BFing a very prem baby after CS - any advice would be appreciated

[lollipopmother]

Hi, I'm asking this for a friend who will soon be giving birth to a very prem little boy (27+5) by CS. I really hope that she doesn't mind me asking and that she doesn't think i'm being pushy/prying in to her business, however I know that she wanted to BF with her previous premie baby but didn't really get enough support at the hospital for it to work out. Maybe this time she won't want to try or won't be in a position to, but I thought I should ask anyway.

So - at such a low gestation is it possible to bf? Would there be colostrum to express if he isn't able to suck? Will he know what to do in the first place?

Also, I know it takes a couple of days for milk to come in for a baby born at term - would it take longer at this gestation? Is there any supplements she could take, I hear that Fenugreek (sp!) can increase milk supply but would that actually be any help?

As you can see, I know sod all about premies but I'd still like to be able to help if she asks.

Thanks in advance.

lollipop, a 28 weeker will not be able to suck and swallow but he can do 'kangaroo care'
www.kangaroomothercare.com/ and he can have expressed colostrum which she will need to get for him several times a day (at least 8) to prime her milk supply for later. She does not need to hurry her milk in - nature will do the job as a result of the delivery of the placenta, and as a result of her expressing colostrum (by hand is the best way, for the first few days, and then her milk will come in, just as it does with term babies).

There is good bf info from BLISS which is the charity and support organisation for prem babies and their families
www.bliss.org.uk/

Hope all goes well for her.

She be able to express breast milk.
This will then feed to baby through a nasal tube.

In the early days baby usually has a constant feed of a few mls and hour using a syringe pump.

As time goes on they will allow a full feed to be put through the nasal tube. Your friend will be able to breast feed normally once baby is strong enough.

Good luck.

A woman in our LLL group expressed for her little boy who was born at 28 weeks. I think he was just fed through a tube for several weeks but she was able to switch him over to feed directly from the breast as he got older and he is doing brilliantly now - all the doctors said the breastmilk was the best thing he could have gotten. IF she's worried about her milk not coming in fast enough maybe she could ask about using donated milk at the bospital? There is usually a milk bank facility for premature babies. Hope it all goes well. xo

Hi lollipop, answered your other post but will also answer this one. My dd was a 27+5 prem baby born by c-section and was breastfed from birth.

As tiktok says, download the breastfeeding leaflet from BLISS -many units give it out but not all do and it contains very good practice. There is also a good La Leche League book (get it from Amazon) called Breastfeeding a premature baby.

Rather than supplements, it's agreed that the best way to establish your milk supply is:

• Early and frequent hand expression of colostrum (there is normally not enough for a pump). I started about 36 hours after delivery, every 4 hours or so.

-Frequent expression, either by hand or with a pump, once the mature milk starts to appear. Bear in mind this can take a bit longer than the 2 days or so quoted by most pregnancy guides when delivery is very early and/or by section. Every 2-3 hours for the first 10 days is the guideline usually given. -kangaroo care if baby is well enough although many hospitals are quite conservative about this. Going to see the baby, having a photo or blanket with you when you express or expressing next to their incubator or cot can all help.

It sounds incredibly basic, but having access to a pump can be a challenge in the first few days. if it's an issue, this is something you can do to help.

Express express express.....express express

Shortly after the placenta is delivered we know that hormone receptor sites around the aerola 'open' for business. If they are used [stimulated by feeding or expression'] they will stay open and continue to ask for milk. If they are not stimulated they gradually shut down [although when and why is not known and probably varies from woman to woman].

Your friend is in the business of 'tricking' her body into thinking it is feeding. Which it will be but via a middle man for a while.

Hand expression can be started asap, and she should just crack on. She can expect to get anywhere form zero to a teaspoon in 20 mins initially. This is about asking for a good supply in the days and weeks to come so maybe prime her for the tiny amounts that will seem ridiculus. A newborn is thought to get a teaspoon to a tablespoon per feed in the first 3 days.
A prem baby in a SCBU may be in need of extra calories as it is in charge of regulating systems it never thought it would have to i.e temp.

The milk will arrive whatever happens, but this early expression will bolster the supply. SHe MUST then express 2-4 hrly as this is how a baby would feed, and ideally at night too as again, this is about tricking the body!! Evening expressing is very important to take advantage of the prolactin surge that occurs, the milk will be available sometime between 2 am and 8 am for her to pump off and store.

Once she is up and running she will be able to relax a bit more and go with her body - if the amounts are less, more expressing, if amounts are steady - carry on, if amounts are huge, enjoy!!
It sounds like a lot to ask - but it's a mirror image of BF a newborn.

Hey, my DS was born at 31w so was too young to suck (they told us the reflex develops at 33w). We took over his nasal tube feeds from day 3 in SCBU and I was encouraged to express from day 1 (I was too tired the night he was born). Only getting a few ml is fine from the start, my milk came in after about 4 days.

Things I did learn:

1. If your friend wants to hold or do skin to skin with her baby, she should be insistent with the nurses - they're busy and often forget.

1. Get her to make the most of any electric breast pumps they have, and not to feel intimidated by mums who can produce loads!

1. Make sure she eats properly, I was expressing every 3 hours and I swear I didn't eat a decent meal for 3 weeks!

Thank you everyone for your quick replies, i've looked at all the links and they are most helpful. One thing I can't find though is when is best to start - everyone suggests straight away but I don't think this is realistic as she's just had a CS and been through a traumatic couple of days (well months actually bless her!) so I think sleeping would be better then starting in the morning - is that ok? I see that Lizzietee mentioned 36h, I think this sounds ok, I take it that there were no adverse effects from leaving it for a bit??

dd2 was a 27 weeker - i started hand expressing the aftrenoon of the day she was born. i second the 'expressing, expressing and more expressing' approach. i did come home breast feeding but i actually think it was quite unusual for a baby of that gestation. a lot of mums started with expressing but i think i was pretty much the only one of the mums i went through SCBU with who came out exclusively bf. i won't pretend though that it wasn't highly stressful - making sure you express often enough is very hard when you have the whole SCBU thing plus other children. it definitely is possible though and i think a lot is dependent on the SCBU staff - i had one particularly fantastic nurse that really helped me.
i take it you're asking on behalf of Worzel? hope all's going well with her and little George.

Hi lollipop. Not sure what influenced the interval between me delivering and starting to express, I think it was one of the ward midwives who got me started. As others have said, being really consistent about doing it is the most important thing.

Def second advice sooner the better, just as if her were born at term by section. Hard and full on but in honesty the ideal. Having said that if it's not possible it's not. The very very critical period is after the milk is in, then it's supply and demand, so the milk has to be removed to order more production.