Breastfeeding Your Preemie

When complications throw a wrench in your pregnancy and the prospect of a premature delivery seems imminent, can breastfeeding your newborn still fit into your mothering plans? According to Carri Buerger and Lori Kolder, both nurses and lactation consultants in the neonatal intensive care unit (NICU) at Lutheran General Hospital in Park Ridge, Ill., the answer is an emphatic yes.

“It is absolutely a reality,” Buerger says. “We encourage breastfeeding to promote shorter lengths of stay for the baby,” Kolder adds. “The acuity of illness is decreased and it lessens the chance of colitis and illnesses during hospitalizations.”

The key is starting right away – and sticking with it.

Getting Started: Pump Early, Pump Often

Usually babies born prior to 31 or 32 weeks gestation cannot breastfeed until they are deemed stable. However, breastmilk can still be given to the infant through a feeding tube that goes through the nose or mouth to the stomach.

In order to establish a milk supply, start pumping your breasts within six hours of delivery. Then, pump every three to four hours for 15 to 20 minutes to continue stimulation and mimic a full-term baby’s feeding schedule. Kolder recommends using a hospital grade, double electric breast pump with a cycling of 60 to 70 times per minute and a suction strength of 215 to 225 to maximize efficiency.

“A lot of pumps at the local stores have a cycling of 18 to 20 times per minute and suction strength of 20 to 30,” she says. “And the strength of a battery-operated pump is dependent on how good the batteries are.”

Collect and freeze every drop of milk expressed. “In the beginning a woman produces colostrum, which is like gold,” Buerger says. “Pumping empowers the mom because even if she can’t have her baby at home and take care of it, this is the one thing only she can provide that is vital to her baby.” As soon as the baby is stable, Mom can attempt breastfeeding. “At 32 weeks they may not feed for nutrition, but it is very rewarding for the mom and something she can look forward to,” Kolder says.

Benefits: The Breastfeeding/Breastmilk Advantage

According to a report put out by the American Academy of Pediatrics, extensive research documents the advantages of breastfeeding, including health, nutritional, immunologic, developmental, psychological, social, economic and environmental benefits. Additional research concludes that breastmilk significantly decreases risk for a variety of acute and chronic diseases.

“There is a huge amount of information available on the immune properties of breastmilk,” Kolder says. “When preemies are given it, they tolerate it better. We ask some moms to pump even when they are not planning to breastfeed because the outcomes are better.”

Mothers benefit as well, with decreased postpartum bleeding, faster return to pre-pregnancy weight and reduced risk of ovarian and pre-menopausal breast cancers.

With early deliveries, Mother Nature also miraculously alters the properties of premature breastmilk to fortify a baby with more demanding nutritional needs. “Mom’s body produces colostrum and milk with different nutritional content than the milk of a mother who carries full term,” Buerger says. “It is higher in protein, sodium, iron and chloride, and pre-term milk also has more antibodies than mothers of full-term babies.

“Breastfed preemies also do better with breast than with a bottle because the baby has control over the flow of the milk. In the beginning, a baby may be too weak to latch on to Mom’s breast and transfer milk, but they will eventually catch on.”

Logistics: Fitting in at the Hospital

When a preemie is stable but not yet able to leave the hospital, parents are usually given nearly free access to the NICU to partake in the care and feeding of their baby. “The NICU is open 24 hours a day,” Kolder says. “The only time we ask parents not to visit is during nursing rounds for confidentiality reasons, or if a baby has an emergency and we can’t have other parents coming in.”

Neonatal units usually work with parents to accommodate their schedules whenever possible. “We have to put babies on a feeding schedule, but we can change feedings to accommodate a mom’s schedule so she has every opportunity to put her baby to breast,” Kolder explains. “We want the parents to visit whenever they can and encourage them to breastfeed whenever they can.”

Like most hospitals, Lutheran General has segregated nurseries, which hold 10 babies per room. Privacy screens are provided for moms who want to pump bedside and separate breastfeeding and pumping rooms are available for one-on-one time.

“In these situations the motherly duties are totally stripped away from them,” says Kolder. “We encourage them to touch their babies, but they are so small that sometimes they are scared to even change a diaper. We encourage them to bring pictures and toys and sing and read to their babies. But when she can’t even touch her baby, one of the most important things she can give is breastmilk, and only she can do that. We reinforce that no one else can do that and it could be a life-saving thing for her child. No medicine, no antibiotic can compete with what is provided by her body.”

Premature Twins: One Mother’s Story

Following a pregnancy filled with complications, Regina Szpak of Huntley, Ill., gave birth to twins at Lutheran General Hospital just two days shy of 27 weeks gestation. It had been nearly four weeks since one of her water bags broke, and her babies were given no chance of survival. Now she was delivering Jennifer, a 12-inch, 1-pound, 8 1/2-ounce miracle and her “big” brother Ryan, 12 1/2 inches long, who weighed 1 pound, 13 3/4 ounces.

“Jennifer was born without a sac around her (hers was the ruptured bag) and her lungs were much more developmentally premature than his,” Szpak says. “There was nothing I could do for them and I had to put them in God’s hands.”

All along Szpak had been committed to breastfeeding. “I didn’t have luck breastfeeding my first child – I couldn’t figure out what to do,” she says. “I was determined with the second pregnancy to nurse.”

Although it would be months before she would actually nurse, Szpak began pumping her breasts almost immediately after the delivery. “I started out with 2-ounce bottles,” she says. “They tested my milk, and once I got the OK they did everything to help me continue pumping. They had pumps available at the hospital and freezer storage so I could bring my milk in. Soon I graduated to filling 4-ounce water bottles. I was a great producer.”

Szpak began nursing Ryan after two months, Jen after three and a half months. “Ryan was pretty simple, but I had to learn how to hold him and bring him up to me, not bring my breast down to him,” she says. “There were about three or four times when I got both of them latched on and nursing at the same time. Otherwise I would come in and nurse one while pumping for the other and then I would switch off. Once their feedings really took off I would go to the hospital three times a day to feed them.”

After four months in the hospital, Ryan was stable enough to venture home while Jennifer remained hospitalized for yet another month. “I was nursing him full time and pumping for Jennifer and bringing it to the hospital,” says Szpak. “She came home on oxygen and with a feeding tube because she had been intubated [on a ventilator] for so long that her vocal cords had scarring that wouldn’t close up.”

Once Jennifer came home, Szpak stopped nursing Ryan and continued to pump for Jennifer until the end of September, some nine months after their arrival.

Looking back, Szpak credited the hospital, including Kolder, for providing a strong support system. “I don’t think I could have done it without the nurses and lactation specialist,” she says. “The nurses worked with me and would change their feeding schedules to make it convenient for me to get there. I was very proud of the fact that I did it, and the support of people willing to work with me was great. They were so small and so sick and I knew that that was what I could do for them. I don’t ever remember feeling that I didn’t want to do it.”

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