World Breastfeeding Week 2024: Breastfeeding tips for premature and new moms, NICU families

Breastfeeding a newborn baby holds a very special place in a mother’s journey of embracing motherhood and often, new mothers are anxious about their breastfeeding journey and baby care before childbirth as there are so many resources of information available to them, which can sometimes be good and useful but can also lead to stress and anxiety. In this article, we are going to focus on the challenges associated with premature babies in the context of breastfeeding, especially when neonatal intensive care is involved for the well-being of the newborn/premature baby.

Before we proceed further, let us understand what a premature baby is. In an interview with HT Lifestyle, Priya Singh, Women’s Health Physiotherapist and Lactation Consultant at Cloudnine Group of Hospitals, Vashi and Navi Mumbai, shared, “A full-term baby is one who is born after 37 weeks of gestation, babies born before that are called premature or term babies.” Adding further, she said that the intensity of care provided depends entirely on how premature the baby is and is classified as per WHO:

• extremely premature – less than 28 weeks
• Very premature birth – between 28-32 weeks of pregnancy
• Moderate to late preterm 32-37 weeks

“Preterm birth is caused mainly by spontaneous labour and sometimes there may be some medical indications where waiting till full-term pregnancy fails given the health risks available to the foetus or the mother. Early induction of labour or a caesarean birth may be required to overcome the risk,” explained Priya Singh.

How can we support parents and enable breastfeeding for babies who are born prematurely and are in a NICU facility?

According to Priya Singh, a few things can contribute to better outcomes in terms of breastfeeding and care of premature babies –

1. First and foremost, ANC counselling/parent counselling: If all the risks are calculated and time is available, detailed counselling of the parents can help build trust in the family beforehand. Now as we have already discussed that if the birth was spontaneous, initial counselling immediately after the birth of the child will provide the same benefits and will play an important role. Counselling involves several levels, like medical counselling, lactation counselling, counselling by the nursing team to start taking care of the baby.
2. Parent and family involvement in newborn care: If the medical condition permits, KMC should be started as early as possible. Skin to skin care will be physically beneficial for both the baby and the mother. Mother’s involvement in the daily care of the newborn such as KMC practice, changing clothes, cleaning, holding, positioning, feeding etc. makes mothers feel emotionally better and since they perform these tasks with the newborn under the supervision of the NICU nursing staff, they feel more confident to do them even after discharge and there is a reduced chance of any complication or readmission due to negligence.
3. Providing support to breastfeeding mothers: Once cleared by the neonatologist, they will need a space to wait at the health care facility for daily KMC (skin-to-skin contact) and breastfeeding and will be able to use a breast pump to express milk whenever required.

Breastfeeding can be challenging if the baby is in a NICU facility and separated from the mother, Priya Singh suggests that the following parameters should be taken care of most –

1. Colostrum Storage: Once the mother is relaxed, colostrum, which is the first milk, is thick and contains high amounts of immunoglobulins containing all the necessary nutrients, can be collected in a syringe using hand expression technique and sent to the NICU.
2. Milk Expression and Breast Pumping: There are two ways of expressing milk 1) by hand 2) using a breast pump. Obviously, if the reliance on expressing milk is high, investing in a breast pump will prove to be very helpful for the mother. Considering how frequently the mother will be expressing breast milk, investing in an electrical or hospital grade breast pump will prove to be very helpful as it takes less effort to collect breast milk and also ensures effective expression of breast milk, thus preventing many breast problems.
3. Maintenance of milk supply: It works on the principle of demand and supply. Early initiation of skin to skin contact i.e. KMC stimulates higher centers enabling milk production and release of hormones (prolactin and oxytocin). KMC helps in regulating the vital organs of the baby. Improves bonding between mother and baby which benefits the breastfeeding journey in the long run. The recommended dosage of KMC for a low birth weight baby is 8 hours a day.
4. Effective Drainage of Existing Supply: Use the correct size breast pump as per the guidelines provided. Warm compresses and quadrant breast massage before expressing are considered beneficial in case of heaviness or swelling in the breast. In case of breast pain, use cold packs which reduce redness and swelling.
5. Storage Guidelines: Breast milk can be stored in a good quality plastic bottle or glass bottle or in a silicone pouch with the correct date and time.

• Breast milk can be stored at room temperature for up to 4 hours
• It can be stored in the refrigerator for 2-4 days.
• It can be stored in the freezer for 6-12 months
• Milk taken out from the refrigerator or freezer can be thawed in water heated to 37°C. Avoid heating the milk over direct heat.

6. Positioning and Latching: Explain and explain the different grips, especially when there are twins to care for and who

• Hold the cradle
• Cross Cradle Hold
• Football Grip
• Double football hold

7. Adequate nutrition and use of galactagogues: Balanced nutrition is vital to maintaining a mother’s health and breast milk supply. Seeking professional advice can benefit mothers in many ways. Galactagogues are milk boosters that can be found in food as well as available as whole supplements. These can only be prescribed by a lactation consultant after ensuring effective drainage and breast assessment.

Caring for a premature baby in the NICU and enabling breastfeeding is a team work that involves the health care staff and the parents. Getting all the information from the right sources is important and allows you to make informed decisions.