Monday, August 03, 2009

World Breastfeeding Week 2009: Preemies

"The milk produced by the mother of a pre-term infant is higher in protein and other nutrients than the milk produced by the mother of a term infant. Human milk also contains lipase, an enzyme that allows the baby to digest fat more efficiently. Your breastfed premie is less likely to develop infections that are common to babies fed breastmilk substitutes. He will be protected by the immunities in your milk while his own immature immune system is developing."
- La Leche League International, "Is Breastfeeding Important For My Premature Baby?"

I consider premature babies an emergency, for 3 reasons - 1, they often have undeveloped lungs and need to be placed in the NICU, 2, thus separated from their mothers they are fed formula instead of colustrum and milk which would help protect them from infections and help them thrive, and 3, mothers and fathers have to fight to be able to give their preemies "Kangaroo Care," even though it is proven to help them develop.

The following is an excerpt from "Handout #1a. The Importance of Skin to Skin Contact. Revised January 2005, Written by Jack Newman, MD, FRCPC. © 2005"

"Studies have shown that even premature babies, as small as 1200 g (2 lb 10 oz) are more stable metabolically (including the level of their blood sugars) and breathe better if they are skin to skin immediately after birth. The need for an intravenous infusion, oxygen therapy or a nasogastric tube, for example, or all the preceding, does not preclude skin to skin contact. Skin to skin contact is quite compatible with other measures taken to keep the baby healthy. Of course, if the baby is quite sick, the baby’s health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin to skin with the mother immediately after birth. Indeed, in the premature baby, as in the full term baby, skin to skin contact may decrease rapid breathing into the normal range."

The University of Michigan created this Breastfeeding Wheel to show the steps for breastfeeding a premature infant.
This is their description for each step:

Step 1 - Skin-to-skin contact starts as soon as infant is stable, and is the first step toward breastfeeding.

Step 2 - Mouth / nose against the nipple. Baby may just rest with mouth against nipple.

Step 3 - Mother expresses milk for the baby - With mouth against nipple mother expresses drops of milk or colostrum onto baby’s lip. Baby may lick nipple or open mouth and---

Step 4 - Smell, Suckle breast, or may open mouth and hold nipple or take one or two tentative sucks.*

Step 5 - Rooting - Baby is awake and alert and actively searching for breast. Putting hands into mouth, licking and showing feeding cues. *

Step 6 - Awake / alert for first suckling. May take one or two sucks, or have a sucking burst of five to fifteen sucks, with long pauses between sucking bursts, or may take a few sucks and come off breast. *

Step 7 - Holding on to the nipple- Suckling and swallowing. Infant has sustained nursing session, may last for 5 to 10 minutes or longer, with frequent pauses but stays latched on to nipple. May nurse with eyes open or closed. Soft swallows can be heard (sounds like ah). *

Step 8 - Breast Meal - Check weight, reduces supplements. As infant takes more milk at breast, he/she will need fewer supplements. Consider pre and post test weights on Baby Weigh Scale. *

Step 9 - Breastfeeding partly on demand. When infant is awake and showing feeding cues, and mother is available, baby should be breastfeed. When sleepy or not interested in feeding Baby should be gavaged.

Step 10- Mother and baby are together day and night and breastfeeding frequently. This step often does not happen until after discharge from the hospital, and frequently is around or after the date baby was due.

*A "wheel" rotates in both directions. Baby may be at Step 6 for one feed, and then move back to Step 4 for the next several feedings. Patience and support, for both the mother and infant are most important!

I found, with my hospital births, that it was a constant fight to keep my babies with me. On the surface they seemed supportive of my desire to co-sleep and feed on demand, but then different procedures kept coming up that separated them from me for long lengths of time, procedures that were more "CYA" than evidence-based.

It is counter-intuitive to prepare yourself to demand that hospitals act in accordance with logic and current research. The hospital's number one goal is the well-being of my child, is it not?

Hospitals are first and foremost businesses that must remain profitable and reduce liability. I have actually come across family doctors who stopped delivering babies because of the restraints placed upon them by hospital policies.

If you have a premature baby, breastfeeding and holding that baby is vital. Do not let hospital policy stand in your way. Do not leave your child in the hands of "experts."

"When my grandson, Sebastian, was transferred back to the local hospital at a week old, my daughter-in-law was surprised to have the nursing staff tell her that it would be too stressful for the baby to continue with the Kangaroo Mother Care she'd been doing.

"Too stressful?" she asked. "Well, let's just see." Sebastian was already connected to monitors that traced his heart rate, his breathing, and his temperature on the computer. She settled him against her chest again and buttoned up the bottom of her shirt to keep him warm and secure. We watched the lines on the graph. His breathing became more regular, his temperature more stable, and the pattern of his heart beating less jagged and erratic.

The nurse looked, too, and didn't say a word. But no one suggested he be put back in the incubator, and from that day on, until Sebastian came home three weeks later, he spent much of the time enjoying KMC -- easing his transition into the world."

- from Kangaroo Mother Care: Easing Baby's Transition into the World
Teresa Pitman, From NEW BEGINNINGS, Vol. 24 No. 2, March-April 2007, pp. 52-55


  1. Friends of mine were also told that Kangaroo Care was too stressful for their horrible that nurses give such bad advice sometimes for no reason other then being ill informed.

  2. This is one huge reason why I have absolutely NO desire whatsoever to go back to a hospital to have a baby, too many "policies". What really disgusted me was that I was SEVERELY sleep deprived by the time I left because they kept waking me up to feed my daughter because she was breastfed but when my younger sister was there as long following her cesarean, because she didn't breastfeed that week (she actually put the baby back to the breast due to constipation issues), the nurses never bothered. She got all the rest she needed to go home.

  3. Our problem was that American Fork's policy was to remove the baby from you while you slept. You could lie with the baby, but if you were asleep you couldn't possibly watch out for her safety. They'd only let it go if Bryan was there and awake. So, I had to sleep VERY lightly, and as soon as someone opened that door, I had to open my eyes and look like I hadn't been sleeping.

    And the non-evidence based bililights policies are a whole other blog post.