Hygiene and storing breast milk for premature or sick babies

Since your baby is immature and extremely vulnerable, it is very important to follow strictly and precisely the instructions given to you at the hospital for expressing and storing breast milk. The various hospitals have different rules concerning access to babies and breastfeeding according to the baby’s age and condition, so it is important to ask for instructions on how to proceed specifically. If no other information is given to you, you can follow these general rules:

• Wash hands thoroughly with soap and water before each expression
• At Bulgarian hospitals you are also usually required to wash your breasts with warm water and neutral soap before expressing
• Wash and sterilise the parts of the pump after each use!
• Put the expressed milk in a sterile container for breast milk and place it in the refrigerator immediately after expressing it if you are not giving it to your baby within the next hour. If the milk is not going to be used in the next 12-24 hours, freeze it as soon as possible after expressing it. (In many hospitals in the country, frozen breast milk is not accepted; the mother is required to express breast milk in the neonatal unit using her own pre-sterilised pump and the baby is given fresh breast milk).
• Do not mix breast milk from different expressions – any additional transfer of milk increases the risk of bacterial contamination.
• It is a good idea to freeze breast milk in small portions – 50-60 ml is a good amount to freeze separately. If big portions are frozen, some of the milk may not be used in time and will have to be discarded.
• Label each container with the date of pumping. When you start feeding your baby breast milk, bring milk in order of expression, starting with the earliest date. The composition of breast milk changes considerably in the first days, so it is good for your baby to receive the earliest milk first.
• Bring the frozen breast milk to the hospital in a quality cooler to avoid even minimal thawing.
• Take a little more with you than you were told. For various reasons milk can be spilled or the baby can suddenly show that he/she needs a little more.

Sometimes the breastfeeding mother may fall ill while the baby is still at the hospital. Phone the neonatologists and ask for instructions on how to proceed with the breast milk. Most likely, you will be asked not to bring milk while you are ill – but the father can bring milk expressed in the days prior to the illness.

Label the breast milk as expressed during illness and do not bring it while the infant is at the hospital. It can be given at a later time when the baby is bigger and at home.

In case you need to take medicines, you will probably be also asked not to store breast milk. Consult your doctor, pharmacist and nursing consultant at what point after the end of the treatment you can again start bringing your baby expressed breast milk. The various medicines take different time to be absorbed by the body, so it is necessary to discuss each medication separately.

The use of herbal supplements should also be discussed with your baby's doctors! Despite being natural remedies, some herbs have a strong effect and are not suitable for use by the mother when the baby is very little or has jaundice.

If your baby develops a yeast infection (thrush) in the mouth and it is passed on to your breasts, the milk expressed during the treatment should be discarded. Freezing does not destroy fungal spores and therefore the milk cannot be stored.