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If you stop pumping after 10 or 15 minutes while your milk is still flowing, your baby may not receive these valuable fat calories. This will mean that your supply will not dry up, and then when you come off the medication you can try to reintroduce breast milk if you so wish. Even worse, some techniques have been adopted that make the situation even more difficult. How can the baby be fed without using fortifiers? However, fortifiers are now being made from human milk breastmilk but admittedly they are not easily available yet and are very expensive as well. Suckling stimulates the back of the palate, and results in intense vagal stimulation, which is vital for the general wellbeing of the baby. Our aim to to try support parents in whateverfeeding choice they want for their baby, whether its your expressed breastmilk, donated breastmilk, breastfeeding or bottle feeding with formula.

A mums experience of using donated breast milk for her premature baby Harry.

Breastfeeding With a Supplemental Nursing System

If you have received one of these pumps as a gift, you will be able to use it later-after your baby comes home and is feeding. But, in the first few weeks after premature delivery, you should plan to rent a hospital-grade electric pump. During your first week or two of milk expression you should use the pump as frequently as times daily-about as often as a healthy, full-term baby would feed at the breast in the early days after birth. The purpose of this frequent pumping is to stimulate prolactin during the time that your body is beginning to make milk in plentiful amounts.

While you may get only drops of milk at first, frequent pumping is important in building an abundant, long-lasting milk supply. You may not see the results of your pumping immediately, but your efforts should pay off toward the end of the first week of milk expression.

Do not set a clock to wake up at night to pump. However, if you wake up on your own-as many mothers do-an extra night-time pumping may help boost your milk supply. You may want to call the nursery, check in on your baby, and use the pump before going back to sleep.

How Long Should a Pumping Last? In the first few days after birth, most mothers express very small amounts of milk-from a few drops to a few teaspoons-at each pumping. During this time, a pumping session should last from minutes, which is enough time to stimulate the release of prolactin. However, after the milk has "come in" several days later, and you produce more than half an ounce at each expression, you should use the pump until your milk has stopped flowing for at least minutes. Also, your breasts need to be emptied as much as possible--meaning that milk flow has stopped-otherwise your body thinks that the milk left in the breasts isn't needed, and less will be produced.

A few mothers say that the milk never "stops" flowing while they pump. As a general rule, you should not pump for more than 30 minutes, even if milk continues to flow. Also, if you pump for this long at each milk expression, you do not need to pump as frequently as a mother who can express her breasts in less time.

What is a "Normal" Amount of Milk? Nearly all mothers of premature babies worry about whether they are producing a "normal" amount of milk. Many things affect the amount of milk a mother produces-especially in the first few days after giving birth. A mother of a full-term breastfeeding baby produces only about an ounce of milk during the first 24 hours after birth, but by the 3rd or 4th day is making several times that amount. Mothers of prematures frequently take a longer time to go from a few drops to an ounce or more at a pumping.

This condition is referred to as a delayed onset of lactation, and is related more to pregnancy complications-such as bedrest, medications for high blood pressure and premature labor, and Cesarean deliveries-rather than to premature birth itself.

No one knows exactly why this is the case, but researchers think that the milk-making hormones or tissues in the breast may be affected temporarily by these complications and medications. A slower onset of milk production does not necessarily mean that a mother will not make enough milk for her baby-only that it may take her a few extra days in the beginning to catch up with mothers who have had uncomplicated deliveries.

Ideally, by the end of the second week of pumping, you'll be producing at least ml about two cups of milk each day. This is the amount of milk that your baby will need at the time of hospital discharge. Thereafter, you will want to maintain or even increase this amount so that you have enough milk to feed your baby after discharge hospital discharge.

Fatigue, pain, and stress-all of which are common among mothers of prematures-cause the body to release a substance that interferes with prolactin. While it may be difficult for you to overcome all of these barriers, most of these do diminish or become more manageable over time.

Some things have been shown to increase the milk supply. First, try to spend as much time in the nursery with your baby as possible during these early days, if that is where you are the most relaxed. Family members often feel that mothers should stay at home and rest after giving birth prematurely, but mothers report that being separated from their babies causes even greater stress.

When you are in the nursery, request a comfortable chair, and use the breast pump at your baby's bedside where you can see and touch your baby. When you are not in the nursery, pump where you can see your baby's picture. If your baby's condition permits, ask to hold your baby in Kangaroo--or skin-to-skin-Care.

Don't be afraid to take pain medications that your doctor has prescribed. These medications can be used safely with breastfeeding, and pain relief is important to milk production. In some instances, prescription medications may be used to stimulate prolactin and increase the milk supply. Typically these medications are used after the second week of lactation, and require a prescription from your obstetrical care provider.

Written by Paula P. Permission granted to distribute for non-commercial purposes For additional questions and for help in transitioning your baby to the breast when the baby is ready, talk to your doctor, the NICU nurse at your hospital, and your IBCLC lactation consultant.

For help in in finding a breastpump rental location or breastfeeding professional where you live, visit www. My story of expressing My daughter was born 8 weeks premature. For her age she was a healthy weight of 2kgs, but to us she was tiny! The day after she was born, a lovely nurse called Jade came along with the hospital pump.

She showed me how to use the machine and so the process began. We started off slow, 10 minutes each breast every four hours and working up to 20 minutes each breast. A day later nothing had come! On the second day, a few drops, and I mean a few appeared! Well the nurse, obviously humouring me, got a syringe and tried to suck up literally 4 drops of milk!

And proudly up I went to ICU with my produce! It was labeled and put in the freezer! They started tube feeding her very slowly at 2mls a feed.

Thankfully the milk started coming in faster and I kept up the routine of pumping every 4 hours around the clock. I wish a nurse would have told me then to keep going! In the hospital I felt like my care and the babies care were very separated as she was in ICU. I believe if she'd been in the ward with me, that the one nurse would have been looking after us both and I think it would have been easier.

For me, this was definitely a gap in the system. When I left the hospital, I purchased the Medula Swing and kept pumping away. I struggled to keep up with her demand. It seemed no matter how much I expressed I could get no more then 40ml a go.

It was difficult to fit in pumping too. I spoke to the nurse and my mam, and both convinced me it that the baby getting 7 EBM feeds and 1 formula feed a day was still great. When the baby started with the bottle to get her suck reflex to work, we saw great results. In my hurry to get her home, I left her to her bottles. When our daughter came home, I decided to hire out a hospital grade pump for a couple of months.

I kept going until she was 14 weeks old. At this point she was doing great and I decided to stop expressing as I was exhausted. I'm happy to have been able to provide expressed milk for my daughter at the beginning of her life, yes I would have loved to have kept going but thankfully today she is a happy healthy one year old and absolutely thriving. Deirde has kindly shared her experience of how she managed to express for 19 months for her son I have always been very pro-breastfeeding and always knew that if I ever had children that I would breastfeed.

Right through my pregnancy with my son Gearoid I never ever thought that I would have any problems. We were landed on the postnatal ward and my husband was asked to leave as it was in the middle of the night. By the time morning came Gearoid was in such distress, he was disturbing the other babies, he was hungry, I was exhausted as it was my third night without sleep and I asked for a bottle of formula, it arrived straight away- no problems getting help there!

I cried bitter tears giving it to him, but he was much happier. At 5pm and after a few more bottles of formula the female doctor who delivered Gearoid came to see me. I told her that I was getting no support with BF Gearoid, that I was fine, but exhausted, and wanted to go home.

She granted my early discharge. I rang my husband and asked him to collect us. On the way home we stopped at an all night chemist, where a bought the only pump they had- a hand pump, and a steriliser and bottles.

That night I tried latching Gearoid, and pumping- neither successful. The next day I rang a friend in New York, who recommended a double electric pump- I went out and got it. Oh the absolute relief when I was able to express colostrum. Gearoid got his last formula bottle at 2 days old and got a colostrum bottle that evening. He never received formula again.

Despite seeing a lactation consultant I was not successful in getting him to latch and I exclusively expressed for him for 19 months. He is the light of my life and I still feel very sad that I could not breastfeed him in the normal natural way, but I did my best. I often look of photos of me smiling with him in that hospital, but beneath that smile was a very worried and unhappy first time mom.

My very special daughter Eilis was born in February this year, and I prepared well by attending breastfeeding classes before the birth and making sure I got some support in the hospital. My husband also posted on the breastfeeding board with my questions from the maternity bed and that was a huge help. My daughter is now 12 months and I love love love breastfeeding her. The health benefits are brilliant obviously, but so is the experience.

How I exclusively expressed: This is for anyone who is currently exclusively pumping. I managed to pump exclusively for son for 19 months and never used formula, apart from the first few feeds. My daughter is currently on a nursing strike, she's 12 months and I am exclusively pumping for her too now, though hopefully she'll decide to like her mams boobs again, we have had the most wonderful 11 months of BF ever!

I live in hope. My knowledge in a nutshell: Until baby is 6 weeks they take around 15 oz a day, after this from oz a day, but every baby is different.

Baby will take less if premature. Until baby is 12 weeks you should express every hours at least and for minutes, to a total of pumps in 24 hours. Also one pump should be overnight, although I stopped that once DS started sleeping through the night. Once your supply is established at around 12 weeks you can slowly reduce the number of times you express so long as you are still producing enough milk.

Keep the stock rotated so that you use the oldest milk first. Heat, in a cup of warm water, only to take the cold out of the milk as if you overheat it you destroy some of the antibodies. Any traces of milk then stays fresh there. They are fine then for around 12 hours- this saves so much time and work. Finally you need a good professional grade double electric pump - I found the medela pump in style great, the ameda Lactina is a fab pump too and cheaper than the pump in style advanced.

Shop around - the prices of the above vary hugely. Several companies also rent professional grade pumps, from 75ee a month - so it works out cheaper to buy one of the above if you intend to exclusively pump for a while. PHNs quite often will lend a pump. This link though was invaluable to me at the time: I got most of this info over the months of pumping from kellymom.

Also if you find you are not producing enough porridge, fenugreek tablets from the health food store, fennel tea, non alcoholic beer, and Motilium tablets are all very good for supply. Motilium is recognised as being very safe to use, but again get your paediatrician's approval. You can get more information on this by looking up domperidone on Kellymom.

I strongly recommend though that you see a lactation consultant or go to a BF support group, esp. The course was paid for by the charity and open to the public and medical professionals.

Nicola O' Byrne from breastfeeding support ran the course for us. Due to the success of the course we will be running it again in a few months. We are in the middle of setting up breastfeeding buddies so parents can talk to other mums who have successfully breastfeed or expressed for their preterm baby. We are also working on producing a booklet on breastfeeding. If you have any expressing or breastfeeding problems and would like to talk to either an experienced mother or a professional lactational consultant, please contact the helpline and we will put you in touch with somebody.

Our charity works with the help of a wonderful lactation specialist who has ample experience of helping prem mums. If you are not in a position to finance this, we will try to cover the costs of one visit and some follow up phone calls. We hope it will help any mums who are in a position to consider breastfeeding their baby. Debra's experience of breastfeeding her son. It explores the development of breastfeeding capacity in very preterm infants, as an immature sucking behaviour is often mentioned as a barrier in the establishment of breastfeeding.

Breastfeeding a premie baby takes time and patience. It may be easier if you know why your baby acts the way he does. When will my premature baby be ready for breastfeeding? Your premie is ready to breastfeed when he can suck, swallow, and breathe on his own. Your premie will have a good heart beat,easy breathing, and good skin color. Babies have 6 different ways of acting,from deep sleep to crying. No eye movement, no bodymovement, steady breathing 2. Some eye and body movement 3.

Heavy eyelids that open andclose, some body movement 4. Wide open eyes that look around. Eyes open, more body move- ment, fussing 6.

Awake and upset Watch your premie when he is just waking up drowsy. Smack his lips 2. Stick out his tongue 3. Put his hands up to his mouth. How do I know that my baby is getting enough milk? While your baby is in the hospital, you can weigh him before and after breastfeeding to see how much he drank. After your baby is 1 week old, look for: Six or more wet diapers each day 3. He will start out sucking 1 or 2 times, then stop to rest.

He may need to practice over many feeds to get strong and use a nice pattern to suck, swallow, and breathe. Babies love to practice! Good sucking means your baby can keep sucking for more than 10 seconds before pausing.

Some premies may be home before they can suck well. You can stop 1 or 2 of your pumps at first. Continue to change the feedings slowly. You can find more information on their website http: Nils Bergman for allowing us to share their expert experience and research with us on our website. Breastfeeding the Premature Baby by Dr. Jack Newman Research by Dr. Jack Newman Introduction Mothers too often have preventable problems with breastfeeding.

Many hospital routines make it difficult for mothers and babies to breastfeed successfully. When the baby is born prematurely, mothers have even more difficulty with breastfeeding, and this is unfortunate because premature babies need breastmilk and breastfeeding even more than healthy full term babies.

Even worse, some techniques have been adopted that make the situation even more difficult. Premature babies need to be in incubators Actually premature babies, even very small ones, often do better skin to skin with the mother or father than they do in incubators. Evidence shows that premature babies and term babies too for that matter are more stable metabolically when they are skin to skin with the mother. Their breathing may be more stable and less distressed, their blood pressures are more normal, they maintain their blood sugars better and their skin temperatures better in Kangaroo Mother Care skin to skin care for most of the day than they do in incubators.

Furthermore, mothers and babies in Kangaroo Mother Care will more likely produce more milk, she will get the baby to the breast earlier and the baby will breastfeed better. A document from the WHO discusses this at length with many references. You can get it at the website http: If the mother is expressing enough milk, babies over about grams usually about 32 weeks gestation babies weigh this much, though there are exceptions can grow just fine with breastmilk only, perhaps with the addition of vitamin D or phosphorus, maybe.

These studies were done in premature babies given a just breastmilk b breastmilk plus banked breastmilk or c breastmilk plus preterm formula. The babies who got the preterm formula did grow faster and bigger but there was a price. How can the baby be fed without using fortifiers? Well, first of all, some babies will need fortifiers, true: However, fortifiers are now being made from human milk breastmilk but admittedly they are not easily available yet and are very expensive as well.

If the baby also has an intravenous, the fluid given orally is cut down even more. This restriction of fluid makes sense, for example, if the baby is on a ventilator to help him breathe because too much fluid may cause him to go into heart failure and prevent his coming off the ventilator. Premature babies cannot go to the breast until they are at 34 weeks gestation This is simply not true.

Indeed, some babies have gotten to full breastfeeding by 32 weeks gestation. This means breastfeeding, not receiving breastmilk in a bottle or tube in the stomach. With Kangaroo Mother Care and early access to the breast, it can be done elsewhere as well. Of course, every baby is different and some babies may take longer depending on whether they were sick with respiratory problems or other issues, but waiting until the baby is 34 weeks gestation before trying the baby on the breast is using the bottle-fed baby as the model for infant feeding.

See the following articles or refer your doctor to them: Early Human Development; ; The second article by Nyqvist had babies born as small as 26 weeks gestation and up to 31 weeks gestation and only a small minority ever used a nipple shield. The key is to take time to get the baby to take the breast well. This does take extra time compared to using a nipple shield with the mother, but in the long run the result is worth it. Nipple shields eventually lead to a decrease in the milk supply which makes getting off the nipple shield very difficult see the information sheet The Baby Who Does Not Yet Latch On.

The way to get the premature baby latched on is not essentially different from the baby who was born at term. See the information sheet When Latching and the video clips at the website nbci. These video clips do not show premature babies but the principles of a good latch are the same. Premature babies can learn to suck without getting bottles as shown, once again, from experience elsewhere in the world.

This is not a way to help the mother and baby. In any case it would not be true that the baby needs a bottle to learn. Furthermore, as different muscles are used when bottle-feeding vs. Premature babies get tired at the breast This is believed to be true because babies, not only premature babies, tend to fall asleep at the breast when the flow of milk is slow especially in the first few weeks.

The baby is given a bottle and because the flow of milk is rapid, the baby wakes up and sucks forcefully. Premature babies often do not latch on well, partly because we teach latching on so poorly. With a good latch, the use of breast compression and, if necessary, using a lactation aid at the breast to supplement if necessary, the baby will get good flow and not fall asleep at the breast. Get that flow increased and you will see that breastfeeding is neither difficult for the baby nor tiring for him.

Test weighing weighing the baby before and after a feeding is a good way of knowing how much milk the baby got at a feeding Test weighing presupposes that we know what a breastfed baby is supposed to get. How can we know since the rules that say a baby of this weight and this age should get x amount of milk are based on babies fed formula by bottle? And how can we say how much the baby would have gotten if he had been well latched on, with the mother using compression, especially if the breastfeeding is limited to a particular time or schedule like 10 or 20 minutes because of the concern that the baby will tire out?

The best way to know if a baby is getting milk well from the breast is to watch the baby at the breast. See the video clips at the website nbci. Premature babies need to continue getting fortifiers once they leave hospital This is a relative new wrinkle in the undermining of breastfeeding the premature baby.

Perhaps someone presented a paper at a conference that showed the baby gained better if the fortifiers were continued even after his discharge from hospital. But, again, more is not necessarily better and breastfeeding is more important than more weight gain, which is not necessarily good.

See the information on fortifiers above. Premature babies and their mothers run into breastfeeding problems much more frequently than do babies born at term. But these can be fixed. Get good hands on help as soon as possible. See also the information sheets available at www. From the biological perspective, in the immediate newborn period of Homo sapiens, skin-to-skin contact represents the correct "habitat", and breastfeeding represents the "niche" or pre-programmed behaviour designed for that habitat.

These are the four basic biological needs. Parturition birth represents a "habitat transition". In the new habitat, the basic needs remain the same. Research over the last ten years provides strong support for the contention that newborn itself in the skin-to-skin habitat, not the mother or the health services, provides these basic needs.

Oxygenation has been shown to be improved on SSC, to the extent that KMC is used successfully to treat respiratory distress. The breathing becomes regular and stable, and is coordinated with heart rate. When removed from incubator and placed SSC, oxygen saturation may rise slightly, or the percentage of oxygen provided to maintain good saturation can be lowered. Heart Rate is increased when placed SSC. Though we can regard this increase as being with the clinically normal range, what is seen is actually a return to the physiologically normal heart rate, the lower rate being due to "protest despair behaviour".

Infants removed from incubators and placed SSC show a rise in temperature and a dramatic drop in glucocorticoids, as predicted by the "protest-despair response".

Mothers are able to control the infants temperature within a very narrow range, far better than an incubator. To accomplish this, her core temperature can rise to two degrees Centigrade if baby is cold, and fall one degree if baby is hot. Skin-to-skin contact is better than incubator for rewarming hypothermic infants.

Self-attachment refers to the phenomenon that fullterm undrugged infants, left on their mother's chest and undisturbed, will all breastfeed spontaneously within one hour, with no help at all. But this behaviour is dependent on SSC. Mother and infant should NOT be separated. The stimulations the newborn gives the mother during SSC elicit caregiving and protective behaviours from the mother.

Even without the increased milk, with the vagal stimulation the infant receives, the gut is better able to use the milk provided, and grows faster. Immunity is improved, demonstrable even 6 months later.

Prematures seem to have poor immune systems, and are susceptible to allergies, infections and feeding problems in the first year of life. Early SSC dramatically reduces these problems. Infections are reduced when SSC and exclusive breastfeeding are firmly introduced.

Necrotizing enterocolitis a potentially lethal and very costly disease to treat has been dramatically reduced in many units following a KMC programme. In no published paper is a single adverse outcome reported for KMC. Positive effects on the mother are better bonding, healing of emotional problems associated with premature birth, among others.

Key to understanding breastfeeding behaviours in the transitional and newborn periods is "state organisation". State Organisation refers to the ability to control the level of arousal, or of being awake. A scale of state organisation can be described varying from deep sleep to hard crying, each being associated with particular behaviours and conditions.

For breastfeeding an infant should be in an awake state, and should thereafter be in quiet sleep for optimal development. KMC has profoundly beneficial effects on the state organisation of newborns. Quite apart from suckling as a means to ingest food, this behaviour has essential effects. Suckling stimulates the back of the palate, and results in intense vagal stimulation, which is vital for the general wellbeing of the baby. Suckling releases hormones similar to morphine in the brain, and gives powerful pain relief to infants.

While it was observed that ability to suck on a bottle only started at 34 weeks post-conceptional age, recent research has shown that suckling from the breast is possible at 28 weeks. Suckling is a myographically distinct behaviour from sucking, and research on sucking on bottles of premature infants shows it clearly to be stressful. Premature infants are unable to coordinate their breathing and their swallowing. What human milk lacks in terms of concentration, it makes up for in terms of variety, well over two hundred NPN compounds have been found.

These are related to the evolutionary immaturity of the newborn. This applies to Homo sapiens as fully as to other mammals studied. At high levels, these hormones are intrinsically neurotoxic to the brain, particularly areas of the hindbrain, and any area which may be already a little hypoxic. Find out about the other Medela business units: Breastfeeding for moms Breastfeeding for professionals Healthcare Company. Getting to know your newborn baby This is the moment you have been looking forward to for the last nine months: What can they see, hear and feel?

Reasons to use a breast pump You may ask yourself whether you will need a breast pump and if so, which one will fit your needs best. There is number of reasons for using a breast pump Going back to work after maternity leave Going back to work after maternity leave is a big challenge and it can be a highly emotional experience of balancing the demanding career and the time spent with the family Finding and instructing a babysitter Entrusting someone with the task of caring for your baby can be challenging - you will have to invest time and effort in finding a qualified babysitter How breastfeeding benefits your baby Breast milk is the perfect nutrition for your baby.

It provides exactly the right mix of nutrients and protective antibodies your baby needs Welcome to Medela Medela aims to promote the health of mother and baby thanks to the vital benefits of mother's milk. Created to enhance your breast milk feeding experience, Sonata is: Medela's quietest personal use pump for discretion in all situations, including late night pumping sessions Responsive: Ideal for initiating milk supply, long-term and frequent pumping More about.

Ideal for initiating milk supply, long-term and frequent pumping The research-based Symphony breast pump has been developed specifically to support mothers throughout their breastfeeding journey: Particularly gentle on extremely sensitive breast tissue Alleviates symptoms of engorgement and helps heal mastitis Brings out flat or inverted nipples Easy to use and discreet.

More milk in less time. Medela Breast Shells for sore nipples More about.

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