Breastfeeding a Premature Baby

Breastfeeding A Premature Baby
It can be a challenge to breastfeed a preemie, but you can do it. Blend Images - ERproductions Ltd/Brand X Pictures/Getty Images

Breastfeeding and Your Premature Baby

Your baby is here! She's beautiful, but she was born a bit earlier than expected. Depending on the gestational age of your premature baby, breastfeeding can either go well or be challenging. If she's only a couple of weeks early (37 weeks), she is considered "late preterm" or "near term." Quite often, late preterm babies are treated like full-term infants, and they can go home two or three days after birth.

Typically, your baby will come home around the time that you were given as your due date. So, if your baby is born before 37 weeks, he will stay in the hospital until around the time that he was due.

Babies born very early may have disorganized sucking patterns, and they get tired out easily which leads to breastfeeding problems. So, it is important to work on this issue. It takes persistence and consistency on your part.

Premature Infants, Breast Milk, and Human Milk Fortifiers

Babies who arrive too early don't get the appropriate nutrients that they would if they were still inside of you. Breast milk provides many important nutrients but often needs to be supplemented with human milk fortifiers in the more preterm babies (less than 2000 grams). Human milk fortifiers contain protein, fat, carbohydrates, and a variety of vitamins and minerals including vitamin D and iron. Preemies need to be supplemented with vitamin D just like full-term babies.

In addition, iron supplementation is recommended because much of the iron transfer occurs in the "missed" third trimester. The more premature your baby is, the more supplementation he will need. 

Why is Kangaroo Care or Skin-to-Skin Contact Important? 

Gone are the days when a premature baby stayed in the incubator all day long with no physical contact.

Early preemies thrive off of being next to mommy. Skin-to-skin contact simply means having your baby undressed (keep the diaper on, though) next to your bare chest. You just hold your baby upright with her tummy against you. Your baby will have your combined body heat to stay warm, and you will both feel a sense of calm. If it is cool in the room, feel free to use a thin blanket over both of you to maintain that body heat. 

Because of this relaxation and warmth, your baby will be more apt to breastfeed and benefit from your breast milk. Skin-to-skin contact also helps you to maintain a healthy breast milk supply. Studies have shown that your breathing helps keep your baby breathing. If you are the type that can't sit for long, you can still provide kangaroo care standing up. You can place your baby in a tank top to support his head and wear a large button-down shirt over that, tying the ends in a knot under your baby's tush.

Providing Your Breast Milk for Your Premature Baby in the Hospital 

Preemies often have problems latching on and breastfeeding correctly.

If this is the case, it is important that you pump to stimulate and maintain your breast milk supply until your baby is feeding better.

Immediately after birth, when you are still in the colostrum stage, it is easier to hand-express. This important first breast milk is thick, rich, and concentrated, so it's hard to express with a pump. You can hand-express every couple of hours onto a spoon and feed it directly to the baby. Over the next few days, your breast milk will become more plentiful, so continue to pump or hand-express every 3 hours to keep your supply strong.

Even if your baby is getting fed intravenously, you can swab the colostrum inside her cheeks. (Studies have shown that preterm babies who receive colostrum make their way out of the NICU faster than those who don't). If your baby is eating through a tube that runs from her nose to her stomach, your breast milk can be given as well.

Once you feel that your breast milk supply is strong and, equally as important, your baby is gaining weight appropriately, you can cut down the middle of the night pumpings. But, be mindful of the amount of breast milk that you're getting. 

Breastfeeding Your Premature Baby at Home 

Generally speaking, babies need to eat 8 to 12 times within a 24-hour period. Preterm babies don't always show signs of hunger. They may never seem hungry, and they may sleep a lot. Here is what you need to do to ensure your baby is getting enough breast milk.

  • Keep your baby close by and feed him immediately upon waking up. It's a sign of maturity if he wakes on his own rather than having to be woken up.
  • Be aware of your baby's hunger cues. If your baby starts to fuss, to smack his lips and lick, or attempt to eat his hands, that's the time to put him to the breast. Crying is a late sign of hunger, and it is difficult to feed a crying baby. Try to avoid that stage.
  • If your baby is not waking herself every 2 to 3 hours, feel free to wake her up (at the later end of the range), place her skin to skin, and hang out. When she begins to stir and hopefully root toward the breast, be ready to feed.
  • Observe and take note of the baby's sucking and swallowing patterns. If your baby has not gotten the hang of breastfeeding yet, you will have to supplement him with your expressed milk. Once he is a bit stronger and has put an acceptable amount of weight on, you can drop the amount of supplemented milk.
  • As preterm babies edge closer to their expected due date, their behaviors change (for the better). You may notice that your baby is starting to nurse more frequently. Don't worry, this is not a sign of low milk supply. It only means that your baby is maturing.
  • Be sure to see your baby's doctor for a weight check 2 or 3 days after you leave the hospital. You will also want to continue to go for weight checks once a week until your official due date has passed. 

Sources:

Journal of Human Lactation. Volume 23, November 2007. Pages 305-392.

Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Seventh Edition.  Mosby. 2011.

Edited by Donna Murray

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