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Archive for February, 2011

Written by Paula P. Meier, R.N., DNSc, FAAN, Rush-Presbyterian St. Luke’s Medical Center.
With thanks to Medela for allowing us to re-produce this article.

Babies classed as premature are unable to suck, and therefore the mothers do need to use a breastpump to exctract breastmilk. Many people think that giving birth prematurely limits a mother’s ability to make enough milk, but this is not true. The extra stress, discomfort, and fatigue that go along with the birth of a premature baby can cause a slow start with milk production. In the first few days after giving birth, mothers may make just drops of milk each time they use the breast pump, so it is easy to get discouraged. Remember, these drops are like a medicine for your baby, because they provide protection from infection. And– this slow start usually gives way to an adequate milk supply by the fifth or sixth day after birth.

Which Breast pump should I use?

Using a hospital grade breastpump to express breastmilk for your premature baby.Studies have evaluated the different kinds of breast pumps available to new mothers. The findings show that mothers who are expressing milk for premature babies should use a hospital-grade electric breast pump-ideally with a double collection kit, so that both breasts can be emptied at the same time. This type of pump is the most effective in stimulating release of the milk-making hormone, prolactin, which results in the greatest amount of milk. Mothers sometimes report that they have received a battery-operated or a less-powerful electric pump as a “baby shower” gift, and want to use it to express milk for their premature baby. While this type of pump is suitable for a mother who uses it only once or twice a day and breastfeeds a full-term baby the rest of the time, it does not provide enough stimulation to establish and maintain a good milk supply for a mother who is pumping for a premature baby. If you have received one of these pumps as a gift, you will be able to use it later-after your baby comes home and is feeding.well from the breast. But, in the first few weeks after premature delivery, you should plan to rent a hospital-grade electric pump.

Premature Baby

How often should I use the breastpump?

During your first few weeks of expressing breastmilk, your should use the pump as frequently as 8-10 times per 24 hour period -about as often as a healthy, full-term baby would feed at the breast in the early days after birth. The purpose of this frequent pumping is to stimulate prolactin during the time that your body is beginning to make milk in plentiful amounts. While you may get only drops of milk at first, frequent pumping is important in building an abundant, long-lasting milk supply. You may not see the results of your pumping immediately, but your efforts should pay off toward the end of the first week of milk expression. Night time pumping helps boost your supply, so speak with the health care professionals about whether you sould be setting your alarm to wake up to pump.

How long should each pumping session last?

In the first few days after birth, most mothers express very small amounts of milk-from a few drops to a few teaspoons-at each pumping. During this time, a pumping session should last from 10-15 minutes, which is enough time to stimulate the release of prolactin. However, after the milk has “come in” several days later, and you produce more than half an ounce at each expression, you should use the pump until your milk has stopped flowing for at least 1-2 minutes. The last droplets of milk released during pumping contain very high levels of fat, which provides most of the calories in your milk. If you stop pumping after 10 or 15 minutes while your milk is still flowing, your baby may not receive these valuable fat calories. Also, your breasts need to be emptied as much as possible–meaning that milk flow has stopped-otherwise your body thinks that the milk left in the breasts isn’t needed, and less will be produced. A few mothers say that the milk never “stops” flowing while they pump. As a general rule, you should not pump for more than 30 minutes, even if milk continues to flow. Also, if you pump for this long at each milk expression, you do not need to pump as frequently as a mother who can express her breasts in less time.

What is a “normal” amount of milk?

Nearly all mothers of premature babies worry about whether they are producing a “normal” amount of milk. Many things affect the amount of milk a mother produces-especially in the first few days after giving birth. A mother of a full-term breastfeeding baby produces only about an ounce of milk during the first 24 hours after birth, but by the 3rd or 4th day is making several times that amount. Mothers of prematures frequently take a longer time to go from a few drops to an ounce or more at a pumping. This condition is referred to as a delayed onset of lactation, and is related more to pregnancy complications-such as bedrest, medications for high blood pressure and premature labor, and Cesarean deliveries-rather than to premature birth itself. No one knows exactly why this is the case, but researchers think that the milk-making hormones or tissues in the breast may be affected temporarily by these complications and medications. A slower onset of milk production does not necessarily mean that a mother will not make enough milk for her baby-only that it may take her a few extra days in the beginning to catch up with mothers who have had uncomplicated deliveries. Ideally, by the end of the second week of pumping, you’ll be producing at least 500 ml (about two cups) of milk each day. This is the amount of milk that your baby will need at the time of hospital discharge. Thereafter, you will want to maintain or even increase this amount so that you have enough milk to feed your baby after discharge hospital discharge.

What is a tongue-tie?
In some babies, the tongue is restricted by a thin membrane underneath it. This can make the tongue look forked, shortened, or heart-shaped when the tip is lifted.

Recent studies have shown that some tongue-tied babies don’t feed well, and will benefit from having the tie snipped by someone suitably trained. The Department of Health has recently issued guidelines on treating tongue-tie in breastfed babies

How can it affect feeding?
Babies need free tongue movement to feed and swallow comfortably. When breastfeeding, they need to press the tongue-tip into the breast, with the nipple far back in the mouth, against the soft palate. If the tongue movement is restricted, they may not attach to the breast fully, or at all. Incomplete attachment to the breast results in lower fat content of the milk, as some parts of the breast are not fully drained.

When bottle feeding, babies need to keep the teat in the mouth and push easily against it.

Possible problems in baby:
• difficulty attaching to the breast and/or staying attached
• very frequent and/or long feeds
• difficulty in swallowing and greater intake of air
• colicky symptoms from increased intake of milk sugar (because fat content is lower, more volume of milk is needed to give the same calories, and this means more lactose in the gut, causing indigestion)
• dribbling at the bottle
• poor weight gain even with copious intake
Later on:
• difficulty in chewing and swallowing lumpy food

Possible problems in mother:
• sore, damaged nipples
• over-supply to compensate for reduction in milk fat (see above)
• reduction in supply over time from the difficulties encountered
• mastitis from poor drainage and nipple trauma
• exhaustion from frequent, long feeds

Other factors which may aggravate the condition or give similar symptoms:
• long labour, and/or difficult birth (eg ventouse, forceps, breech presentation, caesarean birth) causing tension or compression in the head, which may affect tongue movement and make it harder for baby to open the mouth
• swollen breasts from fluid in tissue behind nipple (eg from high blood pressure) or from milk engorgement around 3-4 days
• very large, long or inverted nipples

How can tongue-tie be treated?
We recommend that you do all you can to improve feeding while feeding is under review, or while awaiting referral for treatment. Skilled support in getting your baby into a closer position to attach to the breast more easily will improve symptoms, and may mean that no treatment is needed. An experienced midwife or health visitor, or a breastfeeding counsellor, lactation consultant or other breastfeeding specialist can help with this. Trying different teats for a bottle-fed baby may help. Cranial osteopathy may relieve compression of the head or discomfort from a difficult birth. As time goes on, it may become easier for the baby to compensate for a shortened tongue, and the tie may break later.

Getting good help before treatment also means that any snipping of the tongue-tie will show whether it was actually a factor in the feeding problem.

If there is little improvement from the above measures, the tie can be snipped. This does not damage the tongue at all, takes only a few seconds, and causes little if any pain or bleeding. No anaesthetic is needed, and the baby can feed immediately afterwards. Often the feeding problems improve or resolve. If not, your baby will need to be reviewed for other possible causes of feeding problems.

Where can I get the tongue-tie snipped?
In some areas, treatment is easily available. Ask your maternity unit if there is an Infant Feeding Adviser to arrange treatment. You could ask your GP to refer you to the paediatricians or oral surgeons, but if there are feeding problems, you will need to ask for an urgent referral. You may need to work hard to get support.What can happen if the tie is not treated?
Some mothers are unable to continue direct breastfeeding if there are severe difficulties, but expressed milk could be given if baby can manage the bottle well. In some babies, the tie loosens or breaks on its own, so there is no way of predicting whether a tongue-tie will affect chewing or speech later.

What happens after treatment?
Most babies show improvement in feeding, but this may take some time, particularly if other factors are involved in the problems (see above). It is good to give feedback to all the health professionals involved in monitoring the baby’s progress, so we learn how tongue-tie can affect feeding, and how simple and effective treatment can be.

The word Doula is derived from the Greek and the literal meaning is hand maiden. But a more modern description of a Doula would be someone who “mothers the mother”.

In the past this role would of been performed by a close family relative i.e. Mother or sisters, but sadly nowadays for a variety of reasons, this isn’t always possible and more and more women are turning to Doulas for emotional and practical support, both during labour, birth and post-natally.

There are two kinds of Doula:  Birth or Labour Doula and Post-natal or Post birth Doula.

Birth Doula:

Meets with her client ante-natally and works towards meeting the needs of both parents in order to enhance a positive birth experience. The birth Doula stays with the couple (or Woman only) during the whole of the labour, regardless of length of time spent in labour. The birth Doula will provide continuous emotional support during the labour and can offer advice on relaxation and positioning. Some birth Doulas are trained in massage and reflexology which can help relaxation during labour.

A Birth Doula will also stand as an advocate for the couple ensuring good communication with the professionals;  however it must be stressed that she is not a midwife and does not make clinical decisions, or perform clinical tasks.

There has been a lot of research particularly in America which has found that the support of a Doula during labour can reduce the need for medical intervention-for instance the use of epidurals forceps and caesarean births. And those mothers were more responsive to their new babies. In all, having a Birth Doula means you are more likely to have a more positive and fulfilling birth experience.

If you are interested in more information, please contact www.confidentmotherdoulas.co.uk

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Express Yourself Mums is delighted to launch our new website offering you an easier and clear shopping experience. Breastfeeding and expressing is still very much our speciality, however new product ranges include developmental baby toys, nursing and breastfeeding bras, slings and weaning products. If you need advice on any of our products do contact us and we will be happy to help. Enjoy your visit. We are currently offering Ameda Elite and Medela Lactina and Medela Symphony hospital grade breast pumps for hire and rental.