YES, YOU CAN DRINK COFFEE & BREASTFEED

As a NICU Nurse and IBCLC, I've noticed a gap between current literature on maternal caffeine intake and the guidelines we follow within the NICU for premature infants. This confusion arises from cautionary language regarding caffeine's potential impact on baby sleep (insomnia?!) and irritable behaviour. I would like to challenge this perspective…

Lets break it down:

- Caffeine is indeed transferred into breast milk, but in MINIMAL amounts.

Comparing doses:

- I've directly compared the dose of 125mg of caffeine from a cup of coffee to what we administer intravenously to premature infants in the NICU.

- 125mg caffeine from coffee = approx 0.4mg caffeine transfer in 100ml of breast milk.

- Target dose for a neonate of approx 2.5kg = 25mg, with daily administration thereafter.

Benefits of Caffeine for premature infants!

The findings from the Caffeine for Apnoea and Prematurity Study (CAP) with >2000 premature infants showed numerous neuroprotective positive effects of caffeine administration:

- Prevents apnoea of prematurity, improving oxygenation and ventilation.

- Reduces the incidence of cerebral palsy and motor impairment.

- Reduced cognitive delay

- Facilitates early extubation for ventilated infants.

It was also found that caffeine has a wide therpautic window, minimising side effects for premature infants!

**Safety and Guidelines:**

- The American Academy of Pediatrics suggests up to 300mg is safe for breastfeeding parents.

- One study showed up to 5 cups of coffee a day wasnt associated with changes in infant behaviour.

- Chronic coffee drinking (10-20 cups): Reports of fussiness and poor sleep patterns in infants. (This is a large amount of caffeine and was also consumed alongside softdrink!)

Point of the story!

- If you’re desperate for a cup of coffee, please enjoy one

- Your coffee intake is not likely to impact on your baby’s sleep (though it may impact on your sleep if you consume it late in the day!)

The Ripple Effect that Birth has on Breastfeeding… and no ones talking about it.

As I continue to practice my work with families it is becoming clear to me that so many complexities relating to breastfeeding our babies could be preventable with quality education and early support.

Part of me keeps asking the question… is it motherhood that society and governments don't value? Is that why we're in this situation? Is this why global breastfeeding rates only sit at 48%? (WHO)

The recent Q and A for The Birth Project between ABC’s Nas Campanella and Sophie Walker from Australian Birth Stories discussed that midwifery led care is the gold standard of care, yet only 8% of women are able to access this model of care in the public health care system in Australia. This would certainly align with my experience where families are seeking support after the 6 week check up, looking to troubleshoot a multitude of complex issues that have occurred due to lack of support and quality education both in pregnancy and the early weeks postpartum.

Unfortunately, we're in a time where our health care system is over-burdened, under staffed, and under resourced. We have such a long way to go to change the current practice.

To complicate matters further, birth interventions like inductions, epidurals and cesareans are common in our healthcare system, as is birth trauma. Unfortunately, trauma and intervention can have a ripple effect on the breastfeeding experience for a family dyad. This comes in many forms such as baby’s altered neurobehaviours from birth, poor feeding, delayed onset of milk production, maternal areola oedema and severe engorgement, nipple pain from shallow latching, uncomfortable positioning to accommodate for healing wounds, and so on..

Not many people consider how the birth experience might impact upon the breastfeeding journey. It's a topic that often gets overlooked, but is close to my heart. In my work as a NICU Nurse, most patients I care for within the hospital system are separated from their baby at birth. I understand and anticipate how this will impact upon the breastfeeding journey, looking to troubleshoot and educate families from the moment we meet to empower them to get their breastfeeding journey off to a positive start.

Did you know that receiving intravenous fluids during labor or from a surgical birth can lead to significant engorgement when your milk comes in? A common issue I see in practice and troubleshoot for families is managing engorgement and areola oedema with the onset of milk production.

Engorgement is a natural part of the milk arrival process, but when combined with intravenous fluids during birth, it can become quite an intense experience leading to significant breast and areola oedema. This not only affects your breast tissue but also impacts your baby's ability to latch onto an oedematous areola, as the nipple becomes puffy and flattened in appearance as it fills with fluid.

Why does this matter? Because your baby is learning to feed, and this oedema can significantly impact upon the deep mouthful of breast tissue that your newborn requires to latch on to, to achieve an effective milk transfer.

Without a deep latch, areola oedema can lead to a baby latching very shallowly onto the nipple which can result in a cascade of events that undermine a dyad's breastfeeding journey. This could look something like: nipple damage, poor milk transfer, worsened engorgement, mastitis development, undermined milk supply, infant weight loss >10%, suboptimal nappy output, jaundice, and ultimately the top up trap where a breastfeeding journey is further undermined through the introduction of formula in the early days.

I don’t mean to frighten you, but there is incredible support and education out there to prepare you for your breastfeeding journey (preferably before your baby arrives!)

If you want to learn how you can support yourself in the possibility of experiencing areola oedema during the engorgement phase, I highly recommend you learn the technique of Reverse Pressure Softening!

Reverse Pressure Softening requires you to gently push fluid away from the nipple for approximately 1-3 minutes before latching your baby, creating a more optimal shaped nipple and areola for your baby to latch deeply.

My deepest passion lies in providing quality education that equips you with the tools to navigate challenges. If you're curious to learn more or have any questions/comments, feel free to drop them below or connect with me (ideally, for my class Newborn Ready, Set, Go!)