Tuesday, March 2, 2010

How to establish and maintain milk supply for premature, hospitalized infants

A baby born before 37 weeks is considered a preemie. "Each year, more than 525,000 babies (1 in 8) are born too soon, some so small they can fit in the palm of a hand. Many of these babies must fight just to survive; others must struggle with lifelong health problems." That's according to the March of Dimes Web site.

March of Dimes researchers, volunteers, educators, outreach workers, and advocates work together to give babies a fighting chance against prematurity, birth defects, and low birthweight.

Premature birth is a scary possibility if you're expecting, and terrifying if it happens to you. Many moms of premature babies talk about feelings of helplessness and the sense that they can't care for their tiny baby, who is so fragile they're put in the hands of medical professionals in the NICU (neonatal intensive care unit). But in the case of premature birth, there is something moms can provide their child that no doctor or nurse can give them.

A mother's breastmilk is vitally important to the health and development of her preterm baby. The nutrients and immunities it contains, while important for all babies, are truly a lifeline for a baby born too soon. And it's a lifeline that only mom can provide.

We asked Pamela K. Murphy, Ph.D., M.S., C.N.M., I.B.C.L.C., to share her expertise in establishing and maintaining breastmilk supply for a premature infant. Read on for important information from Pamela about pumping milk for a baby who is too small to feed at the breast, and how to ensure that when the baby is ready, you'll be able to provide all the milk he or she needs to grow big and strong.
Although at first your preemie will likely be too weak to latch onto the breast, it is important to start pumping as soon as you can after delivery, preferably within six hours. This stimulates the hormone prolactin, which is responsible for breastmilk production. Aim to pump six to eight times in a 24-hour period, ideally every three hours around the clock except for one five-hour stretch while you sleep.

This schedule will maintain a steady level of prolactin in your bloodstream. It's important that you produce enough of the hormone, otherwise the feedback inhibitor of lactation (FIL) increases, leading to decreased production of breastmilk and eventually, complete weaning.

A hospital-grade pump should be used to establish milk supply, which takes about two weeks, and keep using it until your baby reaches his original due date. Hospital-grade pumps have strong, efficient motors that yield more cycles per minute. This mimics the efficiency of a healthy, full-term breastfeeding baby. (A hospital-grade pump is very expensive as it is built to be durable for multiple users. These types of pumps are typically rented, with each mom purchasing her own collection kit. Contact your local hospital, pharmacy, or baby boutique to find out if they rent these breast pumps.)

When you begin pumping, you will probably only see a drop or two of colostrum, the yellowish, thick, sticky first milk that is low in fat and high in many other nutrients. This is normal, do not be discouraged. The pump is efficient at stimulating your breasts to produce prolactin and drawing out breastmilk, but because colostrum is thicker than mature milk, the pump will not pull it out as effectively as a full-term healthy baby. The baby's tongue, jaw, and cheeks are more developed and better at creating a strong enough suction to remove this early milk.

Over the next three to five days, your breastmilk will start to come in and the volume you produce will gradually increase. Ideally, you should maintain a pumping log to ensure that your milk volume is adequate to sustain supply. By one week postpartum you should be making at least 300 mL (10 oz) in a 24-hour period. By two weeks postpartum you should be making at least 500 mL (16 2/3 oz). Even if your baby is consuming much less than this, it's important that your body produce that amount so you have a sufficient milk supply when his needs increase.

Some tips to increase breastmilk supply:
  • While pumping, breast compression and breast massage can result in more milk.
  • After pumping, hand expression can help you produce more breastmilk.
  • Apply lanolin to the nipple and areola prior to and during pumping to reduce friction and increase comfort.
  • Make sure you have the proper breastshield size (the part of the pump that fits directly over your nipple and forms a seal around the areola). No more than 1/8 to 1/4 inch of your nipple should be rubbing inside the breastshield. If the breastshield is too tight, the ducts can be blocked, inhibiting milk flow.
Here's something else that's important to know about breastfeeding a premature baby: Premature babies need extra protein, calcium, and phosphorus that our breastmilk doesn't have enough of. This isn't because our milk is deficient, as it's perfect for the full-term healthy infant. But the premature infant needs more of these nutrients because he missed out on the rapid growth that occurs in the last trimester of pregnancy. Your baby will get these nutrients from human milk fortifier added to your pumped breastmilk while your infant is hospitalized.


Pamela is a Lactation Consultant at the Medical University of South Carolina, President at Lactation Resources, LLC, and Designer & Manager at http://www.breastfeedingconferences.com/. She received her bachelor's degree from the University of Massachusetts Lowell, Lowell, Mass., her master's degree from Georgetown University, Washington, and her doctorate from the Medical University of South Carolina, Charleston, S.C. Pamela is also the mother of three children who were each breastfed for over a year.

To support the March of Dimes' mission to improve the health of babies by preventing birth defects, premature birth, and infant mortality, visit the How You Can Help section of its Web site.


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