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The birth of a baby is generally associated with hugging, nursing and bonding with skin-to-skin contact. However, in the case of a premature baby, the situation is quite different. Parents have to observe the baby in incubators with the help of numerous machines, and while worrying about the health of their child, the mothers might find it difficult to know how to feed their baby in the absence of breastfeeding.
Milk expression helps in feeding the baby and being actively involved in the baby's upbringing.
Breast milk and why it is important
When babies are born prematurely, it means that some functions in their body might not be completely developed yet. It can lead to difficulties with digestion and a weak immune system. Milk from a mother can help with growth and development of the baby's immune system.
The first milk, called colostrum, is especially important. Mother's milk is considered to be the best option for premature babies. It helps develop a baby's digestive tract and reduces the risks of NEC (necrotising enterocolitis). It is more likely to happen in premature babies. If mother's milk is not available, then pasteurised donor milk can be used.
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Establishing the supply when the baby does not latch
When the infant is kept in an incubator, he/she may be too small, unstable or unable to coordinate sucking, swallowing and breathing activities. While the process of direct breastfeeding will have to wait, milk production can be stimulated by regular milk expression.
The mother needs to start expressing as soon as she is medically able to do so, preferably within the first few hours after giving birth. Mothers are advised to express between eight to ten times in 24 hours during the early weeks to stimulate milk production. This can be done in consultation with the medical staff at the NICU.
A hospital-grade electric pump may come in handy when the baby is unable to latch. Hand expression is also effective, especially for collection of colostrum.
Even a few drops matter
Sometimes a few drops may be discouraging to the new moms since they may assume that they are not producing enough breast milk. Also, they may feel guilty that their child needs extra assistance in feeding. This is perfectly fine during the initial stages since the initial output is not an indicator of future production.
The colostrum should be offered in small volumes based on the guidance of the NICU staff. Sometimes colostrum may be used in the unit for oral hygiene of the infant, especially when the baby cannot feed orally. With time, the expressed breast milk can be given to the baby using a tube, while direct breastfeeding may start when the baby is stable.
With the approval of the clinical staff, kangaroo mother care is essential.
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The mother needs care, too
Frequent pumping during the period following a premature birth is tiring on both physical and emotional levels. The mothers themselves could be recuperating, worrying and sleeping less. Thus, assistance should not be limited to just pumping alone.
The neonatal and lactation teams could demonstrate proper expression methods, ensure proper fit of the pump, and create a realistic plan, as well as discuss any concerns regarding milk supply.
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A connection beyond the incubator
The development of the premature child is characterised by tiny landmarks - the first milks, the first tube feeding, the first hold of the baby, and, finally, going home. If a woman is not able to breastfeed, then pumping milk allows a mom to take an active part in this process.
Not all mothers develop and sustain their milk production, and this is never supposed to be blamed. The most important thing here is to help the mother and provide proper nutrition for her baby. Being separated from the baby by the incubator does not devalue a mother's care in any way.
(Dr. Harini Sreedharan, Consultant - Paediatrician & Neonatologist, Motherhood Hospitals, Sarjapur, Bangalore)
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