Not enough Milk & Premature Babies

Not enough milk - Course Objectives:

Participants will be able to identify the difference between the clinical presentation of actual insufficient milk supply and perceived insufficient milk supply.
Participants will be able to discuss the etiology and potential indicators of insufficient milk supply.
Participants will be able to describe the measures used to assist mothers with insufficient milk supply.
Participants will be able to describe the essential differences between re-lactation and induced lactation.
Participants will be able to describe the different techniques for managing the processes of insufficient milk supply, re-lactation and induced lactation.
Participants will be able to list galactogogues and/or herbs commonly used to increase milk supply and their effects.

Course Outline: 2 ¼ hours breaks not included
1. Identify the difference between actual insufficient milk supply and perceived insufficient milk supply.

Classification of low milk supply (Woolridge 1995)
Perceived insufficient milk supply and actual or primary insufficient milk supply

2. Etiology and potential indicators of insufficient milk supply.

Careful history taking and breastfeeding assessment
Causes of low breastmilk supply
Infant behaviour, frequent feeding, slow weight gain – poor management or true IMS
Early supplementation & no assistance to stimulate or maintain milk production
Breast milk production if maintained by frequent and effective removal of milk from the breasts.
Congential insufficient glandular tissue, breast surgery, postpartum haemorrhage, anaemia.

3. Management of low milk production

Identify potential determinants and indicators for who is “at risk”
Effective teaching - position, latch-on and how to know baby is getting milk, infant behavioural feeding cues
Frequent feedings - weight check within 48 hours of discharge
Pumping, Galactogogues / Herbs / Alternative therapies
Common problems associated with maintenance of lactation

4. Re-lactation and induced lactation

List at least 5 motivating reasons why a mother may wish to re-lactate or induce lactation
Describe the developmental changes related to re-lactation and induced lactation that occur in the breasts.
Milk composition of induced breastmilk and relactation
Techniques and management related to re-lactation and induced lactation

Premature Baby - Course Objectives:

Participants will be able to list the essential differences between the milk of mothers of term vs premature infants
Participants will be able to describe the needs of the premature infant in terms of nutrition, immunity, and long-term needs.

Participants will be able to describe the mother’s needs in terms of her psychological state and personal feelings.
Participants will be able to describe how best to establish and maintain the mother’s milk supply for her premature infant.

Participants will be able to state research-based advantages and reasons for breastfeeding the premature infant

Course Outline: 2 ¼ hours breaks not included
1. Differences between term milk and preterm milk

Components of preterm milk - ↑concentrations of calories, proteins, lipids, iron, chloride, sodium, potassium, magnesium, sIgA and other antiifective properties.
Preterm milk - suited to growth and immunological needs of premature infant.
Extremely low birth weight babies may need extra nutrients, vitamins and minerals.
Risks associated with fortification of breastmilk, Lactoengineering

2. Needs of the premature infant

Nutritional advantages of feeding a premature baby its mother’s milk.
Potential causes of premature infant mortality that can be prevented by providing breastmilk.
Kangaroo Care helps to regulate baby's temperature, heart rate, respirations, better weight gain and shorter hospital stays.
Feeding regimes for premature infants

3. Mother’s needs in terms of her psychological state and personal feelings following a premature birth and maintaining lactation.

Ways to support the mother of a premature baby with her efforts to breastfeed.
Providing breastmilk for a premature infant helps the mother feel she is contributing to caring for her infant, providing the best start in life and allows for physical closeness.
Mothers of premature infants face many barriers to breastfeeding - maintaining lactation for weeks or months.

When to suggest mother begin pumping and/or expressing her milk and to assist the mother in developing an effective pumping routine suitable to her needs and lifestyle.

describe how to maintain an adequate milk supply over a long period by frequent draining of the breasts as well as the use of galactogues when necessary and with the knowledge and approval of the mother’s medical practitioner.

4. Research-based breastfeeding for the premature infant in the NICU.

(Meier et al. 1993) 4 phase temporal model.
Early breastfeeding is physiologically less stressful than bottle feeding
No scientific evidence for delaying the initiation of breastfeeding until baby has bottle fed.

5. Question and answer period. Total 270 minutes