Lactation Information

More mothers are choosing to breast feed their babies today that ever before. Breast feeding is considered the preferred method of infant feeding by health care professionals. Infants in the NICU who are fed their mothers' milk can especially benefit from its special qualities. Breast milk helps protect infants from infection, respiratory disease, allergies, and ear infections. It is easier for an infant's immature system to digest. There are also special fats in the breast milk that may help an infant's brain and eyes develop. Lactation specialists help mothers with pumping and milk production, as well as helping the baby at the breast.

Mothers who choose to breast feed benefit, as well. Many mothers feel that this is a unique way that they can contribute to the care of their infant, something that only they can do. It also helps many mothers feel more connected with their baby, and less stressed.

Some mothers may still be undecided about breast feeding when their infant is born. In this case, it's possible to give breast feeding or pumping a try, and make a final decision after a week or two. A woman's body is most ready to start making milk right after delivery. For this reason, it sometimes helps to start pumping right away, knowing that it can be discontinued at any time. Whether a woman decides to express milk for a short time or breast feed for several months, breast milk is an important part of her baby's care.

The NICU team is available to answer questions about infant feeding and help parents make a well-informed feeding choice. Parents are given support in their choice and help with reaching their goals.

Mothers who decide to breastfeed are assisted throughout their infant's stay by the lactation (breast feeding) consultant staff. This assistance has several stages.

The lactation consultants meet with mothers soon after the infant's arrival to begin education. This first stage includes:

  1. How to use electric breast pumps
  2. Proper cleaning of pumping equipment
  3. Storing and transporting breast milk
  4. Maintaining a good milk supply
  5. Breast care

As infants progress, lactation consultants are involved with helping mothers learn to handle their infant. This second stage may include:

  1. Skin to skin care
  2. Suckling at the emptied breast

Skin to skin care (also called kangaroo care) is an excellent way to get acquainted with your baby. It is the first step toward breast feeding. This can be done as soon as the infant's condition is stable. Many mothers find their milk production increases after skin to skin care. It can be done while the baby is being gavage fed.

Suckling at the emptied breast can be done when the infant has been extubated and is stable. This is also called non-nutritive sucking. The mother first empties her breasts completely with the breast pump. The infant is then placed at the breast to smell and taste the milk for the first time. This is a "getting acquainted" session, and the infant is not expected to take an actual feeding. Doing this during a gavage feeding calms and soothes the infant. It also helps digestion and improves weight gain. Having the infant suckle at the emptied breast can also help increase a mother's milk supply.

The third stage of breast feeding usually starts when the infant is about 32-33 weeks of adjusted age, although babies are ready at different times. Readiness depends on the infant's general condition and ability to coordinate sucking, swallowing and breathing. When infants have less endurance or energy, they may be given your milk through a tube in their nose called a gavage tube or nasogastric tube. Then they may progress to one feeding a day by breast or bottle. The number of feedings by mouth each day gradually increases as the baby matures. Some babies may need to take part of their breast milk from a bottle until they fully learn to breastfeed.

The lactation consultants will help you learn to position the baby at the breast and latch correctly. Mothers are encouraged to practice breast feeding between appointments with the lactation consultants. Your baby's nurse can make an appointment with the consultants when your baby is ready, or if you have questions about breast feeding or pumping.

Breast feeding mothers are encouraged to eat a diet of healthy foods and nutritious snacks between meals. Drinking water or juice when you are thirsty is also important. Your social worker can give you information about getting a meal tray for breast feeding mothers from the hospital.

Most medications are safe to use while you are breast feeding. This includes pain medication prescribed by your doctor after delivery. Be sure to let your baby's doctor or nurse know if you are taking any medication. This includes prescription, over-the--counter medication and herbal supplements.

NICU mothers who deliver their baby at Cedars-Sinai Medical Center are given a hospital-grade electric breast pump to use during their hospital stay. This type of pump is best for stimulating the hormone that makes milk. It is more effective than battery operated or hand pumps. A double collection kit allows mothers to pump both breasts at the same time, which helps milk production. Information on renting a pump for home use is also provided.

The Lactation Education Center is a full-service breast feeding store with breast pumps to rent or buy, as well as other breast feeding supplies. It is located on the 3rd Floor North, Room 3202(phone: 310 423-5312). Mothers who are eligible can borrow an electric breast pump from WIC. Your social worker can give you a prescription and help you contact WIC to arrange for a pump.

Mothers are encouraged to begin pumping as soon as possible, ideally within 12 hours of delivery. You should pump every 3 hours, with a 4 to 5 hour sleep stretch at night. Pumping 6-8 times a day is essential for developing a milk supply adequate to meet your baby's needs. The milk expressed the first 3-4 days, colostrum, is extremely valuable for your baby. Although it is normal for only a small amount to be produced, it is like special medicine for your baby and helps prevent infection. Toward the end of the first week, the amount of milk you produce will increase. The goal is for mothers to express about 800 ml (3 1/2 cups) of milk per day by the end of the second week. The NICU lactation consultants can help if you are having trouble reaching this goal, or if your milk supply decreases at any time.

For convenience, hospital-grade electric breast pumps are available in the NICU Lactation Room for mothers to use when they come to visit their infant. Mothers may also choose to pump at their baby's bedside. This is encouraged because it helps increase milk supply. Screens are available for privacy. Mothers need to bring their own pump collection kit each time. Disposable collection bottles, caps, and labels are also provided by the NICU.

Mothers with infants in the NICU are encouraged to attend the weekly breast feeding support group. This group is led by a lactation consultant, and provides a chance to meet other breast feeding mothers, ask questions, and learn more about breast feeding.

Despite the challenges of providing breast milk for a premature or sick infant, most mothers find the rewards well worth the effort. The NICU team is there to help make this a successful and positive experience for you.

For more information on store hours and breast pump rental information, please visit the Cedars-Sinai Lactation Education Center.

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