Having a premature baby is an undesirable and unpredictable happening which can bring forth disturbing and contradictory feelings. Several parents express anxiety and guilt caused by the sensation that they might have done something to provoke the premature birth, or that they might have overlooked some important preventive procedure that would keep the child from suffering. These emotions can be greatly potentialized by the fact that the premature baby is usually separated from the parents, in an Intensive Care Unit (ICU). A first step in coping with these emotions is acknowledging them and talking about them to health professionals, specially to psychologists in charge of offering support to parents of premature babies.
The closer, the better
Your so-wanted baby may turn out to be a most frightening image: she is in an incubator, in her diaper or with no clothes at all, head shaven, lying under a glass dome, hooked up to tubes, to a urine collector, and to monitor wires. Despite the technological setting, the little thing lying there is your baby! She really needs the touch of your hands, to hear your voice and, as soon as it is possible, she will be very soothed to be taken in your arms. Remember: it has been widely proven that the physical interaction between the parents and the baby is positively related to less respiratory arrests, to a greater weight gain and to a faster recovery of the neonate. To you, Mom, this interaction will be very comforting, too. It will make you feel useful and it will help you to produce more milk for your baby.
An important thing to keep in mind is that the parents should have free access to their baby in the ICU at all times. In fact, the ideal situation is that mother and father can get to spend the greatest amount of time with their infant. In case the mother is released from hospital before the baby, her subsequent visits to the ICU should be long and frequent. The father can also help a lot during this phase and should be around as often as he can, interacting with his baby at least once a day.
A special diet
Your premature baby was born before her complete intra-uterine maturation could take place and this condition puts her in a risk group. Therefore, your baby is now quite dependent on the kind of nourishment she will get. In this critical developmental phase, neonatologists, nutritionists, breastfeeding consultants and the parents should work side by side, so that the best kind of nourishment is offered to the baby.
If your health crew is not supportive of using your breastmilk, hear a second opinion. You will be happier and your baby will be healthier if you work with professionals who understand the miracle of breastmilk.
If you decide to read the available literature on this topic you will see that neonatologists find better development rates in premature babies who were offered maternal milk than in those who receive industrialized baby formulas (from cow milk). That is because the mother of a premature infant produces milk that is higher in protein and salt concentrations and such concentrations can perfectly meet the premature infant’s special needs. Thus, the best food for your baby is right inside you, Mother!
The physical contact between the mother and her baby should be promoted because it not only strengthens the bonding between them, but it also facilitates the immunological transference from the mother to the neonate through the cycle “intestines- lungs- mammary glands”. In this system of immunological export, the mother involuntarily intakes and breathes antigens (bacteria, viruses and hospital fungi) and her body produces specific antibodies (immunoglobulins) that will migrate to the mammary glands and will ultimately be transferred to the baby through the milk.
A little before the delivery and for the first three to four days after the baby is born, your breasts will start releasing a very special kind of milk, named colostrum. Colostrum, is a thick, yellowish fluid rich in protein, antibodies, and other infection-fighting agents such as leukocytes or white cells. It is easily ingested and has laxative properties to prevent neonatal jaundice. It also contains hormones, growth components and many other nutrients that should not be wasted. Even small quantities of this milk -just some drops – can make a difference in the prevention of necrosing enterocolitis, a frequent intestinal pathology affecting the neonate.
Colostrum is gradually replaced by early, or transitional, milk. Do not be surprised at the way it looks. It is very plentiful, light and thin because it contains 87% of water. Within about two weeks of the baby’s birth, early milk is replaced by bluish-white mature milk.
The methods of feeding low-weight babies
Depending on her clinical condition, a neonate with a thirty-week gestational age or less can be fed maternal milk through a nasogastric catheter. At the age of 30 to 32 weeks, maternal milk may tentatively be fed from a glass, a spoon or in drops. After 32 weeks and a weight of approximately 1,300 grams, breast-feeding is sometimes possible, but it is only after 36 weeks and a weight of 1,800 grams that direct feeding becomes more coordinated and, most of the times, feasible.
The Kangaroo Care
Depending on the clinical condition of the premature baby, some intensive care nurseries may adopt the Kangaroo care, a therapy that views the recovery of the neonate through the direct nourishment and permanent contact with the mother´s body. The premature infant is put in a special baby bag, under the mother´s clothes. Feeling the mother´s heat, breathing rhythm and heart beats, and sucking a little on the mother´s breasts, many times day, the baby may recover much faster. However, this system is not adequate to every infant. Some babies, whose conditions are more serious, will improve through high-tech medical procedures and professional care offered in a well-equipped ICU.
Still better than human milk is the mother´s milk!
The best milk for your premature baby is your own! A pre-term baby´s mother produces a special milk, with higher concentration of proteins, calories, sodium and lower concentration of lactose than term-milk (37 to 42 week gestational age). Thus, be ready: your baby´s most urgent need is you. During the time that she is in the ICU, whether she is being fed your milk or not, stimulate your production by means of hand or machine expression, making milk flow. Don´t feel uncomfortable to ask for help from a professional, from other mothers or from friends, in case you are not able to extract any or enough milk, or in case there is engorgement. By releasing milk from your breasts several times a day, you will be ready to breast-feed as soon as the baby is ready.
A milk richer in fats
At the end of each breast-feeding session you produce a very special kind of milk -the hindmilk. This milk that comes later is much richer in fats than the beginning one. It is therefore much more energetic and rich in calories and guarantees great nourishment to your baby.
Since milk at the beginning of a feeding session is different in composition from milk at the end—the hindmilk, your breast-feeding session should begin and continue calmly until each breast is completely emptied and you make the two kinds of milk available to your baby. Notice that it is the continued sucking motion of the baby or your hand/pump expression, during all the session, that can stimulate the secretion of a hormone named Oxytocin, which will ultimately make hindmilk eject from your breasts. Oxytocin causes the smooth muscles surrounding the lobules to squeeze hindmilk into the breast’s ductal system, a process known as let-down or ejection reflex.
When you are making your milk flow manually, store the hindmilk in a separate sterile container and label it, so that its great nutrients are not wasted and can be offered to your baby in a later opportunity.
Releasing your milk from your breasts
The hospital should provide you with sterile containers where you can store your milk. Your breasts do not need any special hygiene. Wash them thoroughly once a day in your regular bath. Your hands and arms should be very clean and dry.
There are several ways of extracting milk from the breasts. Some nursing mothers can do it very well with the expression of their hands. Others must do it with a special electric pump. There are several models of pumps. It is important to find the one that best suits your anatomy, since some may hurt you and others might not be very efficient.
Keep one thing in mind: despite the fact that it may seem very hard to extract milk at first, it does not mean you do not have enough milk. Relax, be comfortable, alone or in company of supporting or professional people. Some mothers alternate breasts several times during one milking session. Others prefer to empty one breast completely and then start on the other. Both ways work fine granted that you keep the hindmilk in a separate container to feed the baby a more nourishing milk. Remember that the more you milk yourself the more milk you will have. During the nursing period a mother should rest, sleep and eat well and should drink more water than the usual quantity. In order to maintain an adequate milk flow , a nursing mother should breast-feed or milk her breasts at least 6-8 times in 24h.
There is no special care a nursing mother should take in relation to food and drinks, except for alcoholic beverages, coffee, tea and soda that is not caffeine-free. Excessive caffeine consumption by a breastfeeding mother may make her baby fussy and wakeful. Smoking is not advisable either because it diminishes the production of milk. In case your baby is being fed human milk that is not your own, a situation which is not ideal, this milk should be pasteurized, so that it does not transmit any diseases to your baby. Pasteurized human milk is still far better than the baby formulas made of cow milk.
Storing your milk
Your milk should be refrigerated in a fridge (not in its door) for 24h. Milk from different milking sessions of the day can be stored in the same container. After filling the container, it should be closed immediately and labeled with the time and day of the extraction. In case the mother wants to store the milk for a longer period of time it has to be placed in the freezer for up to 3 months.
If your premature baby is in the ICU and you are at home, transport the milk in a box with ice or in a thermal container. Ask the nurse in charge of the ICU to inform you of the quantity and frequency of your baby´s feeding sessions.
Breast-feeding your premature baby
This long-awaited moment may be frustrating at first because your little baby may have difficulty to suck on you breast (on the nipple and around the areola). You should try to position her the best possible way. A phono-audiologist may make a motor-oral test with your baby, to evaluate her sucking strength, position of the tongue and lips, and if there is a problem, to stimulate her to suck correctly.
Pacifiers and bottles should not be used because they may cause a motor-oral dysfunction, also called nipple confusion, after which the practice of sucking on a rubber nipple hinders the correct sucking on the mother´s breasts.
You should be available to spend many hours of your day in the hospital because premature babies have long, and sometimes little efficient, breast-feeding sessions. Your baby is very fragile and sleeps for long periods. She certainly will not be able to suck firmly for more than a few minutes. Be relaxed, and sit in an arm chair that can comfortably support your arm and the child. Be confident, no matter how hard it may be. Squeeze a little of your milk into the baby´s mouth, so that she can feel its taste and smell. For that you will have to press the areola between your index finger and thumb, so that the baby can take the nipple. A good tip is rubbing the nipple lightly on the baby´s cheeks, so that the reflex of search and seizing is triggered. Don´t be frustrated in case she does not suck, right in the first session.
Nature could not foresee the advancements of science and with them the survival of premature babies smaller and smaller. In their intrauterine life they were nourished via blood, through the placenta and umbilical cord. If that nourishment ceases to exist for extremely premature neonates, of very low weight, nourishment administered parenterally may become necessary. Only after sometime can such neonates be fed an oral diet.
In some cases it is possible to use a supplemented milk, that is, an insert made of proteins, calcium, phosphor, sodium, potassium, chlorite and magnesium that is added to the mother´s milk in order to provide extemporaneous neonates with all their special needs.
An even better alternative is supplementing the mother´s milk with powdered human milk, produced by means of a dehydrating technique available only in some health care centers.
This is a moment for re-adaptation for the whole family. The baby may reject the breast at first because the environment is different and she perceives that, but this moment is easily overcome with patience and tenderness. In case the daily weight gain of you baby is not satisfactory, you can supplement breast-feeding with the administration of your own milk in drops.
Don´t be frightened! In the beginning your pediatrician will assist you and your baby as frequently as every two days or at least once a week. It will be helpful if you can take down the number of times she urinates and evacuates a day as well as the color and density of her feces.
When it is time to breast-feed your baby, do it at a warm place so that the baby can be only in her diaper and can have direct contact with your skin. Hold her as long as you can. Do not be embarrassed to ask others to help you with the household chores. Your priority is the baby.
With the right kind of support, many women succeed in breast-feeding their premature babies. You will make it, too, one way or the other. Besides you will feel the joy of having your baby´s skin touching yours, and the joy of trying to give the best nourishment you can to your baby.