URGENT advice needed on expressing prebirth. Friend being induced early.

[bumpiesonamission]

She has been told bubba may need special care and they want to give him formula. Friend is upset, I suggested expressing prior but want to give her support.

Advice please

How early? My friend had her twins v early at 29 weeks an was still able to express colostrum for them. Her milk never came in with two weeks of expressing so they had to be FF anyway. Babies can't really suck until about 34 weeks. Does the hospital have a donated milk bank?

Great idea about the milk bank - good idea for her to ask about this before birth.

Babies get an absolute tiny amount in their first few days - mainly colostrum, and this can be expressed after birth. It's also then possible to hand express milk, or use a pump then the milk comes in properly.

My baby started off in NICU, and was fed part-bm, part-formula. To be honest, I have no real idea why special care babies are so pumped full of formula (and his consultant paed didn't seem to know either), but when he was released (about 5 days), we worked on breastfeeding and he hasn't had any formula since he was about two weeks old. He was a full-term baby though, so quite a different situation.

The hospital should have someone who can advise on breastfeeding a small or early baby - from what I understand, it can be very hard work for the baby, but it doesn't have to be the end of breastfeeding.

Third the suggestion to ask about donor milk.

I had my baby a week ago (!) at 38 weeks and she was below the 2.6kg threshold for discharge. I was told that early/tiny babies are often sleepy and have trouble stabilising their blood sugars, so they go onto a hypoglycaemia protocol which keeps a close eye on this, measuring blood sugar every 2-3 hours. My DD did have some difficulties and we were transferred to SCBU. I was dead against her having formula as my son had cows milk protein intolerance and we've been told it's 50:50 whether she will also have it. Every other baby on my ward was given formula pretty automatically, even though every woman was wanting to breastfeed. The consultant immediately said yes I could have access to donor milk as long as it was only for a few days, and baby was tube fed for about 36 hours. I hand expressed after every tube feed until my milk started to change on day 2-3 then used a medela symphony double electric pump. As soon as DD was stable and back on the ward
I was breastfeeding directly every 3 hours then topping up via the tube with either donated milk or EBM (they have a protocol for how much they need starting at 60ml/kg/day and increasing each day, which equated to giving my baby between 16 and 26ml after every feed) By day 3 I was producing enough to do the top-ups with my own milk.
At the end of day 3 the tube was removed, day 5 we were discharged exclusively breastfeeding. We used about 200ml of donated milk altogether - it really is only a tiny amount required to tide you over.
Doctor said most term babies will have enough reserves (the 10% they are allowed to lose) to maintain blood sugars well until Mum's milk comes in, but early/small babies often can't manage without some form of supplementation.
If she has some time before induction ask to discuss a plan with the infant feeding coordinator. I would think expressing colostrum before the birth is going to yield very small volumes so she would still need a plan B, but reassure her it is likely only to be a temporary issue and she can still breastfeed.

My DS was only 2.7kg at birth and had low blood sugars so had to be on that protocol you talk about. V laborious process started where I fed on one boob and a maternity nurse squeezed colostrum from my other boob into a syringe, then topped him up with whatever she collected. Another option if baby is old enough to latch but the hospital doesn't have access to donor milk.