Moving Towards Breastfeeding

Feeding Your Newborn - Moving Towards Breastfeeding

Moving toward breastfeeding:

There is no "one size fits all" method for achieving effective breastfeeding with a high-risk baby, because each baby and each situation is different. Give your high-risk baby extra time to learn to breastfeed, and let the baby set the pace for learning. Learning to breastfeed effectively is a process that may take days or weeks for premature and many other high-risk babies. However, you and your baby can become a breastfeeding team if you are patient, persistent, and maintain a healthy perspective.

Signs a baby is getting ready for breastfeedings:

Let the physician and your baby's nurses know that you would like to breastfeed as soon as your baby is ready to begin feeding by mouth. In general, a baby must be able to suck-swallow-breathe in a coordinated way to take food by mouth. Some of the signs that a baby is getting ready to do this include the following:

Breastfeeding is usually less stressful for a high-risk infant, because the baby sets the pace - both for an individual feeding and for the process of learning to feed effectively. A baby's heart and respiratory rates, oxygen saturation level, and body temperature tend to remain more stable, and often improve, during breastfeeding. This stability of physical systems means breastfeeding takes less energy and it is less "work" for the high-risk baby. Of course, a baby must actually latch-on and actively suck to get milk during breastfeeding, and this may take time for a baby to learn. When bottle-feeding, milk drips in the baby's mouth and a baby must swallow it, ready or not.

Stages in breastfeeding progression:

The stages listed below, which describe a baby's progression to direct breastfeeding, are meant only as a guideline. Progress varies among high-risk babies. A baby might move quickly from one stage to another, or skip a stage altogether. On the other hand, a baby may sometimes seem to get "stuck" at one stage for a few days or weeks.

Helpful hints for beginning to breastfeed:

Illustration of breastfeeding, cross-cradle position
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What are nutritive feedings?

Nutritive feeding means your baby is able to effectively remove milk from the breast and swallow enough for continued growth and development. This requires nutritive sucking. During nutritive sucking, a baby consistently coordinates suck-swallow-breathe. If you watch, you should notice your baby is sucking at a rate of one suck per second, with a pause for a breath after every few sucks. To take in enough milk, the baby must be able to continue with this pattern for at least 10 to 15 minutes. Quite likely, you will hear your baby swallowing milk, which sounds like a "k" sound in the back of his/her throat, for at least part of the feeding.

In addition to nutritive sucking, a breastfeeding baby must wake and cue to feed 8 to 12 times in 24 hours if nutritive feeding is to be accomplished. Usually, there is a progression of feeding cues and the baby's seems more and more tense until food is offered. Some feeding cues include the following:

Your high-risk baby may need extra time to learn cueing when ready to feed. Many mothers find their high-risk babies are too sleepy and sometimes do not seem to know that they need to eat frequently.

Getting ready for discharge:

Usually a baby is doing more nutritive sucking for hospital discharge to be considered. When your baby is getting close to discharge, you may want to breastfeed for several feedings in a row. (Many mothers "room in" for 24 hours the day before discharge.) After observing several breastfeedings, the NICU staff should have a better sense of the baby's ability to cue for feedings and sustain nutritive sucking, and his/her response to milk "let-down." They can chart the effect that breastfeeding has on the baby's diaper wet and dirty diaper count. You may be asked questions about signs of milk "let-down" during feedings and whether your breasts feel any softer after feedings. They might also suggest using the opportunity to get several feeding test weights.

What is test weighing?

Test weighing allows the NICU staff to monitor the amount of milk your baby takes during a breastfeeding. The baby is weighed immediately before and after the feeding using an electronic scale that can measure very small amounts (one to five grams) of weight. Your baby will be weighed fully clothed, and no clothing is changed until after the baby is weighed after the feeding, as any change could affect the result. Babies do not take the same amount of milk in at every breastfeeding, and test weighing gives the staff a good idea of how much milk the baby takes in over a period of time.

What is involved in a discharge breastfeeding plan?

Your baby still may not be able to consistently demonstrate feeding cues or breastfeed effectively at discharge, but after observing feedings for 8 to 24 hours, the NICU staff will be able to work with you to develop a better discharge breastfeeding plan. Since you and your baby are unique, your discharge plan should be designed with your situation in mind, but it may include all, or some, of the following:

Helpful hints for breastfeeding at home:

When can a mother relax?

You can relax and breastfeed without pumps, devices, or alternative feeding methods when your baby consistently demonstrates the nutritive sucking associated with effective breastfeeding. Your baby should be doing well and getting enough from only breastfeeding when your baby:

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