Breastmilk

The best medicine for your baby. Every drop counts!

Neonatal Intensive Care Unit: 865.305.9834
Lactation Consultants: 865.305.9337

How will breastmilk help my baby?

If your baby is premature or sick and is in the Neonatal Intensive Care Unit (NICU), providing breastmilk for your baby is one of the most important things you can do.

Just as your body protected and nurtured your baby during pregnancy, your breastmilk will continue to protect and nurture your baby!

Breastmilk acts like a medicine that only you can provide! It has more than 200 special cells that cannot be found anywhere else. Some of these cells will build your baby's immune system, protecting your baby from many complications and infections during the hospital stay and long after. Other cells will help your baby's body grow and develop.

Here are some other ways breastmilk helps.

• Digests easily.
• Prevents colds, respiratory infections, RSV, ear infections, diarrhea and meningitis.
• Protects a baby from germs that his mother has been exposed to.
• "Paints" the intestines with protection against a very serious bowel complication called NEC (necrotizing enterocolitis).
• Mothers who deliver early have more infection fighting substances in their milk.
• Helps babies see better.
• Helps a baby's brain grow.
• Decreases a baby's risk of diabetes, cancer, lung problems, allergies and being overweight.
• Studies show that premature babies who received mother's milk have higher IQs and better development than formula fed babies.
• Breastfeeding lowers mom's risk of heavy bleeding after delivery and cancers of the breast, uterus and ovaries.
• Mothers who provide breastmilk for their baby feel really good about it.

It is important for babies in the NICU to get breastmilk for their very first feeding and for as long as the mother can provide it. You can decide how long you want to pump or whether you want to feed your baby directly at the breast later, after you have learned more about lactation and breastfeeding.

Getting Started

The Day Baby is Born:

• Your nurse will help you start pumping your milk very soonafter delivery.
• Wash your hands first.
• Pump every 2 - 3 hours for 15 minutes.
• Turn the dial carefully so that it does not hurt!
• Even if you just get drops, save them!
• You may not get anything at first.
• Start your pumping diary.
• Place a label with your name, date and time you pumped onall bottles.
• Colostrum needs to go to the NICU right away.
• You will learn how to wash the pump parts after each use andsterilize them daily
• Ask a family member to help you with washing the parts andtaking milk to your baby if you are unable to go.

Day Two and Three after delivery:

• Pump about 8 times per day, every 2-3 hours with a 4-6 hourbreak at night.
• Save any drops of colostrum you pump and take it to your baby's nurse.
• Continue your pumping diary.

When milk comes in ( 2-4 days after delivery):

• Breasts should feel heavier, not hard.
• A hot shower, warm compresses and massaging breasts will help your milk flow.
• Sometimes mothers need to pump every 2 hours to keep from getting engorged.
• Pumping 8-10 times per day will help you keep a good milk supply.
• After the milk stops flowing, pump for a few more minutes - for a total of 15 - 25 minutes.
• Start adding up how much milk you pumped in a 24-hour period in your pumping diary.

The first 2 weeks are the most important for getting your body ready to make lots of milk. Please ask if you have any questions or concerns.

Before you are discharged from the hospital:

• Your nurse or lactation consultant will help you obtain a high quality breast pump to use at home. You may either rent a pump, get one through WIC or your insurance.
• Store bought pumps are not the best to use when baby is in NICU and not breastfeeding yet.
• Ask baby's nurse for many bottles and labels as you don't want to run out.
• Watch breastfeeding videos and "A Premie Needs His Mother."

When you visit baby:

• Bring your pumped milk to the hospital.
• Bring your pumping diary.
• Bring your pumping kit and use the hospital pump in the pumping room or by baby's bedside with a privacy curtain.
• Leave fresh milk here as it's best for baby to have some fresh (not frozen) milk each day.
• Ask for more bottles and labels.
• Ask if baby is ready for Kangaroo Care (holding skin to skin) or breastfeeding.

Pumping at home:

• Have a meal or a drink and snack about 30 minutes before you pump.
• A warm shower or warm compresses to your breasts help you relax and help milk flow better.
• Relax. Think about your baby and look at photos or videos of you baby while you pump.
• Listen to relaxing music.
• Try to nap each day.

Nutrition for Mom:

• Try to eat a well balanced diet but don't worry if it's not perfect. Your milk will still be great.
• Get plenty of protein and calcium.
• Take your vitamins. Prenatals with DHA are best.
• There is not a certain amount of water that you need to drink, but you need to drink enough to keep you from being thirsty.

Hand expression after pumping helps empty the breasts better and also increases your milk supply. The lactation consultants can teach you how.

Breastmilk Pumping Diary – Helps you keep up with when you pump and how much you get each time. Then, add it together
every 24 hours. Bring your diary when you visit your baby.

When baby is 10 days old, pumping 20-24 ounces per day is ideal. Ask for help if your supply is less.

If you have multiples, the ideal supply would be enough milk to feed your babies when they go home (16-24 oz. per day
per baby). The lactation consultants can help you to make more milk, but even if you cannot make enough, you can still
breastfeed.

Taking care of your pump parts:

• Take special care when handling your pump parts to keep germs from getting to your baby.
• Keep them in a clean area - not in the sink.
• Wash all parts that touch your breasts or breastmilk with hot soapy water, rinse well and air dry after each pumping session.
• The tubing does not need to be washed unless milk backs up into it.
• If moisture is in the tubing after you pump, dry them out by letting the pump run with only the tubing on it for a few minutes.
  

Sterilizing – All of the parts that you wash need to be sterilized once per day. A microwave steam sterilizing bag will be provided from the hospital. Directions are on the bag. You also may sterilize them in a dishwasher or boil the parts on the stove for 20 minutes, then let them air dry.

Careful breastmilk storage is important!

• Always wash your hands before pumping.
• Do not touch the inside of bottles or lids.
• Do not add freshly pumped milk to milk that you pumped earlier.
• Freeze your milk at home.
• Bring milk in a cooler with ice packs not ice.
  

Using your breastmilk— When your milk is thawed for your baby's feedings, any milk not used in 24 hours must be thrown away. We don't want to throw away any of your milk, so ask your baby's nurse how to divide your milk into very small amounts (less than 1/2 oz) for freezing. She may want you do this for several days, then you can start filling up the bottles.

Smoking
If you smoke, hopefully you stopped during pregnancy and plan not to smoke now. If you do smoke, it is best to smoke just after
pumping, instead of before. If you need help to stop smoking, be sure to ask a doctor, nurse or case manager for information.

Mom's Medications
Most medications prescribed to moms are safe for babies. Talk to a lactation consultant, doctor or nurse about your meds and any new prescriptions.

Breastfeeding in the NICU
When baby is ready to start breastfeeding, the nurse or lactation consultant will help you.

• A good milk supply makes nursing easier.
• Breastfeeding takes practice. Don't expect it to be perfect at first.
• Nipple shield is a silicone nipple placed over mother's nipple and is sometimes used to help premature babies breastfeed better.
• Baby Weigh Scale is a scale that tells how much milk baby is getting from you.
• Supplementation (extra breastmilk or formula) is given if baby needs it.
• As premature babies get stronger, they breastfeed better. Supplementation can be decreased or stopped at this time.
  

Kangaroo Care is a special way to hold baby - skin to skin.While baby wears only a diaper and cap, the parent wears a
front opening top and a blanket is placed over them both. There are benefits to the baby, mother and father. Your baby hears
your familiar heartbeat and breathing, staying warm against your warm skin. This helps a baby have a regular heart rate and
breathing and better weight gain. Kangaroo care helps parents bond with their baby and mothers who "Kangaroo" show improved milk supply and letdown - especially if they cannot breastfeed yet. Ask a doctor or nurse when you can Kangaroo your baby.

The nurses and lactation consultants want to help you be successful.

Be sure to ask for help when you need it!
Your baby's nurse can arrange for a lactation consultant to talk with you and help you

• If you need help with your milk supply.
• If you are having pain associated with pumping or breastfeeding,
• If you don't think your milk has come in when baby is 4 days old.
• If you pump less than 24 ounces of milk per day when baby is 10 days old.
• When baby first starts breastfeeding.
• Anytime you need help breastfeeding.
• When you room-in with baby.
• To set up a plan for continuing to breastfeed at home.

The American Academy of Pediatrics recommends breastfeeding for a baby's first year. If you were not originally planning to breastfeed but have decided to pump because your baby is in the NICU, you may want to consider pumping for as long as baby is in the hospital or until baby reaches full term (40 weeks). Your baby will benefit from any amount of milk you provide, even if you cannot pump for that long.

If you would like to provide breastmilk for your baby, the nurses and lactation consultants at The University of Tennessee Medical Center will help you! Let us help you find a doctor.