Supporting breastfeeding for a baby in NICU- Part 1

My feet my be very small and the way maybe be hard

but I do not walk alone

If your baby is in NICU then breastfeeding can be especially challenging. Depending on how many weeks your baby is when you give birth will greatly affect your breastfeeding journey. What does make a difference however is support both practically but also emotionally to help breastfeeding both get off to a good start but also make it possible for a mother to continue her journey after leaving NICU.

So how can breastfeeding be supported and what practical things can be done to support families?

Having a baby born premature is a very stressful event for the mother and her partner and of course baby. Babies born early require specialist care and so will be taken from a mother at birth almost immediately and transferred to a NICU unit sometimes in the same hospital but sometimes to unit in another hospital. Skin to skin and time with her baby after birth therefore isn’t possible and so the stimulating of the hormones that are needed in the production of milk isn’t achieved. Also due to the fact most premature babies are born due to complications either with them or the mother means that the hormones that are involved in milk production such as oxytocin are likely to be affected.

So support is vital to enable the start of a breastfeeding relationship. In the early hours and days mothers often feel at a loss to know what they can do to care for their babies, separation from baby takes its toll emotionally and anxiety is high worrying about the health of her new baby in NICU. It is vital that mothers are supported to understand the role her breastmilk plays in the care of her baby. This can be challenging for staff as it may seem like asking a mother to express for her baby on top of everything else is too much. However it is vitally important that to start her journey of breastfeeding, a mother starts to hand express her milk as soon after birth as possible in order to stimulate the breasts and the hormones needed in milk production and in order to have milk available for her baby as soon as her baby is well enough to receive it.

support is vital to enable the start of a breastfeeding relationship

Time, compassion and genuine empathy is needed to support a mother at this time, she will be very emotional, be feeling very vulnerable and at a loss without her baby. She may also be physically unwell and struggling with the fact that she has had her baby early. Time spent with a mother gently explaining the reasons why her breastmilk is needed and also that this is a way she can care for her baby is so important. Ive known mothers be told that NICU was demanding her milk for her baby but with no explanation of why.

Why is her breast milk so important to her premature baby?

For sick and preterm babies the importance of breastmilk cannot be overestimated. It supports not only growth but provides protection from infection something that is very important in NICU. In particular, evidence suggests that the use of breastmilk decreases the incidence and severity of the life threatening disease ‘necrotising enterocolitis’ an inflammation of the bowel that premature babies are more susceptible to. In fact in very early babies breastmilk is often the only milk that can be given.

Time will be needed to show a mother how to hand express and collect her milk (colostrum) usually by syringe, how to label and correctly store her milk. Also she needs to understand how supply and demand of her milk works and that she needs to express at least 8x in 24 hours. Setting achievable goals will help a mother to feel more confident. Regularly asking over the next few days and weeks how expressing is going and discussing and showing the correct use of breast pumps is so important. If support is not given and there is a delay in starting to express her milk or a reduction in the frequency of expressing or if a mother is struggling to effectively express her milk, this will compromise her long term supply and also her confidence in her ability to produce milk for her baby. Often this information is a lot to take in and it may be that time will be needed explaining all of the information a number of time to both a mother and her partner.

It can be especially challenging for mothers that had decided that they did not wish to breastfeed but then due to their baby being very early or sick are suddenly being asked to express breastmilk. Again time is needed to explain why the request has been made. Compassion and empathy are also needed so that support can be given in a loving way. Remembering the mothers vulnerable state she may be finding it all very difficult to process and feel overwhelmed, she is now doing something she never intended to do. Patience and genuine compassion will make this time easier for her and her family.  Help in kind ways, it may be simple acts such as helping to fetch syringes or labels or taking any expressed milk down to NICU if a mother is unable to go herself all help.

So what about down on the unit itself?

NICU can be a scary place and a mother can feel overwhelmed. Care is often out of her hands and she may feel there is very little she can actually do for her baby. I use to stare at my daughter in her incubator and wonder if she was really mine. One way to help a mother feel at ease with her baby, facilitate bonding and also help with expressing is showing a mother how to do ‘skin to skin’.

Why is skin to skin so important?

Skin to skin or ‘kangaroo care’ as its called has so may benefits. It helps to regulate baby’s heart rate, temperature and breathing and reduces apnoea and bradycardia (periods of irregular breathing and heart rate that can occur in preterm babies). It has an analgesic (pain relieving) effect which will benefit your baby if under going something like a blood test. It increases time in quiet sleep which may help brain development and growth and enhances mother-baby bonding which also helps reduce stress in mother too. Kangaroo care also improves the chances of breastfeeding and also helps to keep breastfeeding going for longer. How? Because skin to skin stimulates “baby” behaviour such as rooting, sucking and searching the breast. Also being in contact with her baby will stimulate the mothers hormones involved in milk production and so help with her supply of milk.

Getting mothers and babies to do as much skin to skin as they can with their baby on the unit is vital. This will also take time, support and empathy, a mother may be nervous to hold her baby especially if her baby is very tiny or has lots of wires connected. With gentle help and support her confidence to handle her baby will grow.

Patience and genuine compassion will make this time easier for her and her family

What else can help a mother with expressing her milk for her baby?

Showing breast massage and relaxation techniques help to a mothers milk to flow. Expressing close to her baby or if this is not possible, or when at home having a photo or piece of baby’s clothing will help milk production and flow also.

When using a pump it is important a mother is taught the correct technique and that the pump flange fits correctly. Ask a mother if her breasts and nipples are comfortable and that pumping is not painful. Also a mother should be shown how to use a pump to mimic her babies natural pattern during a feed by changing the cycle.

Encourage double pumping as this saves time and may help to facilitate expressing long term.

Help her make a plan for expressing. She does not have to stick to a strict 3-4 hourly routine but help her to avoid long gaps (four-hourly in the day and six-hourly at night) between expressions.

Discuss the importance of the night-time expression as this is when hormone levels are highest. This can be particularly difficult as mothers will need to set alarms to wake them at night and this can be a lonely time without her baby. Partners can play a valuable role in supporting and encouraging during those night time expressions.

Emotionally support must be provided too. Keeping a mother updated on her baby’s progress will help alleviate some of her anxiety. Good communication between the NICU and the midwives on postnatal wards is vital. I remember asking about my baby while on the ward to be told they weren’t sure, this only increased my worry for my babies health and my guilt at being not well enough to go to NICU.  Valuing a mothers contribution in caring for her baby and letting her know how important it is will be invaluable to her. Expressing for a premature baby is very demanding, add to this the recovering from birth, daily traveling to the hospital, long days on the unit and also a home life that may include other children to care for can drain a mother emotionally and physically. Never should we forget the immense work and sacrifice it involves for a mother and her  family.

So what about putting a premature baby to the breast?

My next blog will explore this and how to support a mother with a premature baby that wishes to breastfeed.

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