough when you can?
- Are you eating/drinking enough?
If you are doing all these things and still struggling, please so not hesitate to ask the nurses on the neonatal unit.