Breastfeeding can be tricky at the best of times, put on top of that a baby that is chronically ill or has undergone surgery and those difficulties become compounded. I was unable to physically breastfeed my baby for almost 6 weeks when she was at her sickest, my lifeline came in the form of lactation consultant Susan Shaw.
I asked Sue to share some of her tips and ideas when it comes to breastfeeding in this extremely difficult situation.
What types of challenges might a mother face when trying to breastfeed an ill baby?
When your baby is born premature or ill, they may require careful observation and monitoring. Breastfeeding rarely needs to be discontinued for infant illness. Through breastfeeding, the mother is able to comfort the sick child, and, by breastfeeding, the child is able to comfort the mother.
After the birth, your baby may be admitted to a Neonatal/Paediatric Intensive Care Unit (NICU/PICU). They may need ventilation, which can result in them being unable to respond to you, remaining asleep, and they may be unable to be picked up and handled. Along with their medical situation, this all results in a very difficult and stressful time.
If you are fortunate to be able to handle your baby, then you need to hold, cuddle or lie with your baby as often as you can or need. The chronically ill baby will benefit from the close contact, relaxation and warmth that skin-to-skin contact provides.
Some babies are unable to be breastfed directly or feed orally. This means mothers will need to use other ways to stimulate their breasts to either establish or maintain their breastmilk supply. You will need to rely on either hand expressing, manual or an electric pump (preferably a hospital grade pump the hospital can provide) to express.
Anytime a sick baby is able to take anything by mouth, if a mother is breastfeeding or expressing, we should use whatever expressed breast milk (EBM) you have first. Breast milk provides antibodies specifically tailored to fight baby’s illness and is quickly and easily digested.
Breastfeeding can aid in digestion and help protect babies gut, especially while most chronically ill babies are on numerous medications which may destroy some of their gut flora.
When a baby is ill they may not have the endurance to be able to drain the breast adequately. They may require a top up using EBM or formula, to ensure they obtain the required volumes to enable adequate growth. This top up may be given via bottle or naso-gastric tube (NGT). If the baby becomes too sleepy and too lethargic to breastfeed, a lactation aid or supply line may be used to make breastfeeding easier to obtain milk. As long as the baby can suck at the breast and consume sufficient milk without becoming exhausted.
It is then important you express (double pump if you can) to help drain the breasts as your baby may not have taken much volume off, and seeing that it’s all about supply & demand, we want to ensure you help drain your breasts well when your baby is unable to. Then you will also have EBM to use as a top up.
Some hospitals, the cardiac/renal unit at Melbourne Royal Children’s Hospital for example, use test weighs before and after a breastfeed to see how much the baby takes, 1ml = 1gram. Then the rest gets topped up via bottle/NGT.
You may need to use breast compression (gently squeezing the breast to drain the breast) while breastfeeding to encourage flow, if he isn’t sucking or swallowing well. Again, these babies often have reduced stamina and fins it difficult to feed adequately.
It’s a slow process while your baby improves, so feed by feed, day by day, and baby steps are important things to remember.
What are some ways I can keep up my supply when my baby is unable to breastfeed?
Although you may not be able to directly breastfeed your baby, with help and support from staff, you should be able to make breastfeeding work for you both.
Frequent breast stimulation is extremely important and vital to either establish or maintain your breastmilk supply. Its all about SUPPLY & demand. Massaging and compressing when pumping and feeding can help – some say “…if you’re not using your hands you’re not doing it right…” While expressing, massage and nipple stimulation can really help or gentle feather strokes away from the nipple. Gentle hand express till milk starts, then attach the pump, on a fast rhythm for 2 mins then to the normal pump pace/power. Try heat packs or hot shower (not always practical in a hospital setting) before pumping or feeding.
With the stress, anxiety and possible sleep deprivation you may forget to express, letting your breastmilk accumulate which could put you at risk of blocked ducts, engorgement and/or possible mastitis. Then unfortunately this milk fullness will slow the milk production. A full breast = slower milk production, but an empty breast = faster milk production.
Double pumping is recommended if you are comfortable to do so for 10-15 minutes, as it saves you time but more importantly it allows you to collect milk from both breasts while you let down, helping to establish and increase your breastmilk supply. If double pumping is too difficult to coordinate in the beginning, then single pump alternating sides for 10-15 minutes each, then move to double pumping as soon as you can.
Unfortunately the stress, exhaustion and sleep deprivation can cause your breastmilk supply to drop. Just keep maintaining regular expressing and do not panic if your supply drops. It may, but regular stimulation will certainly help pick it back up again over some days, like 2 hourly 10 minute double pumping sessions during the daylight hours for a few days (and 4 hourly overnight).
It can also be very difficult to find the energy to wake and express overnight, especially if your baby is not with you. However your Prolactin levels (milk making hormone) are high overnight in the early weeks. Try and express at least one time between midnight and 6 am without having too large a gap between breast stimulation. Night time expressing helps stimulate your breasts to make more milk overall.
Try and express by your babies’ bedside, being able to touch and smell your baby (use a hands-free bra to allow you to be hands on while pumping). Your baby’s cry can be a very powerful letdown trigger!
If away from your baby, use video, audio or smell. Smelling your baby works just as well as visual cues. Have a photo or video of your baby, listen to sounds (cries) of your baby or a piece of his clothing you can smell (keep it in a zip lock bag to retain the smell).
It’s important to try and relax when you pump (often easier said than done!). If you’re tense, it’s very difficult to facilitate letdown. A quiet relaxed environment, deep slow breathing may help. Closing your eyes and visualising success can help you relax and not focus on how much milk you’re getting. Close your eyes. Deep breaths and just think of your baby. Try your best to get comfortable, maybe eat some nice comfort foods (e.g. chocolate) and/or drinking something warm.
Make sure you are drinking plenty of water and eating enough food. Keep water and snacks close by at all times, especially while expressing. Staying hydrated is super important for milk production, drink to thirst. You can also eat and drink galagtagogues, which are foods/drinks that boost your supply. You may want to see/discuss with your lactation consultant or GP to discuss further herbs and or medications if you are really struggling with supply.
Try not to have expectations about what you should get or need to get, it’s the stimulation that counts not necessarily volume!
If you’re having to give bottle feeding top ups. Have your baby cheek to breast while feeding, skin to skin is an amazing thing! Then try pumping after your contact time.
Expressing may feel like a huge commitment and extra challenge when you are feeling tired, worried and stressed about your baby. But every drop of your breastmilk is important for your baby. Expressing as frequently as your baby would breastfeed is the best way to maintain your milk supply. Many Mums feel that while expressing is time consuming and can be quite tiring, it is also something really important that only they can do for their baby.
Talking to your family and your baby’s nurse or lactation consultant/midwife can help with working out a routine that fits with your life and helps you achieve as many expressing sessions as possible and make an expressing schedule that fits with you and your baby’s routine.
Depending on how young your baby is will depend on how you express:
- If your baby is only 1-2 days old, your milk may not have ‘come in’, so you may need to start by using gently breast massage and hand expressing in these early days.
- Once your milk comes in, then you can move onto using a hospital grade pump to start expressing on a regular basis, like 2 to 3 hourlies in day time and 3-4 hourly at night (at least 8-10 times every 24 hours).
- This will help to establish and or maintain an adequate breastmilk supply for your baby for when he/she is better.
- If you are expressing for an older baby, mimic the times of his feeds would often be and express around the times of your babies possible feed times.
A sick baby does not need breastfeeding less, they need it more!!
Your plans have suddenly changed, but that doesn’t have to be the way for your breastfeeding journey. You may not be starting the way you’d expected because your baby is ill, but with help and support you can make breastfeeding work for you and your baby
Will I miss out on important bonding time if I am unable to breastfeed my baby for a time?
Not at all!
Skin to skin contact is so important, so even the babies who are so unwell who may not be able to feed on their own, may still be able to be out and cuddled by their parents to enjoy the precious skin to skin time.
If the baby is in NICU or PICU and unable to leave their bed, you are still able to touch, talk and be close to your baby at all times. Once they are well enough you will certainly be able to make up for all the lost cuddles you had, remember you can’t spoil your newborn!
For an ill baby, breastmilk is not just food it is an important medicine to help them grow and develop. In many situations over time as your baby gets stronger, gains endurance, with appropriate help and support, you will be able to breastfeed your baby.
What do you love most about being a lactation consultant?
The bond between a mother and baby is so unique, and unfortunately when you have a sick baby, this really puts a strain on the mother-baby breastfeeding relationship. I have the joy and privilege of supporting these amazing breastfeeding mothers try and re-establish or maintain a breastfeeding relationship with their critically ill baby.
Whether it be exclusive breastfeeding or partial, mix feeding or pain free breastfeeding or to just achieve some form skin to skin contact for that mother-baby unit is so valuable for that breastfeeding relationship.
There is nothing I find more satisfying and gratifying than helping a mother and sick baby who have been struggling with breastfeeding and be able to watch them nurse or express contentedly and comfortably establishing or restoring a breastfeeding relationship for the mother-baby unit
As a mother it is so easy to lose confidence or have your confidence undermined or taken away, so to be able to have some form of contact with your baby is so special, and if I can help create this with my families and support them through their personal breastfeeding journey, however it ends up, I feel I have done my job.
Where can I learn more or find help with breastfeeding my chronically ill baby?
If you have any questions that were not discussed above, do not assume that you must stop breastfeeding, do not stop, get more information. Mothers have been told they must stop breastfeeding for reasons too silly to discuss. Breastfeeding is extremely comforting to an ill baby, it’s also very calming for mother and baby and a major part of the healing process.
Most hospitals will have Lactation Consultants, Midwives, Dieticians, or paediatric/neonatal nurses you can ask for help and support from. Ask what your hospital has to offer in these areas of support and ask for an appropriate referral.
If you have a private Lactation Consultant, make contact and they can either visit or discuss options over the phone.
Some safe appropriate websites:
Royal Women’s Hospital for information including; Clinical guidelines, Breastfeeding sick & premature babies baby, Expressing for sick preterm babies, Expressing in general.
Royal Children’s Hospital for the following; Clinical guidelines, Breastfeeding support and promotion, Parent information-Breastfeeding and Expressing in hospital, Expressing breastmilk for your baby in hospital, Storing and transporting expressed breastmilk for hospital.
If you’re located in Melbourne and could use some of Sue’s expertise, you can contact Sue for more information and support via her website.
What challenges have you faced when trying to breastfeed your ill baby?