Please help: expressing for 29 week premature baby

[megonthemoon]

Good friends have just been on their last pre-baby holiday, but have been unable to come home as her waters broke and she had to have an emergency cs. Baby boy born at 29 weeks and they're now in Spain for at least a month while he gets stronger.

He's about 1.5kg and breathing unaided so strong, and starting to take my friend's milk. But she needs help expressing. Currently only been advised to do it 3x per day for 10 mins per breast which is producing more than enough for her DS now. But I suspect it needs to be much more frequent to establish her supply, even for such a small baby. Plus language barrier makes it tricky for her to get really good advice out there.

I only have experience with term babies and supplemental expressing rather than prem/exclusive expressing. So please can you share your advice wisdom on how best my friend can express and store her milk.

She can't come online herself as limited access to email/web so I'll pass everything on to them via email.

Thank you!

Oh that's nowhere near enough!!

She needs to be expressing every 2-3 hours day and night , for as long as it takes to 'empty' the breast and ideally pumping from both breasts each and every time.

If she doesn't express as often as the baby would naturally feed then her supply will tail off very quickly I would imagine. She can freeze breastmilk - either in ice cube trays, special breastmilk bottles and pouches or whatever facilities the hospital have available.

I exclusively expressed for 9 months for my tube fed prem DD2, it's hard work but very worth it. Hopefully her DS will be able to get on the breast at around 32 weeks so if she can keep her supply going until he can latch and suck she'll have done well

That's what i figured - she's basically trying to mimic a term newborn's feeding pattern, isn't she? As opposed to just getting enough for his needs now.

I'll tell her to up the frequency considerably.

Any other top tips?

Wow - 9 months! That's really amazing :)

Hi, meg, I am afraid that your friend has been given very poor advice regarding the frequency of expressing - best practice is to try and express 8-12 times over a day in the first couple of weeks, basically to mimic what a newborn baby does to establish his mother's milk supply. After that, every three to four hours is usually enough but it needs to be consistent. It is also very, very important to express at least once during the night

Three times a day, ten minutes each side is nowhere near often enough and although it might provide enough for a tiny newborn who is being fed small amounts at this stage, the feed volumes given in hospital increase quite rapidly to around 150-180 ml per kilo per day.

If you want to pass on some good information, I would recommend the BLISS breastfeding leaflet, available here Even if practices at the hospital in Spain are very different, looking at this information can help her decide what actions she can take.

I would also strongly recommend the BLISS messageboard, a very active board including several parents who have gone through the neonatal experience outside the UK.

Agree that she def needs to express every 2-3 hours. Crucial to express at least once, pref twice, during the night (due to the hormone that governs milk production being produced in greater quantities at night). She might find she can drop to fewer longer periods of expressing later on, but right now she needs to do it v frequently to get a good supply established. I feed 9mo DS EBM for all his milk feeds and I would say you need to express for 3-4 hrs per day to maintain supply (for me, it used to be 8-10 x 30mins, now I do 4 x 45m-1hr)

I would strongly recommend she get a hospital grade electric pump. Express both breasts until no more milk comes out each time she expresses (i.e. dont alternate sides as some people do when bfing, do both boobs).

Re storage - think NHS website has info re how long it keeps in a fridge (nb it's v important to keep it in the coldest part of fridge). Don't forget that once the baby has started the bottle, you can't keep the milk for longer than an hour after the feed starts. For freezing, you need to buy special bags to freeze bm in (something to do with special plastic that doesn't have some chemical in it). You can pick them up in Boots or similar, they're pretty cheap.

There's a handy book and your friend might find other useful stuff on the same site.

Ditto to all the above. Expressing every 2 hours during the day and 3 hourly at night works and a double pump makes a huge difference when her milk has come in (assuming from your post this has happened?). And pump until nothing is coming out (and maybe a little bit longer) to make sure the breasts are being emptied (otherwise her supply will drop).

If LO is being tube fed, she should insist that at least some feeds are done while having skin-to-skin (if possible) if not actually latching. Otherwise LO won't associate sucking with getting food. Giving a dummy during feeds when she can't be there also helps.

It's really really tough as you just want to be with your baby all the time, not stuck in a room away from them expressing. But if she can establish her supply, ebf is an option when the LO has left hospital and right now, every drop helps.

Thank you! I have already told her to pump every 3 hours as min, and will pass on all your other advice via email now. Will also fax them the Bliss doc at their hotel.

yy to pumping for a couple of minutes after milk stops, as you actually get a series of letdowns of milk rather than just one, so sometimes the milk has just "paused" for a minute and if you keep going you'll get another letdown.

Breast massage helps a lot imo (but you have to single pump for this as you need 2 hands - I do this rather than double pump - get your friend to try both ways and see what works for her).

I don't think there's anything I could add, except to say congratulations to your friend on the somewhat unscheduled arrival of her DS. And well done to you for being such a supportive friend.

I hope he continues to be strong, and is feeding and home soon. Keep us posted.

I reiterate PLW post about sending congratulations. I got excessively upset about the lack of cards flowers/cards/messages when DC3 was born premmie. Definitely get the special plastic bags to freeze the milk and a good electric breast pump speeds up the whole process. I was able to hire one from the NCT which I know is not much use in as she is in Spain but they are so much more efficient and will help keep up the milk supply. Agree with all the other post re frequent expressing and need to do it at night. It is also worth keeping up the support for her as it can seem hard to keep up with the expressing but is so worth it. My DC very rapidly graduated to being fully breast fed after pulling out all his breathing and feeding tubes.

Thanks to having great friends like you these very difficult times can be got through.

Another thing is breast compression which should be done at the end of an expressing session. Basically you grab the breast at the back, near the base and massage forward. You usually get a few more ml doing this and it helps to emply the breast.

Has she access to a good pump? Hospital grade is best but if she doesn't have access to one, the ameda lactaline is supposed to be nearly as good.

Oh yes, congratulations was the first thing we did :) mainly because I have read on here so often that you simply must regardless of circumstance. And because we are thrilled for them, albeit terrified for them too. Got them to send us photos too - didn't want them to think they couldn't share, plus I like the broody feeling I get when I see any newborn :) Have also reiterated that 'every breastfeed counts' and made the point she has had to work harder to get milk for her DS in one week than I have ever had to with 2 DCs so she has to just feel proud of every single feed he gets from her. Really hope she isn't feeling pressurised to do this, but at the same time it may be a good way of trying to cope with it and feel like she is doing something for her DS when so much is having to be done by doctors and nurses.

He'll be a week old tomorrow :) They can repatriate when he is 2kg - they reckon about a month. 1.5kg now - does that seem a reasonable estimate for 1/2kg weight gain in a premature baby?

1.5kg is a very good weight for a 29 weeker. I think they aim for them to gain 200g a week? Ds3 is 6 now, so it's hard to remember back that far. If possible, it is also better for baby to be put to the breast even if they are not actively suckling. It helps to tune them in to bfing and helps Mum to produce more mild too.

Hi my LO was a 29 weeker nearly a year ago. I was also tol try to express 8-10 times a day, and that it was the overll number of times the really mattered. Personally, and controversially I was told it was fine to go about 6 ish hours overnight, and after a week I sometimes went slightly longer provided that I did at least 8 times to make up for it (which often meant expressing every 2 - 2half hours during the day) as sleep is also important as my body was in shock.

Also it is a fine line to tread not to presurrise to breast feed, but the key thing I found was to set realistic goals, for example until the baby's out of hospital, or until the due date. Its very very hard work to keep going sometimes and every feed does count. I almost gave up many times but am still going strong. And personally the fact I expressed for ever has been a god send. i really don't care about doing it at work now!

If she manages to express more than her baby needs she should freeze it, even if she can't use it or brong it back to the UK prem baby milk is very valuable to any hospital.

That weight gain does seem reasonable. The docs will usually work on weight gain of 18 -28 g a day, and will worry if it drops below that for any length of time, at least they will over here.

Good luck

We brought my 26 weeker home a couple of weeks ago. My expressing schedule was (give or take a bit): 5.30am, 7.30am, 10am, 12 noon, 3pm, 6pm, 9pm and 1am. After the first couple of weeks I produced about 1.5-2 litres a day (my son was on 0.5ml every 4 hours at the time ).

I would have found more than 8 times a day far too restricting (would have disturbed all the kangaroo care - hope she's getting lots of that) but that schedule worked well for 11 weeks.
Now EBF with a couple of expressing sessions a day on top to keep the supply up.
Wish her luck!

Thank you everyone (megonthemoon here with my new name). Baby is doing really well now - exclusively being fed his mum's milk now and gained 200g last week :) Hoping to fly home in about 3 weeks time.

Thanks to you all for your help x

Brilliant news!

Fantastic!

One month on from last update, I just wanted to say a big thank you to you all. Our friends brought their baby back to the UK about 2 weeks ago and he has done so well that on Tuesday he was discharged home, still 4 weeks shy of his due date :) He weighs nearly 2.5kg and is now exclusively breastfeeding :o I got a cuddle this morning - can't believe he and my DD (who is 3 times his weight!) will be toddling off to school together in just a few years time. Thank you for all of your advice - it was hugely helpful and helped get him home and breastfeeding well :)