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Breastmilk is essential for every newborn’s growth and development, but it’s especially critical for babies born prematurely.
The benefits of mother’s own milk
Mother’s own milk (MOM) – often called “liquid gold” – provides the perfect nutrition for babies, says Aliné Hall, Clinical Quality Specialist for Child Health at Mediclinic Southern Africa.
“There’s nothing better than MOM,” she explains. “It contains everything the baby needs – it even supersedes medicine. MOM is especially critical for premature babies, because they’re sometimes delivered 2-3 months before they were meant to be born. They then miss out on the last 2-3 months of the immunoglobulins that the mother passes onto them in utero to build their immunity. But babies can still get these immune boosters through their mother’s breastmilk.
The extra immunity that breastmilk provides is vital for preterm babies who are more susceptible to infection and illness due to their underdeveloped immune systems and organs. It also lowers the risk of necrotising enterocolitis (NEC), a devastating intestinal infection that gets into the gut and can be life threatening or cause long-term gut issues. Breastmilk can also help prevent retinopathy of prematurity (ROP) where being on oxygen can cause eye damage. Studies have also shown that breastmilk decreases long-term cardiovascular problems and may help boost language and academic performance.
“As MOM is so perfect for babies, they tolerate it better, so it’s absorbed much faster,” Hall explains. This speeds up the transition to full feeds. Naturally, the smaller the baby, the longer it takes before they can breastfeed directly. For this reason, premature babies usually start with tube feeds, and we aim to ensure they receive either expressed breastmilk or donor-expressed breastmilk. It’s a slow process, but giving babies this breastmilk early helps support a smoother and quicker transition to a breastfeeding .
“The quicker you can get them off their tubes and intravenous feeds and get them on full feeds, the better they do,” says Hall. “There’s less risk of infection and you can hopefully get them home quicker. Getting a family home and together as soon as possible, especially the baby and mom, is our priority.”
Supporting moms to breastfeed
On World Prematurity Day, the focus is on premature babies and helping them get the best start in life. A big part of that is supporting mothers so they can produce the breastmilk their babies need. This can be a frightening time for parents, and many mothers struggle to make and express milk while their baby is in hospital. “Nurses, midwives and the medical team must support her as much as they can to help her to produce milk,” says Hall. “They must show her how to express and help her understand the importance of rest and fluid.
“Our role is to help the mom as much as possible, which sometimes requires a lactation specialist. There’s a lot of pressure on a mom to make that milk, so it’s vital to safeguard her mental health too and to understand that her emotions coincide with how her baby is doing.”
It’s important to strike the right balance so mothers don’t feel pressured or discouraged. “Two drops of breastmilk are just as valuable as 10ml, Hall explains – especially in the first few days, when babies need only very small amounts. Even a teaspoon of colostrum per feed – the first milk produced after birth – plays a crucial role in strengthening a newborn’s immune system because of its rich nutrients and antibodies. “It’s a fine balance to support that mom, to help her recover, but also to help her produce the milk as soon as possible,” says Hall. “Once the mother starts making milk, it usually gets easier.”
Allowing mothers to hold their babies skin-to-skin as soon as the baby is stable enough is essential, as it’s been shown to improve milk production. To give premature babies the best start, the medical team should minimise separation between mother and baby, Hall says, and provide support to the wider family as well.
Breast milk donations
Sometimes even with support, moms can’t provide enough breast milk. This could be due to their own health issues or medication, having had a multiple pregnancy, or the shock of a preterm delivery. These moms need to know that donor breast milk is available from several organisations.
Mediclinic mainly uses milk from the South African Breast Reserve (SABR) and Milk Matters, which provide milk to hospitals when they need it. Any other breastfeeding mother can donate her surplus breastmilk to either of these banks. That way, more premature babies can get breast milk even when getting MOM isn’t possible.
Parents can be assured that donor milk is pasteurised to remove any bacteria. While it isn’t quite the same as a mother’s own milk, it’s still far better for premature babies than formula and offers most of the same benefits. Premature babies often need extra nutrients, Hall adds, so both mother’s milk and donor milk are usually given with fortifiers to make sure they get everything they need.