678-312-4321 gwinnettmedicalcenter.org 1
Gwinnett Women’s Pavilion Human Milk for Human Babies
2
M
aking Milk for Your Baby Making Milk for your baby is one of the most important things you can do. Your milk contains many factors that help your baby grow better and stay healthy while in the neonatal intensive care unit (NICU). We know that premature infants who receive their mother’s milk have better brain development and are healthier even as they grow older. We understand this is a very hard time for families. Pumping can be tough when you are tired and stressed. We hope this information helps you understand the importance of mother’s milk and assists you with successfully making milk for your baby. Please feel free to ask for help or additional information – we are here for you!
Mother’s milk, time-tested for millions of years, is the best nutrient for babies because it is nature’s perfect food. —Robert Mendelsohn
for choosing Gwinnett Medical Center for your healthcare needs.
we are grateful to have had the opportunity to serve you.
W
hy Premature Infants Need Their Mother’s Milk Breastmilk can help save the lives of babies who are sick or born too early. Infants who drink their mother’s milk grow stronger, get well faster, and are overall healthier. Mothers make specially designed milk for their babies. Mother’s milk for premature babies is different than breastmilk made for full-term infants. It is made special for the needs of the premature baby, and acts like medicine to help them grow and get well.
Benefits of Mother’s Milk Your baby needs your breastmilk. Premature or sick babies fed their mother’s milk have: • Better brain development. • Less life-threatening infections. • Less feeding problems. • Fewer allergies and skin problems. • Stronger bones. • Higher IQs. • Less chance of developing high blood pressure.
1
olostrum is the first type of breastmilk you produce. It is very C important for your baby because it contains: • • • •
Brain-boosting fats. Hormones to teach your baby’s intestines to mature and grow. Antibodies and live cells to prevent and fight infections. Nutritious fat, sugars, and protein to help your baby grow.
The First Two Weeks After Delivery Your colostrum is packed with protective nutrients for your baby. At first, you may get only a few drops of colostrum, but every drop is precious. Be sure to bring it to your baby in the NICU! We will put your colostrum directly into your baby’s stomach. This helps to get your baby’s intestines growing. The first days after delivery are critical for your milk production.
By the time babies reach 2 weeks old, mothers should make 2 cups (500mls) of breastmilk in 24 hours. This helps make sure you have enough milk as your baby grows.
2
Preventing Necrotizing Enterocolitis (NEC) Necrotizing enterocolitis (NEC) is a very serious newborn intestinal infection. About 7% of preemies get it. When a baby gets NEC, all feedings stop for 10–14 days to give the intestines time to heal. This puts them behind on their feedings. Pumping and feeding your baby breastmilk helps decrease the risk of developing NEC.
Good News!
Breastmilk helps protect your baby from developing NEC.
How Does My Body Make Milk? You may have noticed breast changes during your pregnancy as your body got ready to make milk. Once you delivered your baby, your body increased the hormone (prolactin) needed to make milk. Glands in your breasts begin making milk. When your baby sucks on your nipples (or when the breast pump sucks on your breasts), your brain releases the hormone (oxytocin). This causes milk to flow out of the glands in your breasts into small tubes or ducts. The milk then moves down the ducts to the nipple. The first drops are yellow colostrum. In 3–7 days your milk will begin to change in color, thickness, and quantity.
Remember, every drop of colostrum is liquid gold! Your colostrum and milk can be all different colors. Do not worry if your milk is blue, clear, yellow orange, or even green — it is all good!
3
How Does the Pump Work? The pump sucks on your nipples making your body think your baby is sucking. Use your hands to compress or massage your breasts. This helps the milk move down the ducts. The suction from the pump removes the milk from your breasts. Emptying the milk from your breasts tells your body to make more milk.
More pumping + good milk removal = more breastmilk for your baby
How Much Milk does My Baby Need? The first few days of life, your baby needs only a tiny amount of breastmilk. As babies grow, they will quickly need more breastmilk. By the time you take your baby home (around your due date), your baby will need about 500 mls (1/2 quart) of breastmilk a day. Having a good milk supply helps your baby when learning how to breastfeed (about 32-34 weeks). Even though you may store a lot of milk in the first few weeks, you will quickly use it as your baby gets bigger and eats more — do not be tempted to pump less!
The first few weeks after delivery are very important for successfully making enough milk to support your growing baby.
4
Is it Safe to Take Medicine? You can take most of the medicines prescribed by your doctor while pumping breastmilk. Check with your doctor or the NICU staff before changing or adding any new medicines.
Taking Medicine While Pumping Milk for Your Baby • The pain medicine we give to you in the hospital is safe for your baby (only small amounts get into your breastmilk). • You may take Tylenol and ibuprofen. Be sure to follow the directions for taking it safely. • Limit cold medicines. They can decrease your milk supply. • Limit the caffeine in coffee and soda to 1–2 drinks a day. • Alternatives for medicines are usually available. Ask your doctor if the medicine prescribed is safe for your baby.
When sick, our bodies make antibodies that can protect your baby from the same sickness. You can give these important substances to your baby through your breastmilk.
Never throw away your milk or stop pumping without first checking with the NICU staff or GMC Lactation Team.
5
Pumping Milk for Your Baby We recommend you use an electric, hospital type pump. We can help you get a pump. WIC (Federal program for Women, Infants, and Children) often covers the cost of the pumps for mothers who financially qualify for these services.
Getting Ready to Pump • Make yourself comfortable. • Wash your hands. You don’t need to wash your breasts. A daily shower is plenty. • Massage your breasts and stimulate your nipples before attaching the pump. • Put the pump together and plug it in.
How to Pump Your Milk 1. Center the breast shield onto your nipple (the shield is the clear plastic cone that attaches to each breast). 2. Hold the shield gently. If you push it on to your breasts, you may compress the milk ducts and block your milk flow. 3. Start the pump at low suction and increase it slowly. You will learn what setting works best for you.
• B e sure to drink water when you feel thirsty. Keeping your body hydrated will help your body make milk. • P umping both sides at the same time will help produce more milk and save you time.
6
Tips for using the breast pump: • T he right size shield makes the pumping more comfortable. Ask your lactation consultant to check your size. • I f pumping hurts or your nipples do not move easily inside the shield, talk with your lactation consultant. • L ubricating the shield with a little milk or olive oil may make it feel more comfortable. • U terine cramping is normal when you are pumping and is a good sign. • “ Hands-free” pumping can make your life easier. You can buy a special pumping bra, or make one out of an old bra by cutting slits at the nipple sites for the shield.
How Much Milk and How Often Do I Pump? You should pump 7–8 times in a 24 hour period. For example, you can pump every 2 hours while you are awake and once at night. The number of times you pump is more important than how long you pump — you want to stimulate your breasts to make more milk. Be sure not to go more than 5 hours without pumping. At first, pump for 15–20 minutes each time. Once you begin making milk, keep pumping for 2–3 minutes after your milk flow slows down.
umping in the middle of the night is important, especially in the first few P weeks. It helps to increase your milk production.
7
o maintain a healthy supply of milk, do not go longer than T 5 hours without pumping.
Tips for making milk: • F eel your breasts while you pump — if you feel hard areas, massage them to empty all parts of the breast. You will see the milk spray out as you empty those areas. • E mptying your breasts also helps you produce higher calorie milk for your baby. • R emember, the more you “ask” your breasts to make, the more milk they will make — just like the baby would if you were breastfeeding.
Medela Symphony Pump The Medela Symphony pump has 2 cycles: • First one is a 2 minute “fast suck” stimulation cycle • Second one is a “slower suck” stimulation cycle This two-cycle pump helps produce more of the hormone (prolactin) that tells your body to keep making milk. Press the “drops” button to restart the stimulation cycle.
o help your body make more milk, press the “drops” button 1–2 times T during your pumping session to give your breasts extra stimulation.
8
Keeping track of your milk Write in your log book when and how much milk you pumped. It’s a good idea to set a schedule to help you remember to pump on a regular basis. Mothers who keep track of their pumping make more milk.
How do I Clean the Pump? After pumping, clean all of the parts that come into contact with the milk. Use warm-soapy water to wash them. You can place the parts on the top rack of the dishwasher to sanitize them once per day. Allow the parts to air dry on a clean paper towel. You may also purchase and use microwave steam bags to sanitize your kit.
• D o not wash tubing. If it gets wet, it may get moldy and contaminate your milk. • T o remove moisture from the tubing, leave the tubing connected, take off the bottles, and run the pump for 2–3 minutes.
9
Pumping Milk at Home for Your Baby in the NICU Pumping your breastmilk at home is one of the best ways you can help your baby. Your first milk is the clear or yellow colostrum drops. This substance is very important for your baby’s growth. Two weeks after your delivery you should produce 500 mls of milk (about 2 cups) or more each day.
Tips for pumping milk at home: • P ump your milk on a regular schedule. • F ind a comfortable spot, listen to music or watch TV. • Try relaxation exercises. • A sk for help cleaning the pump, labeling the bottles, and bringing your milk to the NICU. • K eep a container of ice near your bed for middle of the night pumping. You can wash the pump parts in the morning. • K eep taking your prenatal vitamins for you and your baby.
Look at pictures of your baby. Research shows mothers who look at their babies make more milk.
Remember, you are the only one who can make the most important medicine for your baby — Mother’s Milk.
10
Storing your Milk You can store breastmilk for: • 3 hours at room temperature. • 2 days in your refrigerator. • 3 months in your home freezer. • 12 months in a hospital freezer.
Tips for storing your milk at home: • Put your milk into the containers we give to you. • U se the labels we give you to place your baby’s name on each container. Be sure to write in the date and time you pumped the milk. • F ill the containers no more than ¾ full (milk expands when frozen).
To keep your milk colder, store it in the back of the refrigerator or freezer.
• Refrigerate the milk you plan to bring to the NICU today or tomorrow. • Freeze the milk you do not bring to the NICU within 2 days.
Bringing Your Milk to the NICU Keep your milk cold or frozen until you can bring it to the NICU. Use a cooler with a cold gel pack to keep your milk cold while driving to the hospital. You may give your milk to the secretary at the front desk.
Bring your pump kit with you so you can pump while visiting with your baby.
Be sure that frozen milk remains frozen while bringing it to the NICU.
11
Kangaroo Care is Good for My Baby and for Me Kangaroo Care or skin-to-skin care was developed in Bogotá, Colombia when there were not enough incubators. The babies held skin-to-skin did better than the babies in incubators! Please ask the NICU staff when your baby will be ready for Kangaroo Care. When providing Kangaroo Care: • Wear a button-down shirt, loose blouse, or a stretchy camisole. • Remove your bra and dress your baby only in a diaper. You want lots of skin-to-skin contact.
Benefits of Kangaroo Care: • Babies feel calmer. • Mothers make more milk. • Babies gain weight faster and go home sooner. • Parents feel closer to their babies and more confident handling them. Don’t be shy! Ask your nurse to help you.
12
Making Enough Milk for My Baby Emptying your breasts completely every time you pump helps them make lots of milk. Letting your breasts get too full and hard in the first 2 weeks, could lower your milk supply.
To increase your milk supply: • Pump on a regular schedule. • Pump both breasts at the same time. • P ump every 2–3 hours when you are awake (7–8 times a day), and at least once at night. • P ump 2–3 minutes beyond the point you begin to see your milk flow slowing down. • M assage hard areas of your breasts to completely empty them. • Relax and look at pictures of your baby. • P ump in the NICU while visiting with your baby.
Most women get more milk from one breast than the other. Don’t worry if there is a small difference. It is totally normal.
Ask for help if you have problems, pain, or notice a decrease in your milk supply!
13
How We Feed Your Baby Before delivery, your baby swallows the fluid inside your uterus (amniotic fluid) to help the intestines develop. Once born, your baby must eat or the intestines become weak. We begin feeding your baby very small amounts of milk and then slowly increase the quantity of the milk for each feeding. These small feedings keep your baby’s intestines moving, developing, and healthy. It also helps prevent serious intestinal problems that may occur in sick and premature babies.
What is Gavage Feeding? Babies do not know how to coordinate sucking and swallowing until 32–34 weeks old. Until they learn, we feed them through a tube passed through the mouth or nose and then into the stomach (Gavage feeding). We use a syringe to squeeze the milk through the tube. We offer a pacifier to help your baby learn to suck and swallow during feedings. Gavage (tube) feedings help your baby get nutrition without having to work and use too much energy.
14
Fortifying Your Breastmilk In the last months of pregnancy, your baby takes in a lot of calcium, protein, phosphorus, and fat to build strong bones and body tissues. When babies are born early, they miss the chance to absorb these extra nutrients. To help your baby grow better and prevent weak bones (rickets), we add these nutrients to your breastmilk. This process is called fortifying your breastmilk.
Premature babies need extra vitamins and iron to help them build strong bones, healthy teeth, and improve brain development.
I ron drops are poisonous to children who do not need them. Store iron supplements in a safe place away from young children.
15
I
mportant numbers at Gwinnett Women’s Pavilion For more information, you may contact: Neonatal Intensive Care Unit (NICU) 678-312-3970 Lactation Helpline 678-312-4743
Thank you to the University of California, San Diego Medical Center’s Infant Special Care Center for allowing us to use some of their patient education content and pictures.
16