hopefully eventually transition to exclusive
breastfeeding, but until this point, a breast pump will be a necessity.
The requirements of expressing breast milk in the early
days and weeks post-partum can add additional stress to what is already a
difficult time, but having good information on how to best establish your
milk supply will assist you to build a strong milk supply and provide the
best nutrition possible for a pre-term baby: mother's milk.
The benefits of breast milk for preemies have been well
researched. Not only can breast milk decrease the risk of necrotizing
enterocolitis (a serious intestinal infection which is a very serious
complication for any baby), but the breast milk from mothers of preemies is
uniquely suited to the needs of these tiny infants. Breast milk contains an high
level of antibodies which can decrease serious infections and illness in
preemies. Breast milk also has growth factors which are very important for
premature babies who are often very small and may have difficulty gaining
weight. Mothers of premature babies also produce milk that is higher in
nitrogen, protein, lipids, fatty acids, vitamins, calcium, and other vital
elements important to the development of preemies.
It is important to begin using a breast pump to provide
stimulation as soon as possible after the birth of your baby. It is best to use
a hospital-grade double electric breast pump at least until your supply is well
established. Your baby's neo-natal intensive care unit (NICU) should be able to
help you locate a place you can rent a hospital-grade breast pump. When starting
to use a breast pump following delivery you will want to follow, as closely as
possible, the feeding patterns of a full-term baby in order to establish a
strong milk supply. This means that it is important to use a breast pump 8 to 10
times within a 24 hour period for at least the first couple of weeks. Frequent
stimulation is crucial to establishing a good supply; just as a full-term
newborn would nurse on demand frequently, but likely for short periods, you must
provide frequent stimulation to your nipples, breasts, and areolas. It is
important to pump around the clock: both day and night. Although at night you
can go for slightly longer periods between sessions. When beginning to pump soon
after delivery, you do not need to pump for lengthy sessions. Ten to twelve
minutes per pumping session is enough. Initially, you many not express too much
in the way of colostrum or milk, but it will increase over the next several days
with dedicated pumping.
At first, the milk you express is colostrum: a thick, yellow
milk that has a very high concentration of antibodies and fat. While there is
not a large volume of colostrum, it is worth its weight in gold! It can
sometimes be difficult to express colostrum with a breast pump because it is
thick and somewhat sticky. If you are finding it difficult, try hand expressing
to see if you can express more. Use a syringe to collect as much of the
colostrum as you can.
Your baby's NICU will give you instructions on storing and
transporting your breast milk. Since preemies are more susceptible to bacteria,
viruses, and other illness, it is important to carefully follow the guidelines
the NICU gives you. Always use sterile collection bottles and sterilize your
pump kit regularly. Fresh breast milk is almost always best, so try to deliver
your expressed breast milk to the hospital as often as possible.
Usually within the first week or two, you should see your
milk supply start to increase. You may find that you become engorged frequently.
Frequent pumping is the best way to combat this. It will subside as your body
starts to regulate its milk production. When your daily volumes start to
increase, you will need to increase the length of your pumping sessions to
ensure you are emptying your breasts as fully as possible. A general guideline
is to pump for 120 minutes per day divided by the number of sessions you are
pumping. Therefore, if you are pumping 8 times a day, you would pump for
approximately 15 minutes per session. This is just a general guideline though
and you may need to pump longer. The breast pump you are using can also vary the
length of time you need to pump since not all pumps are as efficient in removing
milk.
Initially, lactation is hormonally controlled, but this
endrocrine control switches to an autocrine control- supply and demand- over the
first several weeks post-partum. Prolactin, the primary hormone involved in
lactation, dramatically decreases within the first couple days post-partum (one
reason why frequent pumping is vital starting as soon as possible after
delivery) and then slowly continues to decrease over the next 6 to 12 weeks.
Many women who have not pumped frequently during the first few weeks after the
birth of their baby find that their supply starts to decrease around the time
that their prolactin levels would naturally be decreasing. It is best to make
use of the prolactin you have in your system in order to establish a strong
supply early on and then maintain that supply by maintaining the demand through
efficiently and completely removing the milk in your breasts on a regular basis.
Generally, it is important to continue pumping frequently- at
least 6 to 8 times per day- for the first couple of months post-partum or until
you are able to transition to breastfeeding. If you find your supply is becoming
extremely large- 45 to 50 oz. per day or more- it is better to decrease the
length of your pumping sessions by a minute or two than to decrease the number
of sessions you are pumping per day. The frequent stimulation is still very
important. It is also better to establish as strong a supply as you can as
opposed to only reaching the amount that your baby currently needs or is
projected to need upon discharge from the hospital. While your baby's intake is
low, your milk production needs to continue on as though your baby was born
full-term. Trying to increase your supply later on once your baby's intake
increases can be difficult with a breast pump since it will require you to start
pumping more frequently than you already are. It is much easier to decrease your
production once your baby starts breastfeeding. It is also important to continue
to pump at least once during the night at least for the first couple of months
post-partum (or until your baby starts to breastfeed exclusively): until a
full-term baby would start sleeping through the night. However, some women
choose to continue pumping at night as a way of reducing the sessions through
the day and some women find that by eliminating the night session their supply
declines.
Mothers of premature babies can sometimes have more
difficulty establishing their milk supply. This may simply be a result of the
premature birth since the mother's hormone levels may not be optimum for
lactation. This is particularly true for mothers of extremely early preemies and
micro preemies. Difficulties can also sometimes be a result of the medical
interventions necessary with a premature delivery: IVs, cesarean sections, pain
medication, pitocin, etc. Usually,given time,mothers of preemies are able to
establish a good milk supply. Sometimes though, it may take longer for your milk
supply to increase. If however, even with diligent pumping habits, you are
unable to establish a sufficient supply, there are medical interventions that
can sometimes be effective. Domperidone and Reglan are the most common
prescription medications used to increase milk supply. Before turning to the use
of these drugs though, it is best to exhaust all other means of increasing milk
supply. www.kellymom.com is a valuable evidence-based website and has extensive
information on increasing milk supply.
The frequent pumping that is required to initiate your milk
supply with a breast pump can be very overwhelming, especially when you are
already trying to cope with the issues surrounding the premature birth of your
baby. But remember how important breast milk is to babies and even more
important to babies that are born premature. Often it can feel very isolating in
the NICU and you may feel as though there is little you can do for your child,
but you can provide breast milk for your baby. You can provide your child with
something that only you can give; something that is made especially for your
baby and something that meets your baby’s very particular needs.
Stephanie Casemore,
the author of Exclusively Pumping Breast Milk: A Guide to Providing
Expressed Breast Milk for Your Baby, is the mother of a "former" preemie who
was born at 31 weeks gestation. She experienced all the emotions and
challenges involved with having a preemie, hoping to breastfeed, using a
breast pump to initiate and maintain her supply, and ultimately the
disappointment of not experiencing the breastfeeding relationship with her
son that she had hoped for. Casemore exclusively pumped breast milk for her
son for one year. Her website,ExclusivelyPumping.com,
is a unique resource site dedicated solely to the needs of women who are
exclusively pumping breast milk for their babies.
