My first experience of breastfeeding was not how I had imagined it would be. In fact, there wasn’t even a baby involved. Instead it was just me, a nurse and a syringe. My baby had been born earlier that evening by emergency caesarean section at 36 weeks. As I lay helplessly on an operating table that night, my baby daughter was rushed to the special care unit. I didn’t even get to see her.
I had developed pre-eclampsia at the start of my third trimester. Until that point I had enjoyed a completely normal pregnancy so it came as a shock to me when things started going wrong. While my blood pressure steadily increased over the following weeks, the growth rate of my baby decreased. My consultant took the decision to deliver her four weeks early. Isabella was born weighing just 4lb 4oz so it was imperative she received as much milk as possible, as quickly as possible. Before I even came out of recovery, a paediatrician came to ask my permission to give her formula milk until I was well enough to feed her myself. It is difficult to recall exactly how I felt at that point as I think I was probably still in shock. I know I was completely consumed by worry for my daughter’s health. All I wanted was for her to be well and to put on weight and so of course I didn’t hesitate to allow someone else to feed her for the first time if I couldn’t. But I also felt tremendous guilt. Guilt that my body hadn’t been able to take better care of her whilst she was inside me and guilt that I couldn’t be with her and feed her myself in her first few hours in the world. I hated the thought of her lying in an incubator without me there to comfort her. I also knew the risks involved in having a low birth weight child. She was at a higher risk of cot death and of developing complications if she caught an infection but the one thing that I was told could counter those risks was for her to be breastfed. With all that in mind, as my husband wheeled me down to see her for the first time I was desperate to attempt to feed her myself.
Expressing my milk
Unfortunately, as with many premature babies she was too small and too weak to latch on to the breast. After weighing up the options available to us, I decided to express my milk and feed it to her by bottle. I was warned she may never take to the breast if she was fed by a bottle but the alternative was to feed her through a tube and I wanted to avoid that if I could. Every year more than 80,000 babies are born either ill or prematurely in the UK. Many are born so early that the only option is to feed them via a tube. The experience some families face can be a lot more traumatic and difficult than that my family went through. For some, breastfeeding may not seem at first like an option but there are ways to help increase the chances. A spokesperson for premature baby charity Bliss says: “Some babies are born so small and premature that it would be many weeks or months before they can begin breastfeeding. So shortly after birth, mothers, with the help of the team caring for their baby, are encouraged to begin expressing their milk. To begin with only a tiny amount may be produced but with support over time, many mothers can go on to initiate breastfeeding before they leave the neonatal ward.”
Liquid gold in a syringe
On that first night after having Isabella, I only managed to express a tiny amount in to a syringe. It seemed impossible then that I would ever be able to fill a whole bottle. I even felt slightly embarrassed as I took the miniscule amount to the special care ward, until staff explained to me that what I had expressed was colostrum. The nurses called it ‘liquid gold’ because it has such amazing benefits for all new babies but especially for those born prematurely because it gives them an infection fighting boost in their first few days. Rosemary Dodds from NCT (formerly National Childbirth Trust), which supports all parents, including women breastfeeding a premature baby, says: ‘If babies are too young to start breastfeeding, starting to express as soon as possible will send the body the right message. Frequent expressing mimics a baby’s feeding pattern; 10-12 times in 24 hours is recommended without any long gaps and should be continued during the night. There will be small quantities at first but continued expressing and “Kangaroo Mother Care” are the best ways to increase milk supply to meet babies’ later needs.’
Kangaroo Mother Care is the term used for frequent skin to skin contact between the baby and mother. It can help with bonding, stabilising the baby’s temperature and it also supports breastfeeding. I will never forget the first time I was able to do this. My tiny baby was passed to me wearing just her nappy. I tucked her up inside my nightgown to keep her warm and she laid there on my chest so peacefully for about 30 minutes before a nurse came to take her back.
Rosemary adds: ‘There is good evidence that mothers and babies who have Kangaroo Care are more likely to carry on breastfeeding. Skin to skin cuddles support a mother’s hormones to produce milk and enable babies to start to breastfeed when they are ready.’ When it came to expressing, I found the way that worked best for me was to sit next to Isabella after each feed and express using an electric pump. I was also shown how to express by hand, but I personally found I produced more milk with the pump. My milk was then stored in a fridge until her next feed. If a baby has been born very prematurely it can take longer to establish a good milk supply but continued expressing will help. I was lucky that after about four days my milk came in and expressing became much easier. I was able to stop topping up with formula and feed Isabella exclusively with breast milk. The first time I managed to fill a whole bottle was a great moment! After five days we were allowed to take our baby girl home from hospital. It was both exciting and terrifying. I had a long list of instructions from her doctor. They included the temperature I should keep the house at,how much milk she should drink over a 24 hour period. After each feed my husband would update her milk chart so we could monitor any change to her feeding patterns. Sometimes she would take a lot less than others but we were told to look at the total amount through the day not just individual feeds.
From bottle to breast
Health visitors came daily in those first few days at home and warned that Isabella would never take to the breast if I continued feeding her my milk by bottle. Although it was tiring to express so often I was scared to change to breastfeeding because I wouldn’t know how much she was actually taking. I decided to try breastfeeding but every time I put her to the breast she pulled away.
I was beginning to think I would always express but then my mum suggested nipple shields may feel similar to a bottle to Isabella and, sure enough, on only the second attempt she at last latched on.
From that moment on I continued to breastfeed her and she continued to put on weight. By the time she was about four months old she had gone from being under the 3rd percentile on the growth charts to up in the 50th percentile. Our breastfeeding journey continued until she was 13 months old and she has thrived ever since.
Having a premature baby can be a very different experience to the one you imagine having during your pregnancy but it doesn’t have to be a negative one. It is important for parents to seek as much support and advice as possible.
There are various support networks that can help. NCT and Bliss are both very helpful as are many of the premature baby forums on the internet where you can chat to parents who are facing similar issues to you and your child. Bliss has produced a great booklet called The Best Start that provides information and support on expressing and breastfeeding premature and sick babies and is available free of charge through all neonatal units.
I personally found The National Breastfeeding Helpline very friendly and informative. It is open from 9.30am until 9.30pm every day of the year.
The National Breastfeeding Helpline – 0300 100 0212 nationalbreastfeedinghelpline.org.uk
Natalie is a freelance writer. She lives in Northamptonshire with her daughter Isabella and husband Eduard.