Congratulations, your baby has arrived! But she’s a little earlier than expected. You will most likely find yourself in very unfamiliar territory. Your baby is hooked up to machines and you have been discharged from hospital without her. Things are not going as you thought they would and quite frankly it can all be very scary. One of the first questions you may be asking is… when and how can I breastfeed my baby?
Firstly, breastmilk is absolutely the best food for your baby. The sooner she can get it, the better. If your baby has been taken to the neonatal intensive care unit (NICU), it is important that you begin expressing within 3 hours following birth. The hospital should have an excellent grade of breast pump sterile and ready for you to use. They will also be able to guide you regarding storage of breastmilk for your baby.
The sucking and swallowing reflexes do not fully mature until about 36 weeks gestation. Your baby will need to be able to coordinate these reflexes simultaneously in order to drink milk. For this reason, your baby may be fed your expressed colostrum and later breastmilk through a nasogastric tube (a tube that is fed through the nose and directly into your baby’s stomach) until she is ready and able to latch.
At this stage, it is a good idea to offer your baby a dummy during feeds. By doing this, your baby will learn to associate suckling with the feeling of fullness. If you are able, you can also hold your baby at your breast during tube feedings.
Work closely with hospital staff as well as a qualified lactation consultant during this time as they will be able to determine when your baby is ready to nurse. In the mean time, continue to express every 3 hours during the day and every 4 to 5 hours at night in order generate a good milk supply. You may also want to ask your healthcare professional to help you spend some time with your baby in Kangaroo Care – this has been proven to not only speed up growth and development in premature babies but also to help establish and maintain successful breastfeeding.
Time To Latch
The time has come and you have finally been given the go ahead to latch and feed your baby. Bear in mind that this will generally be a slow and easy process. One feed at a time and often this feed will be interspersed with much resting in-between. This is a season when you and your baby are getting to know one another and feeding can initially take lots of practice until you both get it right.
Feeds will start with just one a day at your baby’s happiest time of day and gradually be built up over a few days until your baby is strong enough to come off of the nasogastric tube and breastfeed completely.
Ideally one should sit comfortably in a quiet and private area, close to any equipment that is needed. Use pillows to support your back and another to support your baby. Be sure to avoid any unnecessary stimulation such as bright lights, loud noises, stroking, rocking or even talking to your baby – this can all be very overwhelming for your baby. remember that learning this new skill of feeding at the breast requires a great deal of energy and attention from your baby.
Some mothers find it best to express a little before attempting to feed as this will encourage the let down reflex without baby having to work too hard.
The cradle hold is favoured by most perm babies as well as their mothers. Hold your baby at the same level as your breast, supporting her entire body with your forearm. Use your free hand for additional support on her neck and shoulders. Once baby has latched you can remove this additional support and relax. Make sure that tiny hands and arms are out of the way as this can cause unnecessary frustration for both you and your baby.
Gently guide your baby’s mouth towards your nipple stroking her top lip to encourage latching. Unless part of your breast is actually touching your baby’s face, she will not know that the breast is there.
Because of the immature neurological system of preterm infant, your baby may not open her mouth automatically to latch right away. Gently moving your baby’s face away from the breast and then bringing her back might help. Alternatively, you can try pulling down on her chin with one finger and waiting for her tongue to drop down to the base of her mouth before gently guiding her to latch. If this method still does not work or if it is needed for more than a couple of attempts, it would be wise to make use of a nipple shield until your baby is able to respond appropriately.
Try to refrain from holding your breast with your free hand while feeding as this can limit baby’s ability to latch resulting in poor milk transfer and possibly, sore nipples.
Avoid touching your baby’s face while feeding. Her routing reflex will develop at around 33 weeks gestation and touching the cheeks, lips or chin may cause your baby to turn towards your touch rather than towards your breast.
If your little one’s nose is pressed up against your breast, do not push your breast in to make space as this may cause her to come off the breast. Rather, gently adjust your elbow and tuck her bottom in closer to you – this should angle her nose up giving her space to breathe.
Should your baby experience gulping or choking, adjust her position to make sure that her head is now lying higher than her tummy. If this does not help, you may want to express a little before attempting to feed as this will allow your baby to nurse with a less intense milk flow until she gets the hang of sucking and swallowing.
Perseverance is key in these early weeks of breastfeeding. Keep in mind that learning to breastfeed is a big deal for both you and your baby. Take it easy, one feed at a time and remember that every little bit of progress, no matter how small means that you are one step closer to taking your baby home. Try to mingle with mothers who have been through this before and don’t forget to look after yourself as well – you are going to need your strength and energy for when you get to bring your baby home.
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