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Archive for the ‘Special Cases related to Breastfeeding’ Category

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.

Dr. Jack Newman is a Toronto pediatrician who has practiced medicine since 1970. In 1984 he established the first hospital-based breastfeeding clinic in Canada, at Toronto’s Hospital for Sick Children. He now holds breastfeeding clinics in several hospitals in the Toronto area.

Here he shares some practical tips on how to get the baby on the breast:

Getting the baby to take the breast
Although many people do not believe that the early introduction of bottles may interfere with breastfeeding, the early introduction of artificial nipples can indeed interfere. The sooner you can get the baby to the breast after he is born, the better. However, babies need flow from the breast in order to stay latched on and continue sucking, especially if they have gotten used to getting flow from a bottle or another method of feeding (cup, finger feeding). So, what can you do?

1. Speak with the staff at the hospital where the baby will be born and let the head nurse and lactation consultant know your plan to breastfeed the baby. They should be willing to accommodate your desire to have the baby fed by cup or finger feeding, if you cannot have the baby to feed immediately after his birth. In fact, more and more frequently, arrangements have been made where the adopting mother is present at the birth of the baby and takes the baby immediately to nurse. The earlier you start, the better.

2. Some biological mothers are willing to nurse the baby for the first few days. There is some concern expressed amongst social workers and others that this will result in the biological mothers’ changing her mind. This is possible, and you may not wish to take that risk. However, this has been done, and it allows the baby to breastfeed, get colostrum, and not receive artificial feedings at first.

3. Latching on well is even more important when the mother does not have a full milk supply as when she does. A good latch means painless feedings. A good latch means the baby will get more of your milk, whether your milk supply is abundant or minimal.

4. If the baby does need to be supplemented, this should be done with a lactation aid with the supplement being given while the baby is breastfeeding . Take a look at the Medela Supplemental Nursing System.  Babies learn to breastfeed by breastfeeding, not cup feeding or finger feeding or bottle feeding. Of course, you can use your previously expressed milk to supplement. And if you can manage to get it, banked breastmilk is the second best supplement after your own milk. With a lactation aid, the baby is still breastfeeding even while being supplemented, and isn’t it breastfeeding you wanted for your baby?

5. If you are having trouble getting the baby to take the breast, come to the clinic as soon as possible for help.

Producing Breastmilk:
As soon as a baby is in sight, contact a breastfeeding clinic and start getting your milk supply ready. Please understand, you may never produce a full supply for your baby, though it may happen. You should not be discouraged by what you may be pumping before the baby is born, because a pump is never as good at extracting milk as a baby who is sucking well and well latched on. The main purpose of pumping before the baby is born is to draw milk out of your breast so that you will produce yet more milk, not to build up a reserve of milk before the baby is born, though this is good if you can do it.

If you know far enough in advance, say at least 3 or 4 months, treatment with a combination of oestrogen and progesterone (as in the birth control pill, but without a break, or oestrogen patches on the breast plus oral progesterone) plus domperidone will simulate the hormonal milieu of pregnancy somewhat, and may allow you to produce more milk. Get information about this protocol from the clinic.

a. Pumping. If you can manage it, rent an electric pump with a double setup. Pumping both breasts at the same time takes half the time, obviously, but also results in better milk production. Start pumping as soon as the baby is in sight, even if this means you will be pumping for 4 months. You do not have to pump frequently on a schedule. Do what is possible. If twice a day is possible at first, do it twice a day. If once a day during the week, but 6 times during the weekend can be done, fine. Partners can help with nipple stimulation as well.
b. Domperidone. This drug can help you produce more milk. It is not necessary for you to use in order to breastfeed an adopted baby, but it will help you develop a more abundant milk supply faster. There is no such thing as a 100% safe drug. If you do decide to take it, the starting dose is 30 mg three times a day, but we have gone as high as 40 mg 4 times a day. Using pumping and domperidone, most adopting mothers have started to produce drops of milk after two to four weeks.

But will I produce all the milk the baby needs?
Maybe, but don’t count on it. But if you do not, breastfeed your baby anyhow, and allow yourself and him to enjoy the special relationship that it brings. In any case, some breastmilk is better than none.

Please note: If you decide to take the medications (the hormones and/or the domperidone), your family doctor must be aware of what you are taking and why. Significant side effects have been rare, but that does not mean they cannot happen. Your doctor needs to be following you, and once the baby is with you, your baby’s doctor needs to know that you are nursing him and needs to follow the baby’s progress just as s/he would any other baby.

Always consult your health care professional and ensure your baby is gaining weight accordingly.

Yes its true! Adopting mothers can breastfeed.  Barbara Wilson-Clay, BS, IBCLC tells us how.

Down through history, a traditional way of nurturing and nourishing orphans has been for another woman, often a relative, to put the baby to breast. Sometimes the adoptive mother already was lactating, but if not, the infant’s sucking would bring in a milk supply. The process of breastfeeding an adopted baby is called induced lactation. Research has shown that breastfeeding enhances bonding. Parents are thrilled to learn that their chosen baby can receive some of the wonderful health benefits provided by human milk, including experiencing the interactions which foster attachment between mother and child.

How does induced lactation work? Simply put, sucking stimulation causes the breasts to make milk. In the non-developed world, most women who are inducing lactation simply put the infant to breast and practice very frequent breastfeeding and baby-wearing (holding the infant almost constantly in a sling or carrier).  In developed countries, where adoption is more likely to be a planned event, the process of induced lactation ideally begins before the baby arrives. The mother starts by manually and mechanically stimulating her breasts and nipples using a combination of gentle massage and a rental grade electric breast pump.

The stimulation schedule typically starts with several minutes of massage and pumping several times a day. Gradually, the woman increases the amount of stimulation until she is pumping for 10 minutes 8-10 times during each 24-hour period. (Pumping on a dry breast may pull some. Try lubricating the pump flange with a thin coat of cooking oil to make it more comfortable.) After massage and pumping are begun, medications may help stimulate the breasts to further increase milk production. Some induced lactation efforts begin with physician-prescribed hormones (estrogen and progesterone) that imitate the hormone levels of pregnancy. These medications are withdrawn after a short while, tricking the body into sensing that a baby has been born. The woman may then begin taking another prescribed drug called a galactagogue (a term that means a milk stimulating substance). Although there is no research to confirm effectiveness, some women who don’t want to use hormones may use herbal galactagogues such as fenugreek in addition to pumping and breast massage to help establish milk production. Within a week of beginning the process most women are very excited to discover that they are producing drops of milk! They may notice other changes. Their breasts may feel heavier and the areolae (the skin around the nipple) may darken. Some woman will eventually stop menstruating.  While the milk supply typically builds over time, it is hard to tell how much milk an adoptive mother will make. Some women eventually make enough milk that they can wean their babies off of supplements. Other women have health issues that may affect their ability to make a full supply of milk. No matter. Any amount of milk is of great value to the baby, but the focus should be on the nurturing experience.

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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.