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Breastfeeding

All babies get jaundiced after birth. Breastfed babies may become more jaundiced than formula-fed babies, for a number of reasons collectively known as breastmilk jaundice. Bilirubin (the molecule responsible for jaundice) is a potent anti-oxidant, and it probably does some good things for the newborn baby. This could explain why there are multiple mechanisms in the breastfed baby that work to increase, rather than decrease, bilirubin levels. These factors lead to the diagnosis of breastmilk jaundice.

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Let-down is the other component of successful breastfeeding. Some women make the milk, but don’t get let-down and so can’t get the milk out. This is extremely painful and frustrating. There are different hormones involved in milk production (e.g. lactation) and excretion (e.g. let-down), and stress interferes with the let-down hormones. Experienced breastfeeders will tell you that let-down feels like a “tingling” in the breast, followed by a steady stream of milk. If you’re not experiencing let-down, try deep-breathing and relaxation exercises. Try looking at a picture of your baby, of a calming scene, or listening to relaxing music. Using biofeedback techniques, you can train yourself to “get let-down.” Without let-down, your breasts will be engorged, which is very painful and disrupts the lactation cycle. When all else fails, try hand expressing in the shower. You can’t collect the milk, but at least you will relieve your discomfort and, hopefully, keep up your milk production.

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Milk is made on a supply-and demand process: if your breast is empty, your body will fill it up. When you are only pumping (and not actually nursing), it takes particular commitment to pump on a rigid schedule to maintain lactation – but you can do it! Think how important this is for your baby to keep up your motivation. Pumping through the night is particularly difficult, and probably markes the beginning of a decreased supply for many women. When milk sits in the breast, the body perceives that it isn’t needed, so decreases production. The best way to maintain production is to keep those breasts empty! If you want to increase production, start pumping more often (not necessarily longer.) Every time you “demand” milk from your breast, but it isn’t there, your body will respond by making more. (It takes about 48 hours for you to see an increase.

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While technically not the same thing, the terms breastmilk jaundice and breastfeeding jaundice are frequently interchanged. “Breastfeeding jaundice” refers to the sometimes elevated levels of bilirubin seen in the first few days of life, thought to be due in large part to decreased fluid intake and delayed stooling until mother’s milk comes in. “Breastmilk jaundice” refers to the protracted jaundice (and, possibly, elevated levels of bilirubin) seen in exclusively breastfed infants at more than 1-2 months of age. In these otherwise healthy and thriving babies, their mothers’ breastmilk may contain substances known to prolong higher levels of bilirubin and requires no further investigation.

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Breastmilk is the perfect food for babies and is an extremely important part of NICU care that only MOM can provide. To do this, mothers must pump their breasts and bring their expressed breast milk (EBM) to the NICU when they visit. Pumping isn’t hard, but it’s not very pleasant and it requires motivation to keep at it. Making breast milk takes a lot of energy for your body and, if your body thinks it’s unnecessary, it will stop. Breastmilk production is a supply and demand process: If your breast is empty, your body will fill it up! Immediately after birth – especially a preterm birth – your body doesn’t know you have a baby to feed. You must tell your body to establish lactation (e.g. milk production). Pumping is how you do this without a baby to nurse. Healthy term babies will nurse in the delivery room, and this sucking motion on your nipple stimulates your brain to tell your breast to begin making milk. It takes 3-5 days for your milk to come in. It is extremely important that you continue to pump every 3 hours around the clock during this time because, if you don’t, your body will think it doesn’t need to make the milk and will turn its energy elsewhere. (Making milk takes more energy for your body than growing a baby. See “How to lose the baby weight” for more information.) In the early days, you will produce colostrum, a yellow oily substance that is power-packed with nutrition. Collect it if you can and bring it to your NICU nurse for your baby. Get lots of rest, drink lots of water, and try to relax. (Yeah, right!) The stress hormones are opposite the milk-production hormones. When your milk comes in, you will know it. It is not subtle! The best remedy for an engorged breast is to empty it!

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