Sensitive Midwifery - Issue 44 - October 2019

Breast assurance R egardless of what it is called, colostrum is tailored to the specific needs of a newborn, and especially beneficial to the premature infant. It’s highly concentrated, full of protein and nutrient- dense. This low-in-fat, easy-to-digest first food has numerous benefits for a newborn as it improves absorption of nutrients, gastrointestinal function, neurodevelopmental outcome, and plays a crucial role in building a baby’s immune system. Benefits of breast milk for preemies Human milk is the best choice of nutrition for all babies. Its unique composition is not only advantageous to the premature infant, but is potentially life-saving. Breastfeeding should therefore be considered as important as any medical intervention for premature infants. Preterm infants have not developed fully in utero, meaning they have di ff erent needs and challenges to term infants. A premature baby has an immature and/or dysfunctional gastrointestinal tract, which can cause di ffi culties with digestion and absorption of nutrients. Early, optimal nutritional management is crucial and colostrum expression should take place as soon as possible following delivery. Specific biofactors only found in breast milk (e.g. lactoferrin, antibodies, lysozyme, cytokines and antioxidants) can reduce the infection risk of the preterm infant. Breast milk contains enzymes that assist with digestion; epidermal growth factor, which helps with intestinal maturity; and essential fatty acids that aid in the development of the brain and eyes. Premature babies fed mainly on breast milk have significantly lower intestinal permeability than those predominantly given formula, which means that fewer (potentially disease-causing) particles can pass through the lining of their intestines into their bloodstream. Why are the most needy disadvantaged? Now that’s a relevant question, and the answers lie in concerted and creative addressing of the most common obstacles that prevent premature babies from receiving colostrum! These obstacles are: • The adverse e ff ects on initiation of lactation caused by mammary growth that may be incomplete in a substantially shortened pregnancy • Inhibition of lactation due to maternal stress, fatigue and anxiety • Lack of sta ff to assist the immobile mother with initial manual expression in the postnatal ward • Unclear guidelines regarding who is responsible for assisting the mother in the NICU or postnatal unit • The attitude of NICU sta ff to breastfeeding, as well as sub-optimal lactation knowledge and expertise • No protocol allowing lactation consultants (not employed by the hospital) to assist in NICU • Mom not being able to visit her baby in the hospital • Sub-standard expressing equipment of the hospital and at home How do we make sure premature babies get colostrum? After all, the risks they face increase if they don't! Liquid gold for premature babies Nurse and midwife Annerié Conradie’s special interest in breastfeeding and antenatal education led her to start a private practice in 2016, after working in a private hospital for 14 years. She completed her South African Certified Lactation Consultant qualification in 2018, and loves supporting new mothers and babies on their breastfeeding journeys. Annerié is wife to Francois, and mom to two daughters, Incke (14) and Kristin (11). Continued on page 51 50 eSensitive Midwifery Magazine Issue 44