Sensitive Midwifery - Issue 44 - October 2019

Breast assurance Promoting baby-friendly protocols Regular update sessions on how to implement kangaroo mother care (KMC) is just one of the many ways in which premature-care-unit sta ff can be supported by management to be ‘liquid-gold friendly’. Another is to hold regular training on lactation topics like expression, evaluating quality of feeding at the breast, initiating breastfeeding and the use of a supplemental nursing system (SNS). In fact, it’s imperative to demonstrate manual expression to all postnatal unit sta ff . Protocols and responsibility regarding handling of expressed breast milk (EBM) and time intervals between expressions should be clear and part of the induction programme – and regularly revisited. Not all sta ff members are equally positive about baby-friendly protocols and KMC. Ensuring that this does not depend on ‘who is on duty’ is key to maintaining a baby-friendly environment, and preventing frustration and confusion for the parents. Parents often comprehend very little information just after admission as they are in shock, so sta ff should repeat information, even if given already. Having a written admission to NICU, breast milk and expression protocol that all sta ff have access to is a good idea. All sta ff should also be educated and assessed on the pumps used by the facility (i.e. di ff erent settings, fitting of the flanges, and the content of education given to the mothers on the use of the pump). In fact, hospitals should consider employing a certified lactation consultant to optimise outcomes. Supporting mothers leads to success Counselling mothers of preemies as soon as possible increases the incidence of lactation initiation and contrary to popular belief, does not increase maternal stress or anxiety. Feelings verbalised by most mothers regarding their inability to breastfeed their premature babies immediately after delivery include: sorrow, guilt, disappointment, frustration, sense of loss, insecurity, as well as fear of touching, holding or harming their delicate babies. Health professionals need to recognise that these feelings may not be automatically obvious to the observer. Mothers of premature infants should be educated on: • The benefits of EBM (this should be discussed with the expectant mother during the antenatal period, especially where a risk of prematurity is anticipated) • Method and frequency of expression, both manual and electric • Having realistic expectations regarding the initial milk volume for each expression for the first 24–48 hours postpartum • The expected duration of feeds • The importance of taking in enough fluids during the day, having a balanced diet and carrying on with a multivitamin • Positioning the baby at the breast, ensuring a good latch, as well as how to perform breast compressions and the benefit of breast compressions during feeds (breast compressions maintain a continuous flow of breast milk, which in turn, helps a baby to stay alert and interested in feeding) Sta ff can o ff er further support by encouraging continuous skin-to-skin (where possible); ensuring privacy while the mother expresses milk, and o ff ering her a comfortable chair; as well as praising her for her e ff orts, regardless of the amount produced — every drop counts! If volumes expressed stay lower than expected, sta ff must ensure that the expression technique is correct, and if unsure, they must get the advice of a lactation consultant. Breastfeeding’s a no-brainer There’s more than enough research that proves that premature infants benefit short term as well as long term, by receiving colostrum and ultimately, breast milk. There is an urgency for sta ff to be well educated in this field, and where expertise is lacking, to request specialised lactation assistance. Admission to the NICU is often unexpected and hits most parents hard. Education, support, assistance, attachment parenting, and creating opportunities for fathers to support mothers can help to ensure that the infant not only receives the very valuable ‘liquid gold’, but that a successful breastfeeding journey is established. Contact Sensitive Midwifery for references if required 51 eSensitive Midwifery Magazine Issue 44