Having a premature baby can be a worrying and stressful time for new parents. Many mothers feel like they have little control over, or even relevance to, their baby’s wellbeing.
Breastfeeding a premature baby can be even more trying and stressful experience.
Many mothers of premature babies can encounter many challenges in establishing breastfeeding. However, as with any breastfeeding relationship, once established it usually becomes easier and very rewarding for you and your baby.
Knowing certain things can help make it more likely to get breastfeeding working out well for you and your baby. Here are 7 things you need to know about breastfeeding a premature baby:
Breastfeeding A Premature Baby #1: Breastmilk Is Important
The breastmilk you produce for your premature baby is different as compared to if your baby was born full term. It contains higher levels of protein, DHA, magnesium and iron, and higher concentrations of immune protective factors.
Your breastmilk is important for your baby. Formula feeding increases the risk of NEC (necrotising enterocolitis, a potentially fatal complication of prematurity whereby part of the bowel dies). Formula feeding is associated with lower long term IQ outcomes in premature babies as compared to breastfed premature babies.
Breastfeeding A Premature Baby #2: Kangaroo Care Is Important
Kangaroo care (skin-to-skin contact) is especially important for your premature baby. Kangaroo care:
- Helps your baby to maintain normal body temperature
- Helps your baby to remain calm
- Gives your baby the opportunity to try to attach to your breast
- Assists with bonding between you and your baby
Breastfeeding A Premature Baby #3: Expressing Is Often Important
Premature babies typically have less endurance and ability than term babies to feed effectively at the breast.
So, while your baby grows stronger and more mature, expressing can form an important part of establishing your supply and providing your premature baby with your breastmilk. You will likely need to express a minimum of 8 times in a 24 hour period, starting within the first hour of your baby being born (or as soon as possible).
If you’ve breastfed before, you will know that you can look forward to things getting easier once your milk supply is established and your baby is more mature.
However, if you are a first time mother, the effort of expressing for a premature baby can seem huge and the rewards uncertain. Working with a lactation consultant or speaking with an Australian Breastfeeding Association counsellor can help.
Double pumping with a hospital-grade electric breast pump is the most efficient and effective way to express. Using the highest comfortable vacuum setting to express helps to remove the most amount of milk. You can help avoid nipple damage by placing your nipple in the centre of the breast shield and ensuring it is not too small or too big.
After use of a pump, finishing up with a few minutes of hand expressing can help to remove even more milk.
Breast massage and compression while expressing and skin-to-skin contact with your baby help to increase the amount of milk you express.
You can help trigger your let-down reflex before expressing with gentle massage of your nipples, looking at your baby or a photo of her, or holding/smelling your baby’s recently worn clothes.
Breastfeeding A Premature Baby #4: Use Of Human Milk Fortifier Can Help Very Preemie Babies
Very premature babies have complex nutritional needs. Since a foetus normally accumulates stores of many nutrients in the last trimester of pregnancy, a very premature baby misses out on this.
It’s often recommended for very premature babies to receive human milk fortifier (HMF) to supply them with additional protein and minerals. HMF that is based on cows’ milk is typically used. The use of this type of HMF may adversely affect some of the anti-infective properties of breastmilk.
HMFs based on breastmilk are produced by a small number of human milk banks in North America. It is important for HMF based on breastmilk to become more widely available, especially since use of anything but breastmilk (including use of HMF based on cows’ milk) increases the risk of NEC.
Breastfeeding A Premature Baby #5: Introducing The Breast Can Vary Depending On How Preemie Your Baby Is
Establishing breastfeeding is an individual and gradual process. Some premature babies can breastfeed from 32 weeks gestation, while others take longer than expected. Early and frequent skin-to-skin contact gives you and your baby a chance to practice positioning and attachment – even non-nutritive sucking (where your baby is not swallowing) is helpful.
Breastfeeds will be introduced gradually, starting with one or two each day. It is not uncommon for your premature baby to fall asleep during a breastfeed or to be too tired to feed on some occasions.
Gradually, as your baby progresses to sucking and swallowing well at the breast, top-up feeds may be reduced. A lactation consultant can help guide you about this.
Breastfeeding A Premature Baby #6: Positioning And Attachment Make A Difference
Optimising how your baby is positioned and attached to your breast can help her feed better.
The underarm or ‘football’ hold, with your baby supported up on a pillow, works well for many mothers with premature babies.
Other mothers find holding their baby in front of them in a cross cradle hold works well. In this position, hold your baby in close, chest-to-chest, and support your baby along your forearm, supporting her neck and shoulder blades with your wrist and hand.
Brushing your nipple of your baby’s top lip can encourage her to open her mouth wide. When her mouth is wide open and her tongue down, hug her into your breast to attach.
Seeing a lactation consultant or calling an Australian Breastfeeding Association counsellor can provide you with more tips about positioning and attaching your premature baby.
Breastfeeding A Premature Baby #7: Using Nipple Shields Can Help
Premature babies have immature intra-oral sucking pressures which can reduce the amount of milk they get while breastfeeding. For premature babies, a nipple shield may help with attachment to the breast and can improve the amount of milk they get.
If you are discharged home from hospital breastfeeding with a nipple shield, you may be able to discontinue its use as your baby matures. A lactation consultant can help you with weaning off a nipple shield.