Delivering your infant prematurely is not planned. Therefore, preterm delivery often disrupts a mother's plans including whether she intends to breastfeed or not. Preterm delivery alters breastfeeding plans in two ways. For the mother who did not intend to breastfeed, the neonatology team will be asking this mother to pump her breast milk, while her infant is in the hospital, so that she can provide this excellent "medication" to her preterm infant. For the mother who intends to breastfeed, she also will be asked to pump her breast milk until her infant can receive adequate nutrition from the breast.

Breast milk as medicine
Infants do not develop the ability to take breast or bottle feeds until approximately 32-34 weeks gestational age (about 7 months of pregnancy). Until they reach that age, they receive mother's breast milk through a tube from the mouth or nose to the stomach. In addition, even when preterm infants develop the ability to breastfeed, they often require additional nutrition through at least 9 months of life. Breast milk is by far the best nutrition for preterm infants, but it is lacking in calcium, phosphorus, vitamin D, and protein for very preterm infants. The strong benefit of breast milk lies in its antibacterial and antiviral properties and its enzymes that help a baby's intestines absorb fats, carbohydrates, and protein. Breast milk even contains stem cells that likely help grow the infant's intestine! We call breast milk a "medication" because of the many benefits to protect the infant from infection and support growth of the body and the brain. Nonetheless, even for mothers who strongly desire to breastfeed their infants, providing breast milk to a preterm infant is not easy. To maintain a good milk supply, a mother must pump her breast 6-8 times a day. If a mother does not pump regularly and instead waits for her breast to feel full, her breast milk supply will decrease. Even if a mother pumps 6-8 times a day every day, maintaining milk supply still can be difficult.

Breastfeeding support
Fortunately, we do have some ways to support mothers' milk supply. One is "Kangaroo Care" which allows a mother to hold her infant directly on her chest for a few hours each day. For a mother who wants her infant to learn to breastfeed, we can position her infant on her chest to try some "non-nutritive suckling" where the infant gets the feel of suckling on the breast. When a preterm infant reaches the gestational age to try feeding at the breast, we have more ways to support mother and infant! Preterm infants often do not have much energy for feeding, so the neonatology team works hard with mother and infant to make it easier. To calculate how much milk a preterm infant takes at the breast, we have very precise scales to weigh the infant before and after a breastfeeding! We want to support mothers of preterm infants in all ways to help them succeed in providing breast milk for the infant and to breastfeed if desired. Breast milk is truly the best medicine for a preterm infant, and, therefore, is the greatest gift that a mother can give her preterm child. However, it is not easy, and the MUSC neonatology team greatly admires and appreciates the preterm infant mothers who work so hard to provide this resource to their infants. 

by:  Sarah Taylor, M.D.

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Whether you’ve been caught by surprise or this was meticulously planned, pregnancy is a very exciting time. But those first few months – or maybe even longer – can be more than a little trying when you feel nauseous throughout a good portion of the day.  You’ll learn very quickly that it’s not just as the name would suggest: ‘morning sickness.’


Here are some easy things you can do to feel better: 

- Eat small frequent meals. Instead of 3 regular meals, break that up into 6 smaller meals. You’ll probably feel better if you always have a little something in your stomach.
 
- Avoid fried and spicy foods by choosing some stomach-friendly options. Lean protein – such as turkey - is usually tolerated very well. Other examples are starchy carbohydrates, such as breads, potatoes and bananas.
 
- Do not lie down for at least 2 hours after eating and have a few bites of saltine crackers before getting out of bed in the morning.
 
- Carbonated clear sodas – such as Sprite and Ginger Ale - may help your nauseated feeling. Popsicles are another good choice. 

If you still feel nauseous and need more relief, try taking Vitamin B6 10-25mg up to four times a day. Some studies have found it to be beneficial in relieving nausea. Combining a dose of Vitamin B6 with the sleep agent Unisom is also effective if you are on your way to bed. You might also try drinking ginger tea several times a day or taking ginger in a pill form 2 to 3 times a day.

Finally, if you still don’t feel better, if you have lost more than 10% of your baseline weight or if you are unable to keep sips of water down, talk to your health care provider. The doctor may be able to provide a prescription medicine that is stronger, but may be more helpful in combating your nausea. Your provider can also screen you for any other serious problems that may be going on.

by:  Jill Mauldin, M.D.