Breastfeeding a preemie
If you’ve given birth to a baby prematurely, i.e., your baby has been born before 37 weeks gestation, you may be feeling quite anxious and concerned about the next few weeks and months.
It really can be a roller coaster ride of emotions. Coupled with this you may also be recovering from surgery, as well as trying to work out what is going to happen in regard to breastfeeding and how to get your milk supply established.
Additionally, your baby may not be latching at the breast.
You need to know that your breast milk is still really important for your baby – and yes, it is possible to provide that milk, even if your baby isn’t latching right now.
Breast milk is specifically tailored to your baby, and very easy for him to digest.
Even the first drops of breast milk can provide a coating for the inside of your baby’s gut to protect against allergens and pathogens.
Even small amounts of the first milk, colostrum, can provide a huge amount of antibodies that will boost your baby’s immunity too.
Not only will breast milk strengthen your baby’s gut, but it causes less strain on your baby’s kidneys too, and as your baby has been born preterm, your breast milk also has an excellent, high-quality protein.
Breast milk also provides fantastic resistance to infections and disease. In many special care units, right across the country, where consultants are on board with this knowledge, you will be encouraged to pump your milk and give your fresh milk to your baby.
If you can’t give your fresh milk, the next priority is your frozen breast milk. After that, it will be donor milk, and finally formula.
In these special care units, the staff will encourage you to pump your milk with a quality hospital-grade double pump.
Many breastfeeding mums have told me over the years that providing this milk was the ONE important thing they could do, and they found it to be psychologically beneficial.
From 32 weeks gestation, premature babies can latch at the breast, suckle and swallow, but not all of them will do.
We know that some full-term babies don’t latch initially, so it is variable what a baby will be able to do at the breast.
However, your baby can be encouraged to practice.
Even just licking the breast and nuzzling in will be great practice for him – preparing him to be able to latch on and to suckle, however long that may take.
Meanwhile, if you express your milk, your baby will be able to receive that milk while he is practicing at the breast too.
Even the smallest amount of breast milk produced can be useful to a premature baby.
Your baby may be fed via a small nasogastric tube that will help him to receive the milk, even though he is not attached to the breast and doing it himself.
Some special care units encourage soaking a cotton wool ball with breast milk and placing it in the isolette with the baby so that he can smell the milk while being fed with the tube.
So if you are pumping your milk because your baby isn’t attaching right now, or maybe he is doing a little bit of suckling, but not enough to get all the milk that he needs, ask the staff to help you to express your milk with a hospital grade double pump.
You can pump every two to three hours (no more than 10 to 15 minutes at each pumping session).
If you can pump once at night, that is ideal, to keep up the supply, and your body will start to make milk in the way that your baby WOULD have generated that milk, had your baby been frequently feeding from day one.
Another beneficial thing that you can do with your baby is to do what is called ‘kangaroo care‘ – that means skin to skin with your premature baby, as long as his vital signs are stable.
Even if he’s attached to monitors, the staff can help you to do this, keeping your baby very close.
Skin to skin also has great potential to increase your milk supply, because it boosts prolactin hormone.
Studies are showing how much more milk is made by pumping after you’ve spent time in skin to skin.
Even if skin to skin isn’t routinely encouraged in the hospital where you and your baby are, you may still be able to ask the staff to enable you to spend some time in close contact with your baby, however minimal that may be.
Many babies born preterm start to display those pre-feeding behaviors, and often latch on better and get more practice at it when they do it in skin to skin.
Studies show that your baby is far more likely to be more stable and less stressed when feeding at the breast than if feeding from a bottle.
Also, your baby’s temperature is more likely to be better controlled, as well as oxygen levels, heart rate, and breathing.
Try not to be discouraged if your baby is only taking small short feeds.
As long as you are pumping your milk, then you will be keeping your supply boosted and giving your baby all the practice he needs.
You may help your baby by hand expressing a little bit of milk, first of all, to get that initial let down, which can be of great help.
For quite some time, you may likely be doing a mixture of bottle feeding and feeding at the breast, so it’s good to know how to feed your baby from a bottle in the most breastfeeding-friendly way, allowing him to be more in control of the feed.
As your baby gets better at feeding and doing what he is hard-wired to do, he will very often improve and start to take more feeds over time.
While in the special care unit, you may have been scheduling feeds (by bottle) – even if you have been offering the breast.
This regimented approach can feel like a security. As you allow your baby to come to the breast more and more, that pattern will change dramatically.
Some mothers find it psychologically difficult when trying to orient their baby to the breast, because of all of the changing and different patterns that babies do at the breast.
So prepare yourself. Know that it will take a bit of adjusting to get your baby back to the breast completely, and to get away from that more regimented pattern – but it is possible, and seek out support from people who are skilled in lactation, who can guide you.
As well as seeking out this skilled support, make sure that you have people around you, friends and family who can also support you, and give you as much rest and time with your baby as possible.
Seek out support at your local breastfeeding support group and get alongside other parents who’ve been in similar circumstances to your own, as a means of added encouragement.
Review dates, references & further resources
Version 1.1 published in March 2019. Next review date: Jan 2022
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