Breastfeeding: Natural, but not always easy

Breastfeeding is natural but not always easy. Many moms find that breastfeeding is not as instinctual as they anticipated, but find that with a little help they can quickly gain confidence and increase their comfort. Positioning baby at the breast may feel quite awkward during the first several days but there are techniques that may help reduce mom’s pain and increase baby’s milk intake.

* Remember to call baby’s provider or outpatient lactation for immediate follow up if weight gain,      wet /soiled diaper count is not adequate, baby is not settling after feedings, or baby is not waking to feed at least 8 times every 24 hours. Your baby should gain 6-7 ounces of weight each week, after initial minimal weight loss, for the first 3 months of life.

  • Use a supportive pillow so that the pillow is holding the weight of baby to breast level. A pillow will free mom’s hands to position her instead of lift her.
  • Hold baby tummy to tummy with mom. Sucking and swallowing is more effective and comfortable when his head is not turned to the side.
  • Support breasts, keeping thumb and index finger parallel (lined up) with baby’s lips. Many newborns are unable to feed and keep the breast in place.
  • Line baby’s nose up to the nipple. If latch-on starts too high, it is usually painful for mom.
  • Tickle baby’s upper lip with nipple and as he opens his mouth wide. Advance his lower jaw deeply by applying pressure to his shoulders.
  • Relax and be patient. Rookies need time to learn and help is a phone call away.

If you need help with breastfeeding please call the Overlake Women’s Clinic at 425-688-5389.

Our nurses are expertly trained and experienced in assisting mothers with latching, teaching new breastfeeding positions, monitoring baby’s growth and answering parents’ ongoing feeding questions as baby grows.

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When can I take my preemie home?

When your premature baby was born you understood that there would be medical issues that needed to be resolved before you could take him or her home.  As your baby progressed in the NICU, he or she became more stable and did well, and now you wonder, “When can I take my preemie home?”

A premature baby has some basic tasks to master before he or she can go home.  Your baby must:

  • Breathe all the time
  • Stay warm in a regular crib
  • Feed well

These may sound like simple tasks, but for a preemie these are complex activities they are not ready to do until they have completed developmental stages usually accomplished by full term babies before they are born.

Breathing is one of the most fundamental tasks of living, but before a baby is born he or she does not need to breathe regularly; the task of getting enough oxygen to the body is accomplished through the placenta.  The parts of a baby’s brain that control breathing are not fully developed before about 34-35 weeks gestation (where 40 weeks is the expected full term “due date” in a normal pregnancy).  Before this time babies may experience apnea of prematurity, pauses in breathing.  There is tremendous variability in how much apnea of prematurity a premature baby may experience.  In the neonatal ICU cardio-respiratory monitors watch heart rate and breathing patterns and pulse oximeters monitor oxygen levels to catch these pauses in breathing, apnea events.  If the heart rate goes too low or oxygen level goes down for too long an alarm will sound and a care provider will intervene to stimulate the baby, or give some added oxygen or manual breaths, if needed.  These events typically decrease with increased maturity and stop by full term.  The care team will monitor the frequency and severity of these apnea events and will not send a baby home until the baby has matured enough to be discharged home without monitors.  This usually means observing until a baby has not had an apneic event severe enough to require intervention while sleeping or alone for 5 days or more.

Premature babies are small.  Their small size makes it difficult for them to keep warm.  A premature baby needs to stay warm to grow.  If they are exposed to the world without adequate support to remain warm they will burn too many calories and will not grow.  To help babies remain warm they are usually kept in an incubator.  After they reach about 4 pounds (1800 grams) the team caring for your baby will consider weaning him or her from the incubator to a crib.  This is usually not done until your baby’s temperature is stable in an incubator with temperature of 28 degrees Celsius, or less.

Finally, the ability to feed well is also critical for a baby to thrive and grow at home.  The process of coordinating sucking, swallowing and breathing is fairly complex and premature babies initially do not do this well.  It is common for babies not to be able start taking feeds by mouth until about 34 weeks gestation.  After they start showing some interest in sucking and swallowing it can take weeks before they are able to take all of their milk from the bottle or breast.  The usual standard in the NICU is for a baby to take all of his or her feedings by mouth (by bottle or from the breast) before they are sent home.  This is usually the last piece to come into place before a baby is able to safely go home.

All of these tasks represent normal developmental stages for a premature baby and each baby progresses through these stages at different rates.  The time to attain the abilities to feed well, maintain temperature and breathe regularly, without apnea, can vary considerable from baby to baby.  The Neonatal ICU team caring for your baby will help explain how your baby is progressing and give your baby the support he or she needs.  They will not be able to give you a good idea about when your baby will be able to come home until you are within a couple days of the big event.  Each baby sets its own pace, and this makes predictions difficult.  In this case, like many others, your baby is in charge!

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Overlake Opens Donated Breast Milk Depot (KING 5 HealthLink)

Breast milk is best and that’s especially true for fragile premature babies who are more at risk for infection. Overlake Hospital has just opened a Mother Milk Depot, where moms can donate their surplus milk to infants in need.

Little Leif was not scheduled to make his debut until late September. He had other plans.

“He was born at 28 weeks gestation so about 3 months early. Very early,” said Robin Ballard, Leif’s mother.

Seven-and-a-half month Brecken on the other hand was right on schedule. Brecken’s mom, Madeline Williams, and Robin met for the first time Tuesday.

Two different stories with a common thread: Madeleine is a breast milk donor. And Robin is a grateful mom. Her baby is one of many to benefit.

“We have 12 patients today and I’m thinking 10 of those at some point have had some partial parts of donor breast milk,” said Overlake NICU Manager Lynne Saunders.

Saunders says premature babies are especially vulnerable to dangerous infections of the gut, and breast milk provides protection. Supply is always an issue, though.

“We always need new donors as moms wean their babies an can no longer donate unlike donating blood so we’re always looking for new donors,” said Sandy Salmon, Overlake Women’s Clinic.

Donated milk from Overlake is shipped to a milk bank in Denver where it is screened and pasteurized before being distributed.

“And there’s an upside to having the depot is that we have first access to the milk in Denver for our babies,” said Sunders. “Before we got it as it was available.”

Robin had never heard of the donated breast milk before Leif’s early arrival.

“I think I was asked about it within just a couple hours of him being born someone came in and said we have this program,” said Robin. “It was a little hazy for me at that point, but that sounds great thank you. Do it.”

The idea is to provide a much needed bridge until the mom can supply her own breast milk or to supplement if she’s not able to produce enough for her baby to thrive.

There are now three Breast Milk Depots in the Puget Sound area. The others are in Everett and Tacoma. For more information on how to become a donor, go to the Mothers’ Milk Bank – Rocky Mountain Children’s Health Foundation website.

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Therapy Services for Infants

It’s hard to believe it has been more than six months since I joined the Overlake NICU team. My name is Keren Eliav and I am an occupational therapist representing the OT/PT Department at Seattle Children’s Hospital. Beginning in January 2014, Seattle Children’s Hospital began providing regular therapy services to the infants in the Overlake NICU. I work closely with the nurses, dietitians, social workers, nurse practitioners and neonatologists to provide excellent care to our families. The main focus of therapy services in the NICU is feeding and development.

Feeding is usually the biggest challenge for infants who are fragile or who are born prematurely. Not many people realize the true complexity of oral feeding, including bottle and breastfeeding. An infant must be able to maintain a calm and organized state as they coordinate how to suck, swallow, and breathe. In the NICU, I help determine when an infant is ready to begin oral feeding, and suggest ways to make feeding experiences as positive and successful as possible. This may include using special bottles, altering an infant’s position during feeding, and/or providing various techniques that can help an infant coordinate how to suck, swallow and breathe. It is such a pleasure to watch infants master the skills necessary to be able to safely enjoy their feedings.

I also work closely with families to foster each infant’s optimal development. This includes teaching parents how to conserve an infant’s energy, tolerate increasing sensory input, and progress in their developmental skills. In preparation for discharge from the NICU, I coordinate any necessary therapy support for the infants once they go home. This may be with a referral to early intervention in the community, or follow-up appointments with me at Seattle Children’s Hospital if needed. I look forward to continuing to work as part of the Overlake NICU team to meet the needs of the Overlake infants and their families.

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CaringBridge Support

Having a child in the NICU is incredibly stressful. Although having support from family and friends may be appreciated and needed, you might also find it emotionally taxing to keep up with the many phone calls, emails and text messages received from well-wishers who want updates on your family’s wellbeing. A great resource for families who have a child in the NICU is CaringBridge. CaringBridge is a free, personal website that helps to keep you connected to your friends and family. It provides a space to share updates and pictures, as well as a way for your supporters to leave words of encouragement. CaringBridge even has an option to turn all your journal entries into a hard copy book to create wonderful family keepsake. You can start your free webpage now at

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Hands-On Pumping: Helping Increase Milk Production and Empty Full Breasts

When trying to pump for your new baby, it is not always easy to fully empty your breasts with just pumping alone. Often, after pumping, there is still a large quantity of milk left in the breast. Hands-on pumping can be an effective way to further remove residual milk left behind. In addition, some mothers struggle to produce enough milk for their babies and hands-on pumping can be incredibly helpful to empty the breast and maximize milk production.

Hands-on pumping typically takes place after your normal pumping session. Remove one set of tubing and bottle from the pump, so that you have a single bottle set-up and continue to pump one breast at a time for a few more minutes. Use both hands to manipulate and compress the breast to get additional drainage from milk ducts that did not fully empty. You can also hand express for a few minutes to help facilitate further milk letdown. Every mother tends to find a combination or routine that works for her.

The following is a helpful video from Stanford University School of Medicine. Take a few minutes to watch and it and see how other mothers have worked to increase their milk production with hands on pumping. Ask the NICU and lactation staff if you have any questions about this pumping technique – we’d be happy to help you as you provide your baby with the gift of breast milk!

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Newborn Screenings

Curious what tests newborns need while they are in the hospital?  There are three mandatory tests that will be performed on every newborn before they are discharged home from the hospital.  Also, depending on the size of your baby at birth additional testing may be indicated. 

Every baby in the state of Washington will have a Newborn Screening test submitted while in the hospital.   Each state in our country has something similar but some states will test for different things.  The process is simple. Someone from the lab will come and poke your baby’s heel to collect a small amount of blood for this test. Want to know more?  Here is a link to the WA State Department of Health site for parents:  

Every baby will get a test for bilirubin.  This is a measure of jaundice.  The initial test is done by placing a meter on their forehead and can get a reading from their skin.  This is quick and painless for the infant.  If the level is on the high side your Pediatric provider may request that an additional blood test be sent.   Jaundice is something that occurs in all infants.  While many babies will only need testing few will require treatment with phototherapy. There is no specific number or value that is acceptable.  The number that requires an infant to be treated is calculated on both their gestational age at birth and the hours of age at the time of the lab sampling.

Every baby will have a CHD or Congenital Heart Disease screen test prior to discharge from Overlake hospital.  This is a quick and painless test for the infant.  The test is performed with a pulse oximeter and is able to evaluate the amount of oxygen in the infants blood.  Low levels are a signal that the infant may need further evaluation for a potential heart defect.

 Babies born to women who were diabetic during pregnancy or babies who are smaller or larger than expected for their gestational age at birth are at risk for hypoglycemia, also known as low blood sugar.  Short term hypoglycemia is unlikely to cause the infant long term damage but prolonged and profound hypoglycemia can put infants at risk for brain injury.  Because the possibility of brain injury exists hypoglycemia is taken very seriously.  Most infants can be treated with a small amount of supplemental formula and are then able to keep their blood glucose level in a safe range.  If that treatment is unsuccessful then the infant may require admission to the NICU (newborn intensive care unit) for intravenous fluids.

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Save the Date! NICU Reunion

The NICU staff is actively preparing for Overlake Medical Center’s second annual NICU Reunion.  This celebration will be held on September 7, 2014 from 1 – 4:30 p.m. in the PACCAR Education Center.  There will be activities for all ages and light refreshments.  We hope to see a lot of our graduates and their families. Invitations to this event will be mailed out in early August – so be sure to check your mailbox.  If you haven’t received one please call the unit so we can make sure we get one to you.  Looking forward to seeing you in September!

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Food Safety for Moms-to-Be

Did you know that a woman who is pregnant is in a high-risk group for foodborne illness? That’s because her immune system is altered during this time, so it’s harder for her body to fight off certain harmful foodborne microorganisms that can affect her and/or her developing baby. FDA’s targeted program — Food Safety for Moms-to-Be — is newly updated for 2014 and includes a wealth of materials for educating this special audience. The program features such topics and tips as:

  • Follow the Four Simple Steps to Food Safety. During pregnancy, it’s especially important to be diligent with all of these actions: Clean — wash hands and surfaces often; Separate — don’t cross-contaminate; Cook — cook to proper temperatures; and Chill — refrigerate foods promptly.  
  • Be mindful of methylmercury. Methylmercury is a metal that can be found in fish, including swordfish, tilefish, king mackerel and shark. If eaten by a pregnant women, the methylmercury in these fish can be harmful to her unborn baby. So, while fish is an important part of an overall healthful diet, pregnant women should avoid eating those certain types of fish.
  • Prevent listeriosis. This infection is caused by Listeria monocytogenes — a harmful bacterium that can be found in foods made from unpasteurized (raw) milk; refrigerated, ready-to-eat foods; and contaminated fresh fruits and vegetables. Prompt refrigeration at 40° F or below is critical for preventing listeriosis, as is discarding any food left at room temperature for more than two hours (and following the Four Steps named above).  
  • Avoid Toxoplasma gondii. This parasite is found in raw or undercooked meat, unwashed produce, contaminated water, soil, and dirty cat–litter boxes. If ingested, it can cause toxoplasmosis and harm a woman or her baby. Pregnant women can help prevent this dangerous infection by following the Four Steps and by avoiding drinking untreated water and not touching cat litter while pregnant.  

Online Resource:

Download the Food Safety for Moms-to-Be program and share the handout materials with women in your community. All materials are available in both English and Spanish.

Reference/Resource: U.S. Food and Drug Administration


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Coming Soon to Overlake’s Women’s Clinic: Overlake Mother’s Milk Depot

Human milk is the best nutrition for all babies, including preterm babies. Studies showing strong clinical benefits and recommendations by many health organizations have prompted a growing number of hospitals to provide pasteurized donor human milk for premature infants when mother’s own milk is not available. As highlighted in a previous blog, Overlake is among those hospitals. 

What is a milk depot?

A milk depot is a controlled collection point where healthy, lactating women can donate their surplus breast milk for premature babies. The milk collection, shipping, processing and distribution are overseen, with strict guidelines, by the Human Milk Banking Association of North America, an organization consisting of many banks and collection depots. Our depot will have a partnership with the Mother’s Milk Bank of Colorado who will provide necessary screening and blood testing at no cost to donating moms.

How does the process work?

Moms who have been screened and accepted as prospective donors can come to Overlake Women’s Clinic to drop off their frozen breast milk and have blood work done at our outpatient lab. The milk is temporarily stored in a deep freezer and soon shipped to Mother’s Milk Bank of Colorado for processing along with blood samples. Busy, nursing moms are spared the task of packaging and shipping their donated milk.

What happens after the drop off?

Mother’s Milk Bank of Colorado performs testing on mailed blood samples to assure donors meet criteria (much like testing for blood donation). Milk that is safe for use is then pasteurized, cultured after pasteurization to assure no contamination from processing, and frozen in 2 and 4 oz bottles for shipment to hospital neonatal intensive care units.


Donating breast milk is a true labor of love that can provide life-saving nutrition and immune support to fragile, premature babies. In the US, there is a critical shortage of donor human milk and we hope, by opening Overlake’s depot, to remove some of the barriers from the process and make it more convenient for moms to donate their precious gift. Last year, Overlake’s NICU used over 1000 oz of donor human milk to help critically ill premature babies. Milk banks depend on “drop off” milk depots to meet the growing demand for donor human milk and only milk from a HMBANA milk bank can safely be given to preterm infants in the hospital.

For more information on how you can become a milk donor, call 425-635-6150.


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