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Preparation for Breastfeeding During a High-Risk Pregnancy
By Lenette S. Moses

A mother experiencing a high-risk pregnancy faces so many questions: how long will this pregnancy last? How will I manage? Will the baby be sick? She has so little control. When I was going through this period in my life, I found it helpful to take control in whatever small ways I could. One of these was planning to breastfeed my children, no matter how small or sick they might be. It was important for me to know that I could play this role, despite what else might transpire.

Practices to Avoid:

There are some ways that a mother planning to breastfeed can prepare for this experience. However, a mother who is at risk for premature labor must avoid some of the techniques recommended in typical nursing information books, as nipple stimulation of any kind may induce labor. For example, before the 38th week of pregnancy, she must never: pull or roll the nipple, massage her breasts or stimulate the breasts during sexual intercourse (which is itself normally forbidden).

The growing layer of keratin and the lubricating substance on the nipple must be protected. An important way to do this is to avoid washing the nipple area with soap. The mother should take care to prevent shampoo from dripping onto her breasts as she washes her hair. Soaps will also interfere with the natural acid-alkaline balance of the skin. The slightly acidic level of the nipple provides natural infection-fighting properties, which the alkaline in soap can destroy. Plain water will provide adequate cleansing.

Any mother planning to breastfeed should avoid using a washcloth to scrub her nipples, or rubbing with a towel to dry them. This may wear away lubricating oils, and the skin may become dry and crack. She should also avoid using drying agents such as alcohol, tincture of benzoin, Zephiran, pHisohex or witch hazel. If the natural balance has been maintained, no skin softeners or creams are needed.

Some books recommend expressing colostrums (the first milk) during the latter months of pregnancy. This is not advisable for the high-risk woman, as it could induce labor. In actuality, this practice could also make the breast more susceptible to bacteria and virus, so we do not recommend it anyway.

Methods to Use:

There are so many techniques a high-risk mother can't employ. How can she prepare her breasts?

She can:

  • expose her breasts to air and sunlight (this stimulates production of keratin)
  • use water to clean her nipples
  • remove plastic liners in nursing bras to allow nipples to "breathe" and prevent development of bacteria
  • wear maternity/nursing bras that are supportive but not constricting
  • eat a well-balanced diet with sufficient fats and protein to encourage sufficient production of milk

After 38 weeks, with her doctor's permission:

  • roll and gently tug nipples occasionally to stimulate blood supply and distribute lubrication
  • gently massage her breasts so she becomes more familiar and comfortable handling them, and to stimulate blood supply

Inverted Nipples:

A mother must have nipples that can be grasped by her baby. If she squeezes gently on either side of her nipple and it collapses in, she has inverted nipples. Her nipples will have to be trained into position! The simplest way to do this is to wear milk cups during the last 2-3 months of pregnancy. These plastic cups place the nipple in the correct, extended position. A mother can begin to wear the cups for short periods, then extend to wearing them for as long as 8-10 hours at a time as needed. It is important that she wear a bra that is at least a size larger so that the cups do not press against her breast.

If inverted nipples are not discovered until after the baby is born, the cups can be worn for the short periods before feedings. (They also collect milk drippings.) The electric or manual pumps are also effective for straightening inverted nipples. Cold compresses can also help just before feedings.

Mental Preparation:

Perhaps the most critical part of breastfeeding preparation during high-risk pregnancy is the mental aspect. Though most mothers have concerns about potential nursing problems, high-risk mothers have added stresses regarding the pregnancy and its potential outcome. In addition to the physical preparedness described above, the high-risk mother will gain from:

  • gathering information about nursing in general by reading books and talking to friends who have had positive nursing experiences
  • setting up a 'nursing corner' in a quiet spot in her home, complete with a comfortable chair, lots of pillows and a foot stool
  • thinking about the reasons why she would like to nurse gathering support from spouse, family and friends

A woman going through a pregnancy with problems must also consider the possibility of giving birth prematurely. As unpleasant as this may be, facing this potentiality and learning about the possible sequela will prepare her emotionally. As one mother says, "You have to plan for the worst and hope for the best."

When a newborn is hospitalized, whatever the reason, he may not be able breastfeed right away. His mother cannot simply wait for this eventuality, however. She must trick her body into continuing to produce milk by employing an infant surrogate-some type of breastpump. There are electric, battery-operated and manual varieties, or a mother may do hand expression. Learning about these alternatives, and the pre-nursing experience, will make the whole situation easier if she has to go through it.

Doing any type of advance planning for breastfeeding-for the body and/or the mind-will act as a positive aid for the high-risk pregnant woman. Remembering or learning relaxation techniques such as those taught in childbirth education classes will help her be in better contact with her body. This can assist her in recognizing premature contractions or other symptoms of labor. When she begins to nurse or pump, it will aid in the let-down and smooth flow of milk. Visualizing a happy, healthy mother/infant nursing pair may be the final step in readying oneself for an enjoyable, positive breastfeeding experience.

Lenette Moses is a lactation consultant and a founder of Intensive Caring Unlimited. She has four children and has experienced two high-risk pregnancies.

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