Breastfeeding a newborn holds a very special place in a mother’s journey of embracing motherhood and often, new mothers are concerned about their breastfeeding journey and baby care before the childbirth as there are so many resources of information available to them, which sometimes can be good and useful but also may give rise to stress and anxiety. In this article we are going to focus on the challenges associated with premature babies in terms of breastfeeding especially when there is neonatal intensive care is involved for the betterment of the newborn/a preterm baby.

Before we progress let us understand what premature baby is. In an interview with HT Lifestyle, Priya Singh, Women’s Health Physiotherapist and Lactation Consultant at Cloudnine Group of Hospitals in Vashi and Navi Mumbai, shared, “A full-term baby is where the birth has taken place after 37 weeks of gestation, babies born before that are called as preterm or premature in age.” Adding further the intensity of care which is provided is totally depended on how much premature the baby is and its classified as per WHO:

• Extremely preterm – are less than 28 weeks
• Very preterm – between 28-32 weeks of gestation
• Moderate to late preterm 32-37 weeks

Priya Singh revealed, “The reason for preterm birth are mostly spontaneous labour primarily & sometimes there may be some medical indications involved where there is a failure to wait till full term pregnancy in view of health risks available to the foetus or mother. In order to address the risk there can be early induction of labour or caesarean birth.”

How do we support the parents and enable breastfeeding for the babies who are born early and are in NICU facility?

According to Priya Singh, certain things that may contribute to having a better output when it comes to breastfeeding and taking care of the premature babies are as follows -

1. First and foremost, ANC Counselling/parents counselling: If at all the risks are calculated and there is time in hand having a detailed counselling of parents may help in building confidence in the family beforehand. Now as we already discussed if the birth was spontaneous early counselling soon after childbirth would provide the same benefit and has a vital role. Counselling involves multiple layers that is Medical counselling, lactation counselling, counselling for initiation of baby care by nursing team.
2. Involvement of parents and families in the care of the newborn: If clinically situation permits, initiation of KMC should be started as early as possible. Skin to skin care will benefit the baby and mother physiologically. Involvement of mother in daily care of new born such as KMC practice, changing, cleaning, holding, positioning, feeding makes mothers feel better emotionally and since they perform these tasks with the new born under an observation of an NICU nursing staff allows them to be more confident doing them after the discharge and holds less chances of any complications or re admissions due to negligence.
3. Providing support to breastfeeding mothers: Once allowed by the neonatologist daily KMC (skin-to-skin contact) and breastfeeding would require space in the healthcare facility for them to wait and to be able to use breast pump for milk expression whenever needed.

If The baby is in the NICU facility and is separated from mother breastfeeding can get challenging, Priya Singh suggested the below parameters are mostly to be taken care of -

1. Colostrum collection: once the mother is comfortable, colostrum which is the first milk is dense and high in immunoglobulins with all the required nutrients can be collected in a syringe using hand expression technique to send in the NICU.
2. Milk expression and breast pumps: There are 2 ways of milk expression 1) hand expression 2) through the breast pump. Clearly if the dependency on milk expression is high, investing in a breast pump would be of great help for the mother. Considering how often a mother would be expressing the breastmilk investing in an electrical or a hospital grade breast pump would be of great help as it requires less effort to collect the breastmilk also allows breastmilk drainage effectively in order to prevent various breast related concerns.
3. Sustenance of milk supply: This works on the principle of demand and supply. Early initiation of skin-to-skin that is KMC stimulates the higher centres allows the milk making and releasing hormones to work efficiently (Prolactin and oxytocin). KMC helps in regulating baby’s vitals. Improves mother and baby bonding which benefits the breastfeeding journey in the long run. Recommended dosage of KMC in a day is for 8 hours in a day of a low birth weight.
4. Effective drainage of the existing supply: Using correct breast pump and of a correct size with the guidelines available. Use of warm compress and quadrant wise breast massaging before expressing the milk is known to be beneficial in case of heaviness or engorgement of the breast. Use of cold pack in case of pain in the breast which cool downs the redness and inflammation if present.
5. Storage guidelines: The breast milk can be stored in good quality plastic bottle or glass bottles or in silicon pouches with correct label of date and time.

• At room temperature the breast milk can be stored from 4 hours
• In refrigerator it can be stored for 2-4 days
• In freezer it can be stored up to 6-12 months
• The removed milk from the refrigerator or freezer can be thawed in water heated up to 37 degrees Celsius, avoid heating the milk directly above the heat.

6. Positioning and latching: Explaining and understanding of different holds especially if there are twins to take care for and that are

• Cradle hold
• Cross cradle hold
• Football hold
• Double football hold

7. Adequate nutrition and use of galactagogues: A well balanced nutrition is crucial in maintaining the health of the mother as well as the breastmilk supply. Seeking a professional advice can benefit the mothers in numerous ways. Galactagogues are milk boosters which can be found in food and as well as available in form of whole supplement. These can be only prescribed after ensuring effective drainage and breast assessment by a Lactation consultant

Care of a premature baby in NICU stay and enabling breastfeeding is a team work which includes health care staff and parents. Having all the information from right resources hold importance and allows you to make an informed decision.