NICU Parents Guide for Pumping and Breastfeeding

NICU Parents Guide For Pumping And Breastfeeding

Helping You Supply Breastmilk The Best Nutrition For Your Baby

Helping You Supply Breastmilk The Best Nutrition For Your Baby

Your baby has been admitted to the Neonatal Intensive Care Unit, NICU. You may have been planning on or thinking about breastfeeding and wonder if it is still possible. Well, it is! Babies who are born three or more weeks before their due date need their mother’s milk to help protect them from disease, help them grow and develop, and help with digestion. Only your milk can do all that. Breastfeeding and providing breastmilk for your newborn is one of the most important things you can do for your baby. Even if you were not planning on breastfeeding, breastmilk will give your baby the very best start in life. Breastmilk provides the BEST NUTRITION for your baby.

Breastmilk contains special nutrients that help prevent infections and help shorten your baby’s time in the hospital. Milk from mothers who deliver early is different from milk of mothers who deliver full term babies. It is specially designed for the baby’s needs. Even a few drops of the first milk you produce, called colostrum, contains important infection-fighting cells. Providing your milk for your baby lets you participate in your baby’s healthcare in a very crucial way. Because the benefits of mother’s milk are so important to your premature newborn, you are able to do something for your baby that no one else can do!

Pumping Basics

Establishing Your Milk Supply • The best ways to establish and maintain a good milk supply is to pump as often as you would nurse a newborn baby. • You should begin pumping as soon as possible after delivery, within 6-12 hours. The hospital will provide a pump for use during your stay. • It is best to pump with a hospital grade breast pump and a double pumping kit, so you can pump both breasts at the same time. These breast pumps are available in stores for purchase and can also be rented. Plan to rent a hospital grade electric breast pump at least until your due date plus one month. If you are on WIC you may be eligible to be supplied a pump for use while your baby is in the NICU, ask your baby’s nurse for details.

Preparing to Pump Your Milk • Wash your hands before pumping to keep germs from getting into your milk. • You may want to apply a warm moist towel over your breast and/or massage your breasts gently from the chest wall toward the nipples before pumping, covering all areas of both breasts. Warmth and massage will help with your milk flow and supply.

Pumping Your Milk • Plan to pump 8-12 times throughout the day and one pumping at night. That is every 2-3 hours during the day and every 3-4 hours through the night. For example if your last pumping for the day was 11pm, pump once during the night and again at 6 or 7am. This is as often as your baby would breastfeed. • In the first few days after birth, pump each breast, preferably at the same time, if using a double pump for 10-15 minutes. If using a single pump you must pump each breast for 10-15 minutes each breast. As you produce more milk, watch for it to stop dripping and then pump 2 minutes longer, up to a total of 30 minutes.

• In the beginning you may not see any milk or only get a few drops of milk at each pumping. That’s OK and normal. You must still continue to pump. Your baby only needs tiny amounts of your milk in the first few days and any amount you get will be used. • Remember the more you pump, the greater your milk supply. You will start with a few drops and should obtain 20-30 ounces (600-900ml) every 24 hours by the time your baby is 2-3 weeks old.

TIPS • Allow 20-30 minutes of quiet time for pumping. • RELAX The most common cause of low milk supply are fatigue and infrequent pumping. (the more you pump, the more milk you produce) To help relax, keep a picture of your baby nearby during pumping, or think of your baby and visualize him or her nursing at your breast. Pump at your baby’s bedside or after holding your baby. • Keep a log of how long you pump and how much milk was obtained. A written record will help you pick up early and drop in the number of sessions, time spent pumping or volume of milk obtained, so you can make changes before a real problem develops.

Using a Breast Pump

Electric Pump Read the instruction manual first, but you may have to experiment with different techniques and settings on the breast pump before you find the ones that work best for you. You may want to moisten the rim of the breast flange with water before pumping to create a better seal on the breast. You can either center the breast flanges on the nipple and areola first and then turn the pump on or turn the pump on first and then place the flanges over the breasts. Start the pump at the low/minimal suction setting and gradually turn up the suction so that you feel a deep pulling sensation. Set the level as high as comfort allows, the highest level may not be needed. Pumping should not hurt. Decrease the suction if it causes discomfort.

Suction cannot be maintained if the seal of the flange on the breast is broken, so check the seal of the flange periodically. Also watch for the rhythmic pull and release of the nipple and areola in the flange. When you are finished pumping, to break the seal between your breast tissue and the breast flange, use a clean finger and press in on your breast, just above the breast flange. If milk has pooled in a flange, tilt it so that milk can drain into the collection bottle as you remove the flange. Then turn off the breast pump. (You may prefer to turn the breast pump off first, and then break the seal between the flange and the breast.)

Hand Expression Every mom needs to learn to hand express their milk. Even if you have a pump, it may stop working or you may forget a part of the pump at home. Use a clean container with a wide opening to collect your milk. A margarine tub works well. Wash your hands. Place a warm washcloth on your breast to help your milk flow. Massage your breast to help increase the amount of milk you express. Do this by placing one hand under your breast for support. Apply gentle pressure, using a circular motion with your other hand. Massage from several starting points, always working from the chest toward the nipple. Repeat on the other breast. Hold the clean container near your breast. With your other hand, place your fingers and thumb

abut one inch behind the nipple. Press back toward your ribs and squeeze in and down, rolling your fingers and thumb toward the nipple. This will express milk into your clean container. Rotate the placement of your fingers and thumb around your nipples to empty all areas of the breast. When milk flow slows down, switch to your other breast. Expressing your milk gets easier with practice. Don’t be discouraged if you can only express a small amount in the first few times. If you keep practicing you will get better.

Collecting and Storing Your Breastmilk

Collecting Your Breastmilk Obtain containers and labels from your baby’s nurse in the NICU. Wash your hands before handling your breast pump and storage containers. Pumpdirectly into the storagecontainers supplied to you, only the milk for this pumping session will be placed in these containers. You will pump into new containers at the next pumping session. Write the date and time, the milk was collected, on the Label supplied, and place it on each container of milk obtained. Breastmilk that is not labeled will not be accepted in the NICU. Place the collected milk in the refrigerator if you plan to be at the hospital within 2-4 hours, if not put it in the freezer. Always store the milk in the back of the freezer or refrigerator. (This is where the temperature is the coldest.)

Transporting Your Breastmilk Use frozen cold packs in a cooler for frozen milk and ice for milk from the refrigerator. Place Milk in an insulated bag or cooler with a frozen cold pack or ice. The farther you live from the NICU, the more likely it is that you will have to pad the inside of the cooler with extra cold packs or ice to keep frozen from thawing. Frozen milk must be kept frozen and cold milk, from the refrigerator must be kept cold.

Cleaning the Pump Parts 1. Always clean the parts after each pumping session. 2. Separate the parts that come in contact with the milk. If using the Medela® attachment kit, separate the yellow valve and white membrane. 3. Rinse the parts in cool water to remove the milk protein. 4. Wash in warm soapy water with a milk liquid detergent, do not use anti-bacterial soap. 5. Rinse in clear water. 6. Allow the parts to air-dry on a clean towel or paper towels. 7. Do not wash the tubing. If you notice moisture in the tube, run thepumpwith tubingattached for 1-2 minutes or until dry.

How long milk is usable depends on where you store it. Breastmilk cannot be refrozen if thawed. Milk Stored Here: Is Safe For: Refrigerator 72 hours (if fresh)

24 hours (if thawed) Frost-free freezer that is part of your refrigerator (around 24° F) Deep Freezer at 0° F

4 months

up to one yea r

Skin- To- Skin Care

Holding Your Baby Close Skin to skin or (Kangaroo Care) is the practice of holding your baby dressed only in a diaper and cap, on your bare chest (if you are Dad) or between your breast (if you are Mom), with a blanket placed over your baby’s back. This skin- skin contact benefits both you and your baby. Youmay bea little nervous about trying Kangaroo Care. If your baby is very small or sick, youmay be afraid you’ll hurt him. But you won’t. Your baby knows your scent, touch and the rhythms of your speech, heartbeat and breathing, and he will enjoy feeling that closeness with you. Kangaroo care can help: • Calm your baby • Help him gain weight • Maintain his body warmth • Regulate his heart and breathing Skin to skin has emotional benefits for you, too.

It builds your confidence as you provide this closeness that can improve your baby’s health and well being. You are giving something special to your baby that only you can give. By holding your baby skin-to-skin, you will feel the experience of new parenthood and closeness to your baby. Ask the hospital staff if you can provide skin-to- skin care with your baby when visiting the NICU. Kangaroo care is safe and beneficial. Take your pump kit with you when you are planning to do skin-to-skin and pump right after. This will help your milk supply.

DATE _________ SKIN-TO-SKIN ______________

TOTALS

TIME MINUTES AMOUNT IN ML

DATE _________ SKIN-TO-SKIN ______________

TOTALS

TIME MINUTES AMOUNT IN ML REMEMBER • Wash hands before pumping • Pump each breast 10-15 minutes each session or at least 100 minutes a day (per baby)

• Pump 8-12 times a day (every 2-3 hours during the day with one 4-5 hour break at night) • Wash all pump parts after every use