Breastfeeding
New mums in our Neonatal Unit may be faced with extra challenges. The following may help achieve a positive breastfeeding outcome:
There is a breastfeeding policy which all staff adhere to. Staff are trained in the management of breast feeding preterm babies.
Staff will help mothers to establish 'skin to skin' contact as soon as baby's medical condition allows.
Our staff can provide information and support needed to:
- Start milk expression soon after birth.
- Maintain lactation.
- Understand the breastfeeding process of an early (preterm) baby.
- Mothers should be informed on best techniques (breast massage, nipple stimulation, hand expressing and use of breast pumps). Breast milk should be expressed at least six times in 24-hours if the baby is too small/ill to feed. Dual pumping (using two collection sets together) increases milk volume and saves time.
Our neonatal feeding policy supports breast milk feeding for all babies admitted to the unit.
Pasteurised and banked donor milk is considered if mothers’ breast milk is unavailable.
Staff encourage 'breastfeeding practice' as soon as baby's condition allows i.e. contact between breast and baby's mouth, becoming acquainted by smelling, licking and tasting, transferring gradually from scheduled feeds to demand feeding, and the avoidance of use of bottles until the baby has established good suckling ability at the breast.
During tube feeding the baby can be stimulated with breast or other oral stimulation.
There is evidence that use of teats may confuse oral function in breastfeeding babies.
All guidelines and procedures consider the individual baby's needs. In the Neonatal Unit there will always be babies who for one reason or another are not able to breast feed and who need to be fed with a bottle to thrive, because of longer periods of hospitalisation or who may need a dummy for comfort.
Parents are encouraged to 'room in' prior to baby's discharge and to assist the transition to exclusive breastfeeding.
Community neonatal staff are trained to give continued breastfeeding support following discharge from the Neonatal Unit.
There is breastfeeding support in the community.
Your premature/sick baby will be more able to digest breast milk than formula milk and it will help them to recover more quickly. Therefore, you will be encouraged to provide your breast milk for them. Help and support will be given to enable you to express your breast milk and progress to direct breastfeeding if you wish. Breast pumps are freely available for loan.
If you are unable to provide your own breast milk, donated breast milk may be available. (This is breast milk which has been donated and pasteurised. Strict screening processes are in place for donors and milk).
The Neonatal Unit feeding advisor is available to discuss any feeding issues.
If you are discharged home and your baby remains on the Unit, arrangements can be made for the loan of one of our breast pumps. Please ask the nursing staff for details. Expressed breast milk can be frozen and transported to the Unit. The staff will be happy to give you advice and any further information if required.
Bottle feeding
Breastfeeding your baby for the first six months allows for the best start in life as per the recommendation from the World Health Organisation.
However, when baby has been born early and/or born very poorly, breastfeeding can be challenging to start and prolong. Your baby needs milk for energy and growth and can be offered donor breast milk given by nasogastric tube, cup or bottle.
Modern manufacturing techniques have improved and researched in order to try and emulate mothers milk. Careful preparation of those milks is required so please read the instructions very carefully.
For mums who wish to bottle feed their babies, please bring two starter packs of formula feed into hospital with you.
Touch
Touch, containment, skin to skin, positioning of baby are all aspects of developmental care.
Holding your baby is extremely important for you as a parent and for your baby and expressing love of your baby through holding is instinctive without you realising it. Sometimes when a baby has arrived unexpectedly or is ill, some of those instincts are put on hold for a period of time (due to separation of mother and baby, shock of the delivery) and it is not unusual for a parent to say initially that they don’t want to touch their baby, that they feel frightened in case they hurt their baby or disturb him/her particularly when they are in an incubator and/or on a breathing machine.
Touch is extremely important to promote the connection between you and your baby. Touch is personal, the Neonatal staff are touching baby gently often wearing gloves or during painful procedures whereas your touch as parents is kind and loving and babies can tell the difference.
The Neonatal staff will encourage you to touch and hold your baby even when baby is poorly and they will help guide you, suggesting where best to place your hands if baby has many wires/tubes attached. They will help you to read baby’s cues/signals and provide you with a small leaflet about approaching behaviours baby may show and about behaviours baby may show when stressed.
A baby with smooth regular breathing, pink stable colour, smooth movements, hands clasped, finger holding, bringing hand to mouth, sucking, tucking in arms and legs to his/her body, holding his/her hand, frowning, cooing, smiling, actively turning to sounds, bright eyed highlight the characteristics.
This baby will respond to being held and touched. This baby is well organised and able to spend time looking and being bright and stimulated.
When baby becomes tired he/she will begin to fuss, cry, his/her colour will change and he/she may need other strategies to calm him/her, for instance a term aged baby maybe telling you he/she wants a nappy change or a feed.
An early baby has possibly just had enough and cannot get comfortable and begins to tell you this through the body signals, eyes beginning to droop, body tone lowering and becoming limp, face grimacing, eyes go glassy, has a weak cry, hands are just sitting in mid air above the baby, holding fists tight, becomes very fidgety, may cough, sneeze, sigh, have a panicked look on face, move rapidly from being asleep to awake back again to sleep.
Stopping the activity you are doing whether it is talking/stroking/changing nappy might help. Still hands will usually help a baby, bringing the body into a tucked position, hand on head /chest and hand holding arms and hands together, positioning a roll around baby to support them and help gain composure, covering with a blanket and resting. He/she may also need a nappy change and a feed so you must observe baby well to know what they are asking for.
The medical nursing staff caring for your baby with the developmental specialist who has assessed baby can help you with this.
Sitting alongside your baby you will be able to observe a lot and tell the staff what he/she likes or dislikes where they like to be touched, if he/she can tolerate stroking what he/she does when their temperature is measured under the arm etc.
When your baby is stable the nurses will suggest to both of you to have some skin- to-skin time with baby, often called Kangaroo care. This can seem quite scary when baby has been small and sick but the medical and nursing staff are able to help you with this. They will make sure there is space around the incubator or cot for a comfortable chair and a screen, they will have mentioned to you that baby is getting near to the time for kangaroo care and have asked you to wear or bring suitable clothing.
Please view the following presentation used to train the staff, so that you can enjoy the skin-to-skin time with your baby. Dads love it too and being in a very feminine environment may feel inhibited initially but once you try it you will want to do it again. It is good for parents and baby. It will also help with your milk production if you are expressing. It is a diary moment.
However, its ok if you don’t feel ready for kangaroo care. You can get to know your baby in other ways and wait until your baby is bigger or feel you want to do this when you stay overnight or when you get home.