Your baby is hospitalised in our ward and you want to breastfeed. This guide will help you throughout your stay in the neonatal ward and when you are back home.
We will be there to accompany you and support you in your choice.
The benefits of breastfeeding in preterm infants
- Breast milk helps start the intestinal transit. The components of breast milk are perfectly suited to your baby's digestion and growth.
- Breast milk contains many immune factors. These factors act locally on the digestive tract, and they also have an effect throughout the whole body which is reinforced by Kangaroo Care. Your milk protects your child from the risk of infection and the risk of allergy.
- Breast milk helps to develop neurological, visual and psychomotor functions.
- It has been shown that babies have better control over suction-swallowing-breathing with the the breast than with a bottle. Babies are more stable, they have much less apnoea and bradycardia.
- For mums, the act of giving milk to her baby is an opportunity to share with her baby.
These advantages mean that breast-fed babies develop well, are not overweight and are less sick than babies fed with artificial milk.
Breastfeeding is not only ideal in terms of nutrition but also for the emotional development of the baby.
The various stages
Pay close attention to your baby’s behaviour. Babiesl have different skills depending on their age and how awake they are. At the start of this learning process, we will be strict on how often and how much you feed your baby. We will slowly adapt to your baby’s rhythms so that he/she will eventually be able to breastfeed on demand. While nursing, we will take advantage of this moment to provide your baby with supplements.
Contact with the breast
This is the baby’s first contact with his or her mum. Proper latching requires seeing, talking, touching, feeling and skin-to-skin contact (kangaroo method). It is best to express your milk before kangaroo care or contact feeds so you can take full advantage of this moment, without any interruptions.
Breastfeeding for the first time
“Discovering” the breast: this means holding your baby against your breast and nipple even if not drinking milk (or falling asleep) simply for the warmth, smell, sight, and taste of the breast and milk.
The first feeds
Learning how to breastfeed: the baby opens his or her mouth, latches onto the breast but has difficulty keeping it in his/her mouth or makes 2-3 sucking motions and then falls asleep. Your baby may be able to start the flow of milk (let-down reflex) but may have difficulty maintaining the flows. Support your breast with your hand so that your baby can keep the nipple in his or her mouth. Limit breastfeeding to 30 minutes so that your baby doesn’t become too tired. After breastfeeding, don’t forget to collect your milk.
Your baby latches onto your breast correctly and is able to keep it in his or her mouth with little or no help, the tongue is down when latching onto the nipple. We can see the baby suckle and we can hear him or hert swallow. At first, we will weigh your baby before and after breastfeeding to see how much your baby has eaten. Little by little, your baby will be able to breastfeed on demand. In other words, he or she will be able to drink as much and as often as he or she wants. There will no longer be any time restrictions.
We will give you a “Fleur de Lait” booklet that will help you follow your baby’s progress. Each week, you can colour the petals of the flower corresponding to your child's behaviour.
As soon as your baby's health allows it, you can breastfeed.
It is very important to find a comfortable position for breastfeeding to prevent cracks and to ensure everything goes smoothly. Give yourself plenty of time for your first breast-feeding sessions, and give your child time to learn, discover and find your breast. As you learn, we will show you the various positions you can use. Choose the one that is right for you.
It is important to alternate sides with each feed. Let your baby feed on one breast for as long as he or she wants and then offer the second breast. If you give both breasts, start with the breast you last offered during the last feeding.
1. Find a comfortable seating arrangement, and surround yourself with cushions. Your baby's body should be very close to yours (his or her belly against you).
2. Gently brush your nipple against your baby’s upper lip. As soon as he or she opens their mouth wide, bring your baby up to your breast and place your areola in his or her mouth so that your baby can latch on.
3. Support your breast with your hand (don't let go too quickly so your baby can latch on and won't lose the nipple).
4. Make sure your baby's mouth is opened wide and his or her tongue is out and down when latching on so that it gently massages your areola (this is very important for stimulation). His or her lower lip should be curved outward and your baby should take your nipple as well as as much of your areola into his or her mouth as possible.
5. Bring your baby's buttocks toward your body so that the nose is free.
Relaxing the areola
If the muscles in your breast are too tense, you can gently massage this area before putting your baby to breast.
Swollen nipples usually occur between 2 and 3 days after delivery. There is even more swelling when your milk comes in.
The goal of massaging your areola is to soften your nipple so that it’s easier for your baby to latch on. The harder or more swollen the areola, the more time it will take to soften it.
The areolae should be massaged when the nipple and areola are swollen and hard to make it easier for your baby to latch on.
There are 3 different techniques. Use the one that is right for you and with which you are most comfortable:
1. In 2 steps, press on the base of the nipple and turn it one quarter turn.
Then change the position of your hands.
2. In 1 step, press on the base of the nipple with 3 fingers from each hand.
3. In 2 steps, turn the nipple one quarter turn with 2 or 3 fingers on each side. Repeat this step, but this time with your fingers above and below the nipple.
Why pump breast milk?
Unfortunately, for various reasons, your baby may be unable to breastfeed or cannot stimulate the breast enough. In this case, it is necessary to go through the breast milk pumping stage. By doing this, your body will start producing milk.
Your milk has come in but your baby doesn’t know how to breastfeed. You will need to express milk to maintain good breast milk production. In this case, the goal is to produce enough breast milk to meet your baby’s needs. For information, a good average milk production is 500 ml of breast milk per day in the third week.
You will be away and you would like your child to continue drinking breast milk. You are in fact creating a supply of breast milk.
You are taking medications that do not allow you to breastfeed. In this case, you should express your milk so that your body continues to produce milk during your treatment. Unfortunately you must throw this milk away.
What equipment do I need?
Make sure to use comfortable and efficient equipment. It must also be easy to assemble, clean and use.
Manual breast pumps
Manual breast pumps are easy to use and don’t require a power source. Its small size means that it’s easy to bring with you, you can take it everywhere you go. The milk expression cycles depend on your rhythm. The suction used to express the milk is controlled by the force you use to operate the handle. Manual pumps are recommended for when lactation has been induced as well as for short and/or episodic periods.
Electric breast pumps
This type of pump is used starting from the first few hours after delivery and for as long as needed. It is quite practical, and the expression suction is adjusted automatically using a button. Therefore, the suction stays the same throughout the entire cycle unless you decide to change it. The number and length of the cycles stays the same.
This type of pump is more expensive to purchase. You can rent them in pharmacies and medical equipment loan shops (e.g. Hospilux). Electric breast pumps are ideal for inducing lactation as well as for the long-term. Dual breast pumps exist (possibility to pump both breasts at the same time). We recommend them because it cuts the expression time in half and increases stimulation two-fold and at the same time, it increases the amount of milk produced. It is also fine if you decide get a single electric breast pump. The only essential function of a breast pump is the adjustable suction force. Buy the one that is right for you.
The cup must be COMFORTABLE to prevent lesions and must be suitable for your breast to ensure that it is leak proof. It must be possible to clean and sterilise the pump. There are numerous models available on the market. Buy the one that's right for you, making sure it's compatible with your breast pump. Buy at least 2 (it is not possible to rent this equipment).
The bottle must be compatible with your equipment. Preferably buy a graduated bottle in plastic (glass breaks!). You can see how much milk you are producing. Make sure it’s not for single use only and that it can be cleaned and sterilised.
It should be leak proof with a screw-on lid. Ideally it should be possible to fit a nipple so that you don't need to handle your milk when you want to give it to your baby. The bottle should be labelled with the date and time the milk was expressed. Do not fill the bottles up to the last graduation mark.
How often should you express milk and for how long?
Preferentially, breast milk should be expressed immediately after breastfeeding and at regular time intervals. If your baby has a fixed feeding rhythm (e.g.: during hospitalisation), the best is to express your milk at the same rhythm.
The minimum frequency is 8 times per day EVEN AT NIGHT. In fact, hormone levels are higher and better stimulate the production of breast milk at night. The smaller the quantities of milk expressed, the more often you will need to pump. Be aware that frequency influences the volume of milk.
During the first few days until actual milk production (approximately 1 week), it is advisable to pump each breast for at least 15 minutes every 3-4 hours. After that, you will need to pump up to 2 minutes after the milk begins to flow.
How should I care for my equipment?
Wash your hands before each use.
The pump must be completely disassembled and cleaned with a cloth and soap and water 1x/week. You must also sterilise all the parts that can be sterilised 1x/week. Do this more often if necessary.
The cup and its components must be disassembled after each use. These parts must be cleaned with soapy water (there should not be any traces of milk), thoroughly rinsed with clean water and allowed to air dry on a dry and dust-free cloth. At home, the cup must be sterilised 1x/day.
The bottles must be thoroughly cleaned and sterilised after each use. The collection bags are for single use only and cannot be reused. The nipples, rings and caps must be thoroughly cleaned and sterilised after each use.
How do I give my milk to my baby?
The milk that has just been pumped should not be heated and can be given directly to your baby.
The are many techniques that can be used to feed your baby. If your child is not yet able to suckle efficiently, it is not recommended to use a bottle. In this case, you can use a cup or a syringe.
However, these techniques are difficult to use. They must be taught to you by a qualified person. When your baby is able to suckle efficiently, you can give a bottle.
Breast milk that has been refrigeration must be reheated. Warm it up in a bottle warmer or a water bath. Avoid microwaves as much as possible because it alters the nutritional qualities of your milk.
After reheating your milk, never forget to check its temperature before giving it to your child.
How do I store my breast milk and for how long?
In order to correctly store breast milk, hygiene is extemely important.
Don’t forget to mark the date and time your breast milk was expressed on the containers in such a way as that it can't be erased.
To transport breast milk, you must put it in an insulated bag or a cool box. As soon as possible, put it back in the refrigerator.
Reheated breast milk must be given within one hour of being warmed up and then must be thrown away. Milk that has been reheated and has cooled down MUST be thrown away.
Freshly pumped breast milk can be stored at room temperature for a maximum of 4 hours and maximum 1 hour in a room with a temperature above 22°C. If you do not give your milk immediately after you have expressed it, you must put it in the refrigerator.
Fresh breast milk can be stored for up to 24 hours in a refrigerated cooler. Fresh breast milk can be kept for up to 72 hours (= 3 days) in the refrigerator. Thawed breast milk, even when stored in the refrigerator, must be discarded after 24 hours.
To keep breast milk longer, you must freeze it Breast milk can be kept for a maximum of 2 weeks in the freezer compartment (ice cube tray) of your refrigerator. Your milk can be kept for up to 12 months in a “large” or “separate” freezer at a minimum temperature of -20°C. If your freezer does not cool down to -20°C, the breast milk will keep for up to 6 months.
Manually expressing milk
Why express milk manually?
- Mechanical breast pumps are ineffective and/or uncomfortable.
- The mother prefers this more natural method.
- The method is practical, free and ecological.
- To give her colostrum when she is separated from her baby.
- To relieve pressure in the breasts.
- To help her baby by inducing the flow of milk.
- To prevent breast engorgement.
- To stimulate, increase or maintain milk production.
The technique known as the Marmet technique was developed by a mother who had to express her milk over an extended period of time.
This method combines massage and stimulation to encourage milk production and the ejection reflex. This technique is efficient and does not lead to any problems. Like any technique, all it needs is a little bit of experience and application to show its effectiveness. That said, it is very easy to learn.
The entire operation should take 20 to 30 minutes when manual expression is replacing a feeding.
- Express milk from each breast for 5 minutes.
- Massage, caress, shake for 1 minute.
- Express milk from each breast for 5 minutes.
- Massage, caress, shake for 1 minute.
- Express milk for 3 minutes.
These times are advisory only. They should be continued if there is no milk yet or very little milk. If the milk production has been properly induced, watch the flow rate and change breasts as soon as it decreases. Any one step of the technique may be repeated and if needed.
Caregivers will guide and advise you all throughout your learning process. Please feel free to ask us any questions you may have.
1. Place you thumb and first two fingers on the breast, about 3 cm behind the base of the nipple. Your thumb should be above the nipple and the 2 other fingers beneath it, as shown on the diagram. Avoid cupping the breast.
Form the letter “C”, do not cup the breast.
2. Push the fingers firmly into the chest wall. Avoid spreading the fingers apart. For large breasts, first lift and then push into the chest wall.
Push against the chest wall, roll and then finish the rolling movement.
3. Roll the thumb forward as if taking a thumbprint. During this time, transfer the pressure from the middle finger to the index finger. Repeat rhythmically. Move the thumb and fingers in order to drain the other parts of the breast while paying attention to the position of the fingers.
4. Do not squeeze, pull or slide on the breast as this may cause tissue damage.
Do not squeeze, pull or slide.
5. To stimulating the flow of milk, massage the milk producing cells and ducts. Gently caress the surface of the breast from top to bottom. Gently shake the breast, while leaning slightly forward.
Massage, caress and shake.
Is my milk good for my baby?
When a baby is born prematurely, breast milk is tailor made and perfect for the development of your baby as well as to protect your baby from infections.
However, it is necessary to lightly supplement the milk with protein in order to meet all of your baby’s needs and to encourage growth. The composition of the milk adapts to the age of your child and varies during breastfeeding. These changes are responsible for variations in how the milk looks. Breast milk does not also taste the same. At first, it’s thirst-quenching at the start of the feed and then it becomes richer and tastes like what you have been eating. Your milk changes at the same time as your baby, it is always adapted to your baby’s age and needs.
Your milk will change in appearance and colour, it will turn blueish in colour, this is normal. Your breasts will become softer but they will still produce as much milk. The breasts of all breastfeeding women normally change in this way.
How should I eat?
You can eat anything you want in reasonable amounts, like you did during pregnancy, your baby will love the changes in how your milk tastes.
Don’t forget that your baby already liked the taste during your pregnancy. No foods should be automatically ruled out if you eat in a varied and balanced manner, for example fresh vegetables, dairy products, fish, lean meats, wholemeal bread. Drink to quench your thirst. Avoid alcohol, tobacco and stimulants.
Do I have enough milk?
Be aware that during the first three days you don’t have milk but a small amount of colostrum that is just right for the size of the baby's stomach. Colostrum is very important, it contains many antibodies and is very nourishing.
After 3 days, breastfeeding starts (possibly even 7 days in the event of Caesarean section).
Until the three week mark, this is transition milk, and after three weeks it is called mature milk. It’s not common for there to be drops in milk production. Demand controls supply, the act of suckling or expressing milk stimulates milk secretion.
Milk production is increased more by the frequency of feeds (or breast pump) than the duration. If less milk is being produced, you will need to express milk more often for your baby, if possible near the baby or with a picture of him nearby if you are separated.
It’s very normal for a baby to want more milk during periods of growth. These growth periods occur between 7 and 10 days, between 6 and 8 weeks and around 3 months. During these periods, the child is much hungrier, therefore breastfeed more often and your milk production will adapt to the additional needs.
Is my milk good for my baby?
Engorgement during the first few days is normal, this is called lactogenesis (or milk production). It may be decreased by early breastfeeding and frequent feeds or by the using a breast pump more often.
For relief, in the event of pain, offer your breast to your baby or use a breast pump. You can also take a shower or apply hot or cold compresses and massage the areola.
In most cases this will cause the milk to flow, which you can then be able to collect in a bottle. Afterwards, your breasts may still become engorged when you haven’t fully emptied your breasts.
How to avoid and relieve painful nipples?
Make sure your baby is in the right position. Avoid anything that could dry out and alter the smell of your nipple (soap, alcohol, disinfectants, etc.). After breastfeeding, rub a drop of breast milk on the nipple and areola, this will help heal and protect, and let it air dry.
During the first feeds, you may feel unpleasant sensations such as tightness or pinching in the nipples. This is absolutely normal and will not last long. If the pain persists during breastfeeding, do not hesitate to contact us.
How do I know my baby has had enough to drink?
If you need to know exactly how much your baby has been drinking, he/she can be weighed. Your baby’s nappies should be very wet (because the more your baby drinks, the more your baby pees), he/she should pee 4 to 5 times a day, and have a bowel movement 1x a day.
What is nipple confusion?
Babies don’t drink milk from the breast the same way as from a bottle, different techniques are used. At the breast, babies have to push their tongue out and massage the areola to have milk, with bottles, the tongue can stay inside the mouth and they will still get milk.
To limit this confusion, cups, spoons and nursing aids should be used instead of bottles.
To successfully breastfeed and to limit the confusion, it is very important that you are present during feeds. Ideally, you should be as often as possible. If your baby learns to drink from the bottle before the breast, he/she will suckle with their tongue pulled it and therefore will not massage the areola. This means that when your baby breast feeds, it may not trigger the flow of milk. Therefore it is better that your baby first learns to drink from the breast followed by the bottle.
Does my baby have diarrhoea?
Breast-fed infants rarely have diarrhoea. Bowel movements have a unctuous or liquid consistency and may contain lumps. They will have a yellowish ochre colour and the colour may vary depending on the mother’s diet. The amount and frequency of the bowel movements may vary during breastfeeding; your baby may have bowel movements each time the nappy is changed or only once a day.
Why is my baby crying?
Your baby may cry for different reasons: hunger, colic, wanting to be held, too hot, too cold… It’s the only way your baby has to express himself or herself.
It is important to respond to your baby’s tears, in particular don’t hesitate to take him or her in your arms, give him or her a hug and talk to him or her. You can also wear your baby in a baby carrier, you won’t be spoiling your baby, you’ll just be meeting his or her needs.
I have the impression that my baby isn’t feeding as well
It’s possible that the progress of your baby isn’t steady. Your baby is small and immature and has a lot to learn. You may be discouraged if it seems that your baby is sometimes slow to learn, but each baby has its own rhythm. If your baby falls asleep at the breast or doesn’t feed as well, it’s just a learning phase. Keep encouraging your baby and don’t lose your morale.
For information, a good average milk production is 500 ml of breast milk per day in the third week. Writing down how much milk you've collected over a 24 hour period helps us to see if your are producing less milk so we can act accordingly.
The entire care team in Neonatal ward is there for you if you have any doubts or additional questions. Don’t hesitate to contact us at 4411 3157 if necessary.