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Feeding your baby breastmilk

Expressing breastmilk

Colostrum

It will be important for you to begin expressing breastmilk as soon as you can once your baby is born, preferably within in the first 2 to 6 hours following birth, in order to establish a supply of milk and to collect your first milk, colostrum, also known as ‘liquid gold’. Colostrum is highly concentrated with nutrients and antibodies which are extremely beneficial for your baby and it will be important for you to begin collecting and storing this so that you have some ready to give to them when they are able to feed. Tiny amounts of “buccal colostrum” (colostrum placed into your baby’s cheek) may be able to be given even before they have had their corrective surgery, in agreement with your surgeon, so it is important to begin collecting your milk as soon as possible.

If you are pregnant, you can also begin collecting and storing colostrum before your baby is born, after 36 weeks gestation. You should discuss this with your midwife.

Hand Expression

Hand expressing is the most effective way to begin collecting colostrum and you can use a sterile syringe or cup to do so. Don’t be worried if you only produce small amounts to begin with, babies’ stomachs are very small (around the size of a marble) and it is not a sign that you will be unable to feed them sufficiently or progress to breastfeeding. Your midwife and NICU nurses will be able to help you with the hand expression technique and storage of your breastmilk. Alternatively, this useful guide and video has been produced by the NHS

It can also be helpful to get your partner to assist you with collecting milk initially, by operating the syringes or holding the cups as it can be fiddly (and may also help to make them feel useful). Alternatively, your midwife or the NICU staff will be able to help.

Breast pumps

After a couple of days your colostrum will change to more mature milk and the volume you express will begin to increase. You may notice that your breasts are fuller and warmer and that your milk changes slightly in colour. At this point you can begin using a breast pump to express your milk. If you do not have a breast pump, an electronic hospital-grade breast pump can be borrowed from your NICU so do speak to the staff about this and how to use it when you are there.

How often should I express?

It is important that you express breastmilk at least 8 times in a 24 hour period. You are trying to imitate a baby’s breastfeeding pattern and they will feed roughly every 3 hours. It is also very important that you express at night, as this is when your body produces the most milk-producing hormone, prolactin. It is advised that you express at least once during the night, preferably between 2am and 4am (NHS, 2019). Although it can be tiring, this routine will help you to be ready to breastfeed your baby should you wish to, in a way that responds to their needs, as babies are hardwired to feed throughout the night.

How long should I express for?

You should express for as long as your milk is flowing well rather than being guided by a set amount of time. Every woman is different, but for most, expressing takes around 15-20 minutes. Once your milk is not flowing as freely and begins to slow to drips is when it is time to stop.

How much should I feed my baby?

The NICU team will be on hand to guide you with how much milk your baby should have whilst you are there. In the early days, this will be dependent upon a number of factors such as your baby’s weight, how well they are tolerating feeds and if they are also receiving other fluids. This will be reviewed regularly and, if required, a dietitian may also be involved to ensure that your baby is getting everything that they need. When you are discharged, if you are still feeding your baby expressed milk, you will get to know how much is right for them by reading their cues and observing if they are content after feeds, having wet and dirty nappies and gaining weight. Your GP, health visitor, midwife or NICU team will be monitoring this closely and will be on hand if you have any queries.

Supporting your milk production

Having a baby that is unwell and admitted to NICU can be a very stressful time and this can affect the amount of milk that you produce. When we are stressed the level of oxytocin, the hormone which releases milk from the breast, is inhibited. It is therefore important to find ways to relax while expressing in order to encourage the “milk ejection reflex”. Making sure you are comfortable, listening to music, having low lighting and ensuring privacy are some ideas for helping you to feel calm when expressing. Being next to your baby and looking at them or touching them in the early days can also help. If you are away from them or using a pumping room located in the hospital, looking at pictures or videos of them and having one of your baby’s bonding squares or blankets nearby or to smell can also be beneficial. When your baby is well enough, having skin-to-skin contact with them will also help to support your milk production.

Skin-to-skin contact, also known as “kangaroo care”, involves holding your baby naked against your bare chest under a blanket and can be enjoyed whether you intend to progress to breastfeeding or not. The practice can benefit expressing mothers as it initiates strong instinctive behaviours, stimulating your body to release hormones including oxytocin, which in turn encourages the production and release of breastmilk.

Skin-to-skin contact can also benefit you and your baby by:

  • Regulating your babies breathing, heart rate and temperature
  • Reduces your baby’s levels of stress hormones, particularly after painful procedures
  • Builds your baby’s immunity by enabling colonisation of your baby’s skin with your friendly bacteria
  • Helps you to develop a close and loving bond with your baby
  • Calms your baby when they are upset and helps them to build a strong attachment to you

(UNICEF UK, 2024)

It is also important to ensure you are eating and drinking enough to support your breastmilk production. Breastfeeding requires an extra 500-700 calories per day to fuel the milk making process (La Leche League, 2024). Having snacks and a water bottle to hand whilst you are in NICU, enquiring about hospital meals and enlisting the help of family and friends to make sure you are eating and drinking well are top tips.

What to do if expressing is painful

Expressing breastmilk should not be painful. Pain can interfere with your goal to provide breastmilk for your baby so it is important to address it as soon as possible. Slight discomfort, especially as you first begin to express breastmilk, can be normal, as the collagen fibres in your nipples begin to stretch and you first start to experience “let downs”, which can feel tingly or like pins and needles (Children’s Minesota, 2024). Anything more than slight discomfort should be discussed with your midwife, NICU team or health visitor straight away.

Non-nutritive sucking and breastmilk

Research has proven that non-nutritive sucking (NNS), which involves giving your baby something in their mouth to suck such as a dummy or your finger, encourages the development of sucking and swallowing reflexes which is especially important for OA/TOF babies (Sherwood Forest Hospitals, 2020). It is important to discuss NNS with your baby’s SALT team and surgeons before commencing, to ensure that it is safe to do so. Your baby in time may then be able to progress to dummy/finger dips (dipping a dummy/your finger into your EBM for them to taste), which can help them to begin to learn the taste of your breastmilk ready for when they start to feed orally. Research has shown that doing so can reduce the length of time it takes to establish breastfeeding and can also decrease levels of stress hormones and pain (Orovou, 2022). It may also be possible to offer an “emptied” breast (a breast that has been recently fully expressed) to your baby as a method of providing NNS, but this will need to be discussed with your SALT and surgical teams beforehand to establish how appropriate this will be for your baby.

Other benefits of EBM

EBM can also be used in providing mouth care, or buccal care, to your baby, in agreement with your NICU and SALT teams. This involves putting tiny drops of your EBM into your baby’s mouth and onto their lips and it can be beneficial to begin doing so within the first few hours of life. Breastmilk’s unique antimicrobial and moisturising properties can help to keep your baby’s mouth and lips healthy and improve comfort, especially as your baby may be receiving many oral procedures such as suctioning and intubation. (The Northern Neonatal Network, 2017). Using your milk can also support the development of your baby’s taste and smell senses until they are able to feed (Aoyama, 2010). Spending time doing these small tasks for your baby can help you to feel closer to them and reassured that you are making an important contribution to their care even though you may not be able to hold or breastfeed them just yet.