July 2019 Newsletter: Breastfeeding a Premature Baby

By Agnes Nemes-Chow, BMSG Volunteer
Photo credits: Agnes-Nemes Chow

Agnes is a stay-at-home mother of seven children aged between 2.5 months and 11 years. Originally from Hungary, Agnes married a Singaporean and has been living in Singapore for 16 years. She and her family stayed briefly in Australia prior to 2011, and returned to Singapore in January that year when she unexpectedly gave birth to a premature baby. The following is her story on how she was thrown into the waters of breastfeeding a premature baby back then.

Agnes’ son was born at 33 weeks gestation and had to stay in the Neonatal Intensive Care Unit (NICU) for three weeks.

How it All Began

When we moved back from Australia to Singapore in January 2011, I was then expecting our third child and I didn’t realise that the place where we were living in then was a dengue cluster. I was feeling unwell for a few weeks during my second trimester but I just assumed they were pregnancy symptoms. I only casually mentioned to my gynaecologist that the General Practitioner (GP) I had been seeing had suspected I had dengue. During a growth scan later on, they found that my baby was too small for his gestational age but there was nothing we could do about it at that time. A few days later, at 33 weeks, I went into labour and gave birth to a baby weighing only 1.6 kg baby, but thankfully, he was healthy baby. Our son had to stay in the NICU for almost three weeks till he was able to be fed expressed milk from a bottle.

Initiating Breastfeeding

Agnes (masked) with her baby at the NICU doing kangaroo care. Agnes and her husband spent many days and nights at the NICU to ensure that they were able to feed their baby expressed breastmilk before he could attempt to latch.

I had experience in breastfeeding full-term babies but I had no idea about breastfeeding a premature baby. After birth, my baby was taken to the Neonatal Intensive Care Unit (NICU) straight away so I had no chance to breastfeed him. I was wheeled to the maternity ward and I could only see my baby later at night. There was a very kind nurse, who taught me how to express colostrum into a syringe so I kept doing that and it was encouraging to see that after 1-2 mls at the beginning, I could express more and more subsequently.

My baby only took 2 ml of milk for his first feed, but that was all that was needed then. He was fed through a feeding tube. After I was discharged, I was very determined to express as much milk as I could for my baby and we delivered the milk to the hospital every day, sometimes twice a day. In the NICU, the doctors told me that it was very important, especially for a premature baby, to receive breastmilk instead of formula so that he receives all the antibodies to fight infections.

In the NICU, the doctors told me that it was very important, especially for a premature baby, to receive breastmilk instead of formula so that he receives all the antibodies to fight infections.

Conflicting Advice

Some of the doctors also encouraged me to keep trying to breastfeed, so I did. Others told me that such small babies may not end up breastfeeding so the advice was conflicting. My baby never seemed to show any interest in breastfeeding in the initial days when I tried to feed him and I didn’t receive any practical help from the medical personnel. I think the problem was that I was unsure about when he had already been given EBM so when I was allowed to hold him, he was not hungry. The main concern was for him to gain weight and we were told that he could be discharged when he reached two kilograms and was able to drink from a bottle.

Agnes’ son (middle) continued to thrive into a healthy baby and was able to eventually fully direct latch.

The Importance of Support

When he was transferred to the nursery, I asked if it was possible for me to try breastfeeding and they allowed me to try. I made sure that I was there for many hours so that I didn’t miss the feeding times this time around. My baby’s weight was already 2 kilos then but his mouth was still tiny and he struggled to latch and got tired and fell asleep very easily. My husband was my greatest support at that time. He wanted me to spend as much time in the hospital as possible so that I could keep trying to breastfeed my baby. He thought it was the critical time to establish breastfeeding and he was right!

Agnes’ 3rd child (middle) happy with his siblings!

Going Home!

After 3 weeks in the hospital, we finally got to bring our baby home! The older two children were 3.5 years and 20 months old then. I had to continue expressing milk at home. My routine was to wake my baby up (as he tended to sleep throughout the whole day), breastfeed, give expressed milk from a bottle and then pump for each feed. It was very tiring for me and my older kids were especially needy as I was previously away from them so much when I had to go to the hospital. When my 1.5 years old son, who could already drink from a cup, saw the bottle, he also asked me to give him milk from a bottle! It was total chaos at home those days.  At that stage, my baby was only taking a small amount through direct latch and drank a good amount from the bottle. As the days passed, I noticed he was drinking less and less from the bottle and that was a sign to me that he was able to get more from the breast. After about two weeks, when he wasn’t really drinking much from the bottle anymore, I did away with it and we just continued with direct latch. Finally, my life got easier!

Agnes’ son is now a bubbly and healthy 8 year old!

Advice for Parents

From my experience, I believe that it is important to inform the hospital staff that you want to breastfeed your baby and to coordinate the feeding times so that the baby is hungry enough at the time you want to try latching baby. Even if the baby seems too small and weak to feed, through skin-to-skin contact (kangaroo care), the baby can be encouraged to be near the breast. Mums must make sure they express milk at least every three hours, not only to provide milk for the baby but also to establish a good supply so that when the baby can direct latch, there will be plenty of milk available. It is important to spend as much time as possible in the hospital to give kangaroo care to the baby and to keep on trying to breastfeed. It’s a good idea, too, to also ask for help from a lactation consultant.

Breastfeeding a premature baby is very challenging but with good support and perseverance, it is definitely possible. It’s important to start to direct latch the baby as soon as possible and not to give up even if it doesn’t work at the beginning. They will grow and get stronger faster and will be able to latch eventually. If the baby is discharged on bottle-feeding, it’s important to always latch the baby first for each feed and only give expressed milk as a top-up. This way, the bottle can be removed after a while and the baby can be directly breastfed.

Notes for Parents with Premature Infants

  • Ask questions! Don’t be afraid of the medical personnel as they are really there to help you and your baby
  • Offer your baby donor milk such as from the KKH Milk Bank.
  • As soon as baby has been admitted to the nursery and separated from you, ask for a hospital-grade breast pump so that you can start stimulating your breast milk supply! It is recommended that this happens within the first three hours after birth.
  • Hand express colostrum into cups or syringes so that baby can be fed with these precious drops. Colostrum is an extremely potent source of antibodies and no single drop should be wasted!
  • Get help from the hospital lactation nurses and lactation consultants.
  • Kangaroo care and spending lots of time skin-to-skin with your baby helps you reconnect with your baby! Grab every opportunity to bond with your baby! Studies show that skin to skin is a great way to kickstart milk production. Mothers who pump beside their babies tend to yield more milk.

July 2019 Newsletter – Learn More About Big Latch On Global!

By BMSG Editorial Team

The 1st to 7th August every year is celebrated as the World Breastfeeding Week. This is an initiative founded by the World Alliance for Breastfeeding Action, WABA for short. Many healthcare agencies and breastfeeding organisations around the world take this opportunity to raise awareness on breastfeeding. The Big Latch On is one such initiative which aims to normalise breastfeeding by bringing together mothers and all supporters in small gatherings around the world. It has grown to become an event which many communities look forward to annually.

An example of a Global Big Latch On session going on as captured from the Instagram account of the Global BLO [Credits: Global Big Latch On]

Who Makes Up Big Latch On (BLO) Global?

The BLO is an initiative that is run by two organisations. The first is The Women’s Health Action (WHA), which is a non-profit organisation and a registered charity, partially funded by the NZ Ministry of Health. The WHA started the BLO movement in New Zealand for the first time in 2005. The second organisation is Small Beginnings Group, LLC, which  is a small business that provides family wellness and lactation services in Portland, Oregon. 2019 marks the tenth year of the Global BLO!

In Singapore, Breastfeeding Mothers’ Support Group (Singapore) (BMSG) organises this yearly to bring all breastfeeding mothers to a common venue in an act of support and solidarity to the breastfeeding cause. All breastfeeding women, their children and family members, including supporters like husbands and relatives, as well as breastfeeding advocates, are welcome to the event. 

What Do People Do at the Big Latch On?

The BLO provides the guideline for hosts who want to organise Big Latch On events in their community. As long as all activities are compliant with the World Health Organization (WHO) International Code of Marketing Breastmilk Substitutes, the event simply requires breastfeeding mothers to come together for a minute or two and simultaneously latch or pump/hand express during the stipulated time for the BLO. 

When the synchronised latching/pumping session ends, organisers will count the number of mothers who had taken part and the numbers will be added onto the global count of mothers who have breastfeed their babies during the Big Latch On. Pictorial evidence and documentations are required by the BLO to ensure honesty in its counting process.

BMSG conducting the Global BLO in 2017 at Hong Lim Park [Credits: Ash D Photography]

Notable Big Latch On Records

There have been many encouraging and inspiring numbers contributed by many breastfeeding communities around the world, with the biggest number, 3,738, of breastfeeding mothers gathered at a single location which occurred in the Philippines previously.

The BLO believes in supporting small and local groups for the following benefits: :

  • Breastfeeding mothers need not travel far to a location to participate in a Big Latch On event 
  • More breastfeeding women can take part in the Big Latch On in as many countries as possible
  • Keeping it local means higher opportunities for women living in the same area/country to meet and form more breastfeeding communities 
  • Having many locations mean that other entities and institutions, such as businesses and community places, can help to promote their support for breastfeeding which will help breastfeeding women know that they are welcomed in the community, which essentially can spark more conversations about breastfeeding

The more breastfeeding mothers come together, the more places mothers can refer to in order to give and receive support. While the BLO also recognises the importance of online spaces for mothers to come together and rally support, the BLO does not encourage any virtual synchronised events/meet-ups. 

Singapore’s Contribution to the BLO

BMSG x NUH Big Latch On in 2018 [Credits: BMSG Singapore]

This year, BMSG is organising the Big Latch On in just a few days’ time! This will be the seventh year that we are organising this event. As a provider of breastfeeding support and counselling, we appreciate any effort to bring breastfeeding to the fore; to normalise it, to create conversations and to provide education about it. 

We strongly believe events like the BLO are great conversation starters and will encourage many breastfeeding mothers to come together as a community. This is a step in the right direction in  nurturing and growing the village of mothers and a community of breastfeeding supporters.

Big Latch On Singapore 2019

This year, together with the Association for Breastfeeding Advocacy (Singapore) (ABAS), we are partnering with ActiveSG in being part of the National Day Celebrations at SKH Campus for our Big Latch On. 

Some of the activities going on that day are:

  • BLO synchronised latching/pumping segment (all breastfeeding mothers are welcomed!)
  • Babywearing Zumba with our instructors from Nawal Haddad Fitness
  • Storytelling Sessions by BMSG volunteer and children’s books enthusiast Far’ain Jaafar
  • Lucky Draw (for registered participants only!) with up to 17 amazing prizes to be won contributed by our generous sponsors
  • Other fringe activities by ActiveSG which include Kampung Games for Children
  • Exclusive goodie bags for the first 250 participants containing merchandise and gifts from BMSG, Active SG, as well as our generous sponsors
  • BMSG counsellors on-site for free face-to-face counselling; to get your all your breastfeeding queries answered!

We promise fun and excitement for the whole family! We have limited numbers of goodie bags with lots of freebies and vouchers for you to bring home. Register for FREE now: http://bit.ly/blosg2019