Breastfeeding a Premature Baby

mom in hospital bed breastfeeding newborn

Breastfeeding, although it may be more challenging with a preemie, is one great thing you can do to help your little guy or gal to get off to the best start. Breastfeeding provides the perfect nutrition for a premature infant because your breast milk automatically adapts to your baby’s needs, something formula just can’t do. This is so important for a premature baby because your breast milk not only provides just the right amount of calories, fatty acids, vitamins, and protein for your premature baby, but it also helps your baby in other ways.

Your breast milk is perfectly suited for your baby. It is more easily digested than formula, which is particularly important for preemies as their digestive systems are not as mature as full term babies. Scientists have yet to figure out how to replicate all the ingredients that are found in breast milk. Breast milk contains nutritive components as well as components that help fight infection. In fact, about 80% of the cells in breast milk are macrophages. Macrophages are cells that help fight off viruses and infections. Because preemies face a higher risk of infection, feeding your baby breast milk is even more important. By breastfeeding your premature baby, you will help protect her delicate and immature immune system and give her the best nutrition possible.

Before You Start Breastfeeding

If your baby arrives early, you may not be able to breastfeed her right away. Premature babies are often fed through a nasogastric tube to start off with, especially if your baby is born before 33 weeks. Babies do not develop the suck-swallow-breathe reflex that is needed for breastfeeding until they are about 32-33 weeks gestation. To help your baby get ready to breastfeed, there are some things you can do. You should talk to your hospital caregivers to help you and your baby prepare for breastfeeding.

Get lots of skin to skin contact with your baby. Many hospitals encourage “kangaroo care” for premature babies. Before your baby can start kangaroo care, she needs to be stable enough that she can breathe on her own, or have minimal breathing support, and she also needs to be able to maintain a normal heart rate, oxygen level, and body temperature while she is being held. Kangaroo care is a type of skin-to-skin contact that gives moms and preemies a way to bond. It also helps preemies prepare for breastfeeding and has provides other health benefits for preemies.

Pump breast milk for your baby. Your preemie probably won’t be able to breastfeed right away, but you can still provide her the best nutrition by pumping breast milk for her. Pumping is very important when you have a preemie because your baby will not be sucking at the breast and stimulating your body to produce milk. The first few weeks after a baby is born are critical for establishing a good milk supply. If your baby isn’t nursing at the breast you will need to stimulate your breasts to produce milk by pumping. Your hospital will probably provide you a hospital-grade pump while you are in the hospital, but after that you may need to rent a hospital-grade pump. You can also purchase a double electric pump like Medela’s Pump in Style; however, a hospital-grade pump is preferable when pumping for a preemie.

newborn baby

Pumping for a Preemie

Keep everything you pump, no matter how small the amount. When you first start pumping for your preemie you may only produce very small amounts of a yellowish substance called colostrum. It may seem like a minute amount and you may even wonder if it is enough to bother saving. Colostrum is very important for your preemie because it is very rich in carbohydrates, protein and protective antibodies. You should keep whatever you pump even if it just a few drops. Your baby will not eat very much during his first feedings so every little bit you can pump is important and should be kept.

Pump frequently. Since your preemie is so little, you may find it very easy to pump enough milk to meet his needs. Because of this, you may be tempted to pump less frequently. You should pump about every three to four hours, even if you are producing more milk than your baby is taking at the hospital. You can always freeze the extra milk to save for later. Plan to pump every three hours for about 10-15 minutes using a double electric pump. At night you can go a little longer between pumping sessions, but you should not go longer than five hours without pumping. Ideally, your pumping routine should mimic your baby’s eating routine so that once your baby starts nursing at the breast, your body is already in a similar routine as your baby. It is important to pump frequently because pumping frequently helps establish a good milk supply. Preemies often have a weaker suck and may not nurse as efficiently as full term babies. Pumping will help you to develop a good milk supply, and hopefully once your baby gets stronger, she will be able to nurse well enough to maintain this supply.

Drink plenty of water. Drink a large glass of water about an hour before you plan to sit down to pump. You may also want to keep a glass of water nearby while you are pumping because pumping can sometimes make you thirsty.

Massage your breasts before you pump. Massaging your breasts may help you to pump more. Try massaging your breasts before you pump. You can also try massaging your breasts after you have pumped for a while and notice that you are no longer pumping any milk. Watch for when your breasts stop producing milk. When you notice this, take a break from pumping for a few minutes, massage your breasts and pump again. By using this technique, you may be able to pump as much as an ounce of extra milk or more for your baby.

mom holding baby in rocking chair

Storing Pumped Milk

When you pump your breast milk, you should store it in small bags or containers. You can purchase special storage bags in which to keep your breast milk. Ask your hospital caregivers how much you should store per bag and if it is okay for you to bring in frozen breast milk. Some hospitals do not allow the use of frozen breast milk. Label your breast milk with your baby’s name and what date the milk was collected. The hospital will use the milk in order of when it is dated. See Breast milk storage guidelines for more information on how to store your breast milk.

Breastfeeding Your Preemie

Once your baby is strong enough to breastfeed, your hospital caregivers will help you get started. Your baby may start out by just licking at your breast. She may suck at the breast for a while before she actually starts to swallow any milk. Preemies take a lot longer than full term babies to nurse. It may take her as long as 40 minutes to an hour for just one feeding. If she refuses to suck or keeps falling asleep, you should stop nursing and try again later. If you find the process is frustrating, you may want to work with a lactation consultant to help you. Your preemie may not suck well enough to empty your breasts when she nurses. For this reason, it is a good idea to pump after she nurses to make sure that your breast is emptied. Preemies may only nurse on one breast per feeding. This is not uncommon or something to worry about. To keep your supply up, you may want to pump the other breast after your baby nurses.

Breastfed Preemies May Need a Supplement

Your doctor may advise you to give your baby a special supplement. Supplements can be added to your breast milk. You can even give your baby a supplement while you breastfeed by using a special tube feeding device that allows your baby to nurse and take the supplement at the same time. This may seem discouraging to a breastfeeding mom, but supplementing will help your baby to thrive. Once your baby gains weight and starts breastfeeding better, you can work with your doctor on weaning from the supplement.