EPISODE 29

Breastfeeding a Premature Baby

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Episode Transcript

November 13, 2020

Is breastfeeding a premature baby different?! How can I know what I am doing and if I am doing it right?!

This is Maureen Farrell and Heather O’Neal. And this is The Milk Minute. An inclusive evidence-based podcast hosted by midwives and lactation professionals. That’s us. Here to talk to you about all things lactation and boobs, body positivity, mental health, all the Milky topics. Join us for another episode.

Hey everybody. Welcome to The Milk Minute. Hey guys, we wanted to make sure that we had this episode ready for World Prematurity Day in November. So we are going to talk about feeding a premature baby. And we are specifically talking about babies that are less than 35 weeks. Yeah. Between 35 and 37 weeks.

Those are like late preterm babies. So yeah, there’s still kind of preterm, but they probably won’t go to the NICU. They might, but they might not go to the NICU. And they kind of just come with their own bag of stuff to deal with. So we’re talking about preemie preemies that are less than 35 weeks. The chances are very good they’ll go to the NICU and different things that you’ll want to prepare for and things that you can do while your baby is in the NICU to achieve breastfeeding success.

Let’s take a minute to thank our sponsor¬†Aeroflow. Oh, tell me more about that. You know, do you ever wake up in the morning and you’re like, I would love to call my insurance company today? Literally never once have I thought that. Okay. So people at Aeroflow knew this. Good. And they decided that it would be in everybody’s best interest if they developed a business where they contacted your insurance company to order your breast pump for you. This sounds good. So you literally never have to call your insurance company to work out getting a breast pump, which is fantastic because no one ever wants to do that crap when they’re postpartum. And the other cool part is they will text you and let you know when it’s time for you to replace your pumping parts and when your insurance will pay for new ones.

So maybe, you know, your pump parts are fine for now, but if insurance is going to cover a new set, great. I mean, I don’t know about you, but I’m not really combing through my insurance benefits information postpartum to see when I qualify for replacement parts. No, not at all. Right. So we’re going to go ahead and put a link in the show notes for Aeroflow. And when you click that link, it’s super easy. You just put in all of your insurance information and then somebody from Aeroflow contacts you directly, and you have like a real person that you talk with and then they do all the dirty work for you. It’s fantastic. I couldn’t recommend it enough.

Please, just do yourself a favor and¬†get your pump through Aeroflow. It’s going to save you so much time and trouble. Right. And they have all the top brand name, pumps, replacement parts, and accessories. You know, they’ve got cooling gel pads. They’ve got those pumping bras, all the stuff you need. One place. Yup one place. So I guess the only thing left to say about that is you’re welcome. Yeah, you’re welcome.

We have kind of some basic guidelines for things you can hopefully plan for, but yeah, I wanted to kind of start out, like, if you are pretty sure you’re going to have a baby before 35 weeks, so maybe you have a particular condition prenatally where that’s really likely, or you, you have to be induced or have a C-section for some reason earlier than then, or you have preterm labor stuff like that.

Like let’s, let’s start with okay, so you’re pretty sure your baby’s coming before 35 weeks. What do we do next? Well, as providers, I’m always trying to get you in with a consult with the NICU team to talk about what you can expect at the birth all the way up until the very end of your NICU stay and taking a tour of the NICU.

So that can just eliminate a lot of fears that you might have that, you know, just the fear of the unknown, like where’s my baby going to be going? Who’s going to be taking care of them? When can I see the baby after I’m done with my birth, you know? Baby probably is going to get rushed to the NICU because that’s where it goes.

After you have a baby premature that’ s going to probably need a little extra help. So, you know, just helping your brain understand that nobody’s stealing your baby. You can go visit them usually a couple of hours after. And then at what point can you start the feeding process or the pumping process?

Yeah. And I think that’s really important. You know, most of the clients that I support who are having a premature birth, you know, I’m just, I’m their doula. I’m no longer their primary care provider there. And that’s what I always encourage them to do. I’m like, hey, if your doctor hasn’t set this up yet, you should talk to the NICU, talk to the charge nurse there, figure out who’s going to be your ally in that situation.

Who’s going to be the person you go to when you have questions? Yeah. What does it just physically look like? Cause every NICU is different. The like protocols and set ups and time slots are all going to be different in every facility. Whether or not, you know, you can stay with baby or whatever.

Like that’s different by facility and country and region. So I encourage you, if you have a high likelihood of having a premature baby to figure all that out prenatally. Yeah. And then also just like a quick note, if you are a pregnant person who is naturally leaking colostrum in pregnancy, you can go ahead and collect that milk in milk saver shells, and freeze them in syringes for after the baby is born.

Like say you’re a person that always has your babies early. Like there are just some people that have preterm labor and they know what’s going to happen. So you can start wearing those milk saver shells, like even in the shower, that’s a classic time that you let down. So, you know, just grabbing them right after your shower, when you start to feel the let down and collecting it because they will use those syringes of milk to colonize the baby’s gut and set them off on the right track when they’re allowed to eat.

Yeah, absolutely. And to be clear, we are not recommending that you pump at that point because nipple stimulation can cause contractions and labor. So we just want to make sure, especially if you’re already somebody in a danger zone there. Like, we’re not encouraging that anymore, but wearing milk saver shells or putting a little cup under your nipple if you see yourself like leaking, when you get out of the shower or something, that’s all great. Save that stuff.

It has to be collected in a clean way though. So like make sure you’re grabbing a sterile cup because if your baby is a NICU baby, we have to be extra cautious about sanitation and making sure that you’re collecting this milk with the least amount of bacteria possible.

Yeah. I like to get a pack of little medicine cups that are sterile, things like that that are just easy to collect milk in. Especially if you’re hand expressing, say after birth, you know, like you’re not going to get an ounce of milk. So it’s nice to just have a really small container, right. And, and understand that a small amount is what’s expected.

You’re not supposed to be collecting ounces and ounces of milk. Even two drops is good because you can actually take those two drops on your finger and you can wipe it around inside the baby’s mouth, on their gums. And that is going to do several things. That’s first of all, they are getting colonized with your flora and then also they’re getting to taste their mom, their mommy’s milk.

And then they’re also, you are introducing some antibodies, which is great. So don’t think that just two drops is nothing because it’s something. Yeah. And digestion starts in the mouth. You know, it starts this whole chain reaction that baby has never experienced before. So it’s okay to just start real small.

Yeah. It can kind of wake up their bowels, you know, like in the morning when you drink that first sip of coffee and you’re like, God, I have to poop already. Like it’s not really the stimulant in the coffee yet. It’s that your digestion has been activated. It started in your mouth. So your baby might actually pass their big meconium plug because you had those two amazing drops.

Yeah. So when you know that you’re going to have a preemie. Say you go into labor and you’re like, oh gosh, it’s too early. I’m going to have a preemie. Immediately get through your head that this is now not normal. So you don’t have to force yourself to do all the normal things that we normally tell you to do.

You are now in a zone where it’s okay to do things a little differently just because you have to. So for example, we tell people not to pump immediately, not to pump for a while after they have a baby. So in your case, if you’re going to have a baby that goes to the NICU, that’s no longer true. If you are separated from your baby, we need you to pump within the first two hours after birth.

And then every two to three hours around the clock after that. I mean that’s overnight and everything because we are simulating having a baby there. If your baby’s not there, we need to pretend that we have one with your pump. And if that doesn’t happen, then we just don’t see a good supply coming in and it kind of starts you off on a, on an even weirder foot.

Yeah. And I think sometimes very well intentioned nurses will say, oh, you know, pump every three to four hours just when you can. Because you know, they’re feeling bad for you and you’re tired and maybe you had unexpected surgery and you know, who knows what happened. However, if it’s really important for you to be breastfeeding your baby and exclusively giving them breast milk, then that’s not setting you up for success.

Right. And it actually starts even before that. So if you’re having a premature baby, you look directly at your provider and say, I want delayed cord clamping. And they should say, okay, because this is pretty, pretty standard now that we delay cord clamping with all babies, but especially preemie babies. Because they, more than anybody need that extra volume of blood.

Because when they go to the NICU, they’re going to get blood draws frequently, probably. And they have a much less risk of having a blood transfusion or needing a blood transfusion if they had delayed cord clamping. And it also prevents brain bleeds and it’s just, prevents anemia and they get out of the NICU faster if they have had delayed cord clamping.

And also of course babies that are not anemic and babies that have that blood volume are going to breastfeed better. So please make sure that your provider is on board with delaying that cord clamping even if you’re having a premature baby. Yeah. And you know, the reality of delayed cord clamping in a hospital is usually 60 seconds, but 60 seconds is better than nothing.

You know, I still say if you can advocate for more, advocate for more, because most placentas are going to keep having blood transferred to the baby through that cord for several minutes after birth. I’ve felt some cords pulsing twenty-five minutes postpartum. So, but that, you know, usually within the first five minutes, most of that is transferred.

Yeah. I mean, and they might tell you no if you’re in the OR and you’ve had to have a C-section just because it’s so cold in there, you know, they can’t keep a teeny tiny baby in such a cold environment for too long. But definitely, you know, they should be able to do 60 seconds. And then we want to make sure that you are getting to do skin to skin as soon as possible.

So if you are able and the baby is able, then you can advocate for that. But there’s a chance that you might not. So just understand that it’s normal to be told no to do skin to skin. They have to get that baby stable first, but that is always going to be one of the goals that you’re shooting for. Like as soon as we possibly can, let’s get that baby on your skin to do kangaroo care in the NICU and they can do their procedures and their vital signs and a lot of their assessment while they’re on you during kangaroo care.

So don’t be afraid to ask. Yeah. And you know what, for a lot of NICU parents, that might not happen for a week or two, if things are really severe with baby, but don’t think that then it’s not worth it to advocate for that. Any amount of skin to skin with your baby at any age is going to be beneficial for both of you.

And not even just to feed. Just having them skin to skin, stabilizes your stress hormones, and it stabilizes their stress hormones and their vital signs. And it’s also going to stimulate your nipple/ nipples. So even if, even if they’re not. Your one big nipple right in the middle of your chest.

Right. Who knows? I haven’t seen, I haven’t seen every nipple in the world. Yep. Not yet, but we’re on our way. If Facebook doesn’t shut us down first for violating community standards, that’s pissing me off anyways. Even your baby, just nuzzling your nipple is going to help stimulate your nipple. So don’t think it’s not doing anything.

It’s definitely doing something. Yeah. And if, you know, if you can manage it, doing skin to skin care while pumping is going to make your pumping output better. You know, and yeah, sometimes it’s hard. You’re like, huh, baby. I don’t know. But if you put on one of those hands-free bras and kind of tuck baby in up top, cause they’re usually pretty small.

You can, you can manage both sometimes. Or even just like just do one breast and have baby on the other side, you know? Cause that’s just gonna hopefully help your hormones really line up. Yeah. And, you know, mentioning that, they’re probably not going to let you sleep at the NICU. So when you go home. The USA, most facilities won’t, but a lot of other countries have started implementing rooming in with baby as a norm.

Wow. That’s amazing. And I wish we could get there. Yeah. I think that at the perinatal partnership summit two years ago or something, there was someone presenting from a hospital up in the Northeast where they had just renovated their whole NICU. So everything was rooming in and it was so awesome. So those changes are happening in this country, they’re happening in other countries.

So it’s absolutely worth asking if it’s possible for you to remain with baby. But if you can’t, you still have to pump at home around the clock. Remember that, like, if you miss those middle of the night pumps, you will have supply issues, most likely. So when you go home and you’re trying to pump in the middle of the night, try to look at a video of baby.

If the NICU doesn’t have live video feed of your baby that you can get on an app, you can take videos of your baby throughout the day, while you’re there, and then watch them while you’re pumping. It’s going to help your milk let down much easier and get your hormones where they need to be to get this milk.

And I’ve even heard of people getting a weighted toy and like cuddling it while they pump, which just like, you know, we all love cuddling stuffed animals. It gets your oxytocin flowing for sure. Gosh, what else was I going to say? Oh yeah. I was going to say, if you don’t live near your hospital, at least in the United States, you usually can find a¬†Ronald McDonald house¬†or another similar organization that provides housing for NICU.

Yes. I think the rule is you have to be 40 miles away from the hospital to qualify. Yeah. And you don’t have to be like in need or anything financially. I think you qualify, if you are. Yeah I think it’s just distance based.

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Hmm. That sounds really nice. Well, it is really nice. Nice because I mean, I used to get really bad cramps myself and I had a lavender heat pack that I would put on. And it just makes sense that you would have one for babies. Yeah. I was kind of just thinking like, Hmm. I could use this for my own self. Yeah.

I mean, it’s got a mixture of lavender, chamomile, lemongrass, peppermint, and spearmint. Oh, I love that. Yeah. I mean, how great is that? If I had gas and you came over and just tied that around me, I would love you. You would be a happy baby. I would be one. I’d have one happy tummy. Yeah. We have an exclusive offer for you, our listeners.

If you¬†go to Happi Tummi’s website,¬†you can enter a promotional code, MILKMINUTE10 for 10% off. Yeah. And they have way more products than just that. That just happens to be my favorite one. Yeah. So we’ll put the link in our show notes. Yes. And don’t use gas drops. Just get Happi Tummi. Yes. Again, it’s promo code MILKMINUTE10 for 10% off.

The important thing to remember with these NICU babies, are their biggest issues. Because if you can understand what their biggest issues are, you can understand why the feeding is going the way it’s going or not going. So their biggest issues are their ability to coordinate, suck, swallow, and breathe, which is very difficult for them.

Just neurologically they don’t begin to get a sucking reflex until 34-ish weeks. Yeah. Like all of the reflexes that we check for in the newborn exam that are going to help them coordinate those movements just are not there. Yeah. They’re little neurons are just like freaking out when they’re trying to suck. And then they choke because they can’t figure out how to swallow and breathe at the same time.

And then they will have a spell, you know. We call it spelling in the NICU where their O 2 saturation start to dip and their heart rate starts to slow down and they turn blue and it’s really scary. So if you are home any point in time with any baby and they do this, I want to make sure you know what to do.

So someone is going to call 911 because regardless of whether or not the baby pinks up again, they still have to go to the hospital. If they’ve had a spell, they need to be monitored for 24 hours to see why and what happened to make sure it doesn’t happen again. So somebody is calling 911, and somebody else is stimulating the baby.

You don’t shake the baby, but you can take your hands up and down its back and just rub its back forward and away from yourself and you can flick their feet and just kind of help them come to. Sit them up. If they’ve got milk kind of like draining out of their mouth when they are staring at you, like they’re shocked, pat them on the back pretty hard.

Trying to clear any milk that might be in the bronchials that they’ve inhaled by accident. And just so you know, breast milk that’s inhaled into the lungs is actually, it’s obviously not great, but it’s, it should not cause aspiration pneumonia like formula would. So if your baby inhales breast milk, it’s okay.

We just need to get them breathing again. So that’s what you do if your baby has a spell. And of course those little Owlet socks are great to have, especially if you’re bringing home a NICU baby, if you’re ever scared about that. Yeah. Sort of, I don’t know. We don’t. Like actual data we have on those is really like, do they actually help that much? I don’t know.

So I don’t know if they help, but they can help anxiety. Yeah. Yeah. Maybe we’ll have to do a whole episode on those because I have thoughts. Anyway, I got a lot of thoughts on that. So many thoughts, but then the other biggest issue that they have is maintaining their energy to finish feedings. Yeah, without burning too many calories.

Yep. It’s really hard for them to stay warm enough and active enough just to complete normal tasks that babies do. And you know breast milk isn’t very high in calorie and digestion requires a lot of calories. It takes up a lot of energy to actually digest the food. So we want to make sure that they are positive on the side of calories, you know, for what they’re digesting.

So, you know, we’re not eating celery here. Right? So some options that you can advocate for in the NICU, we wanted to go over these because I think a lot of people just don’t know what to ask for to make your breastfeeding journey easier. You can always ask if your baby can non-nutritively suck on your breast after you pump.

So some babies are not ready to take food by mouth in the NICU. So for whatever reason, maybe they’re getting food through an IV. It can happen for a number of reasons, but the option to have them suck on your empty-ish breast is an option for some babies, as long as it’s not going to cause them to burn too much energy.

Always every single day you’re in there ask your NICU team when you can try regularly breastfeeding. And just remind them like, Hey, I want to do this. I understand that it may not work this time, may not work next time, but I want to try it. Can we try it today? You know, and there’s no rule that says babies below X age can’t breastfeed. Babies who are 27 weeks have been able to successfully breastfeed babies who are 34 weeks have been able to successfully breastfeed.

It’s just, it entirely depends on what their state of health is and what their specific health problems are at that point. And you never know when it’s just going to work. Right? Exactly. And I’ve seen it so many times where the team is rounding on the babies and it’s pretty subjective. They round with the nurse and they say, how was the baby last night?

You’re like, oh, pretty good, stable vital signs, blah, blah, blah. That’s the perfect time for the nurse to advocate or the parent to advocate for, “hey, since the baby’s doing okay, like when can I start direct breastfeeding?” And sometimes they’ll stare at you and they’ll be like, yeah, let’s give it a try and they’ll let you do it maybe like once a day.

You know, because they don’t want to burn too many calories for the baby, but they’ll be like, yeah, let’s see how it goes. It’s super important. So just remind them, it’s fine to remind them. Absolutely. And then something else you can advocate for is asking for a room to room in, in the NICU for a few nights before you’re discharged.

So even if you have one of those hospitals, that’s not that bougie where you can’t stay in the NICU all the time, they typically have a couple of rooms that they will allow parents to room in before you’re discharged. So just ask for an extra night if you need it. You know, they might standard, I think is one, but there are times where if you’re just really anxious about taking home your preemie, or you need to work with the lactation consultant they have on staff there are a couple more times, ask for a couple more days.

The worst I can do is say no. Yeah, and just, you know, never forget that any amount of human milk that you’re giving your baby is beneficial. Even if they are mostly supplemented with other foods, even if you’re never going to fully be able to exclusively breastfeed, that’s okay. You know, NICU babies that are fed breast milk are discharged sooner than their formula fed counterparts.

And we just see this again again, again. It reduces the chance of so many different complications that we see NICU babies have really commonly, especially the GI stuff. Yeah. Like NEC. Oh the, yes. What NEC is, our shortened form of just basically bowel death. Where their bowels just start kind of slowly turning black in time and breastfed babies just don’t have that as much.

So that’s a huge perk. And then as far as just like the day-to-day babies living in the NICU, remember that there are other options other than bottle feeding. So I’m not saying the nurses are going to agree to cup feed your baby every single time, but you could. You know, if, if you are alone and you don’t want your baby to associate bottle-feeding with you, because you want to breastfeed, you can try cup feeding your baby.

And that is fine because the research actually shows that babies get less stressed out by breastfeeding than they do bottle feeding. Bottle feeding can be very stressful. It’s not the most natural experience for them. And they have more gas that they’re taking in just naturally with a bottle, which can be hard on their tinier tummies.

So, and they’re trying to negotiate that with their reflexes and stuff. So their vital signs tend to improve when they’re breastfeeding. So just remember that. Yeah. So just remember cups, spoons. You can sometimes use a feeding tube on your finger and let them suck on your finger. And you can always try an SNS, a supplemental nursing system, but we’re going to actually do a whole separate episode on that, because that can be a little complicated.

But those aren’t, you just have a bunch of options here. Yeah. So keep pumping for your baby. Remember that cleanliness is very important for a premature baby. So when you’re pumping at home, you cannot be too clean. You need to be sanitizing your pumping parts once every 24 hours and washing with soap and water in between, air drying and making sure that they’re covered and not getting nasty stuff spilled on them.

We have a whole¬†cleaning pump parts episode¬†that you might want to go back and listen to if you have a NICU baby, but making sure that you’re washing hands before you’re pumping just all that stuff. Please be very careful. Yeah. And this is the time, you know, a lot of, a lot of our episodes, we’re like, okay, this is the guideline, but here’s what most people do.

This is not the time to deviate from the guidelines. Yeah, this is the time that we’re like, no, you really need to do everything you possibly can to give this baby and you the best shot. So then there will come a time when your baby is discharged and you get to bring that baby home. And it’s always so funny when you bring a baby home because you look at them and you’re like, so you live here now.

Like nobody is gonna come take you away from me. Yeah. But ain’t, nobody makes us wake up at 7:26 for a feeding again. It’s so funny. Just mentally wrap your mind around the fact that you two are not two separate people yet. When you are bringing home a premature baby, you need to just go ahead and pretend like you’re already, you’re like you’re still pregnant.

¬†You know, baby wear that baby and breastfeed, and that’s pretty much all you’re going to be doing until that baby reaches its 40 week due date. You know? So like if your baby is 37 weeks adjusted, you can go ahead and mentally wrap your mind around three more weeks of baby wearing and breastfeeding and nothing else.

Yeah. And a lot of baby carriers will say that they’re not safe for babies under eight pounds. So if you want to baby wear, the carriers you’re going to focus on are the woven wraps, the stretchy wraps and the ring slings. Those like structured carriers are just not great for little babies, right?

You’re going to want something that’s a lot more stretchy because you want to wear that baby pretty high up. You want to be able to kiss their head and you want to be able to have them snugged in really tight.¬† But not so tight that they can’t breathe. You can’t, you can’t get the structured ones or the woven ones tight enough to feel safe with a baby, that little.

You know, some of the woven wraps I feel like just the ones that are just a big piece of fabric, you can do it with, but it definitely takes a little bit more like practice with how you wrap your baby. So. And just constantly check on them, you know, they’re right there against you. So using those early feeding cues and making sure that baby is, is nice and snugged in and that will eliminate some colic for ya.

It should. And it can also eliminate some of that anxiety you have about bringing home a preemie. Yeah, and really encourage your partner to do that. And to wrap babies skin to skin. Already with a, with a breastfeeding experience, a lot of partners feel a little bit disconnected and that’s even more so with a NICU baby where maybe they’re only letting one parent come in at a time because of COVID protocols or whatever, you know, so make sure that your partners included in that way.

And they really feel like, I’m important. I’m an important caregiver. My body can help keep this baby healthy too, just by keeping the baby warm and all of that. And having them do those things so you can do things like take showers and maybe catch some sleep, but you can know that that baby is warm, cared for with low stress hormones and that your partner is going to feel like they’re a part of it. It’s really, really important.

And they can also wash your pumping parts. We always say that. Oh yeah. We’re like, the sexiest thing you could possibly do is sanitize and wash my pumping parts. Bless. Yeah. So if you’re having a preemie or you just had a preemie, congratulations on your baby.

We acknowledge the fact that it’s very stressful and we hope that this episode helps you out and gets you guys back to where you need to be. And, you know, as my mother always says, if you don’t like the weather, wait a minute. And that baby will grow very quickly and things will be different every week.

So don’t be afraid to reach out if you need anything. Right. Thanks guys. Thanks for listening to The Milk Minute. If you haven’t already please like, subscribe, and review our podcast wherever you listen. If you’d like to support our podcast, you can find us on Patreon at¬†Patreon.com/MilkMinutePodcast. To send us feedback, personal stories, or just to chat, you can send us an email at [email protected]

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