Breastfeeding the prem baby

Having a baby early is worrying. They are small and need help. For many parents this can be a time of extreme worry and powerlessness. Your body knows what to do – from the moment your baby is born oxytocin kicks in, promoting prolactin and you start producing milk. Your premature baby is no different from any other new born and your milk gives their gut a lining through which essential antibodies can pass and help strengthen their tiny bodies.

Me with the small and mighty Katherine White. My oldest was born 9 weeks early in May 1999. She is now at university, never once letting her early start to life hold her back in any way.

If you know your baby will be premature

Start to collect colostrum through hand expressing. This gold milk is really fantastic for ensuring that your baby gets added protection so if you can collect some then its worth doing. Please look at this clip below for the best way to hand express.

Hand expressing works best with a bit of warmth so many find that they get better results if they either apply a warm flannel to the breast beforehand or straight after a hot shower. A full term new born baby has a stomach the size of a cherry so that of your prem baby will be much smaller so don’t panic if you just get drops – they really are liquid gold and every little bit helps.

Your baby is here

There is evidence to show that if you start expressing within the first hour after birth it can have a long term positive effect on your milk supply. Now this may well feel like the last thing on your mind to do – you may be in shock or pain. Do not stress out if you don’t manage to get things going straight away – there is time but you need to be consistent so in the early days so you need to be stimulating milk production in your breasts between eight and twelve times in twenty four hours, including at least once at night – this might be by your baby feeding effectively at the breast, or pumping sessions.

How long should you pump for? Well you should pump for two let downs of milk. So what will happen is that the drops will start to appear and you may feel a fullness, a tingling sensation in your breasts. This is your milk letting down – you want to pump for two let downs rahter than a specific amount of time. If you pump for 30 minutes, through 4 let downs (for example every person is different) then you are potentially over stimulating your supply and maybe creating problems for your self further down the line.

Once the baby has had any breathing tubes removed then we can start to look at breastfeeding. Pump your breasts for 15 minutes before placing them on you skin to skin with their mouth near your nipple. It may be that they will do non nutritive sucking which is where they stimulate the breasts for comfort, jaw muscle development as well milk production stimulation. The reason for partially emptying your breasts is that the flow slows which helps the baby to manage its airway better. This milk can be saved for feeding through a tube or cup.

You may also want to think about a nipple shield which the baby may find easier to latch on with. There is no best time to wean the baby from the shield and from personal experience I just kept trying until one day they latched on without. As long as position is changed when feeding (not every feed but at least twice a day) then using shield is a good way to get a premature baby on the breast. You need to change position to ensure that all the breast receives stimulation for milk production which helps stop any blockages occurring.

Premature babies will eat less per feed as they just have a smaller stomach. You may also find that they fall asleep more as eating is a very tiring activity for them. Try and keep them awake by blowing on them, tickling their feet. We need to keep them feeding not only for weigh gain but also to help stimulate your milk supply (don’t worry as they grow and feed more they will stimulate you to make more milk)

If you express whilst you are on the ward or near your baby as this is shown to increase the amount you pump. If you can get a photo of them then that will help. If you are worried about privacy then a screen or a scarf will help help shield you from others.

Relax! Don’t stress! Yes I know its so easy to say but it does inhibit the production of oxytocin which your body needs to produce milk.

It used to be thought that babies under a certain gestation didn’t have the ability to suck and swallow, or that directly breastfeeding was tiring to them. Happily, more recent studies have disproved these concerns. Once babies are well enough to breathe unaided (off ventilation and continuous positive airway pressure – CPAP), they can be brought to the breast. Smaller and younger babies will still need to have some of their milk given to them via tube feeds, syringes or cup feeding, but this allows you and your baby to learn to breastfeed together without a feeling of pressure. As they are small then there’s a strong chance that their muscle tone will be lower – make sure that you ask for extra support until breastfeeding is established.

Bottle feeding the premature baby – there is one evidence to show that the introduction of the bottle to the premature baby can impact breastfeeding success. If it is to used then make sure the feeds are paced. Links at the bottom of the page.

Premature babies often find it easier to feed in laid back breastfeeding positions. This is where you are supported in a reclined position with your baby tummy down on top of you. This helps gravity to ‘stick’ your baby to you and stops them slipping off. What this position does is stimulate reflexes that a baby has from birth when they can crawl up the body to the breast and feed. You can also hold your breast in a U hold with the hand underneath and finger either side of the areole. If you need to sit in a more upright position, then supporting the whole length of your baby’s body close to yours with a hand behind their shoulders means they don’t have to support their weight and stops them from curling in on themselves.

You may find that your newborn baby is not as able to communicate the fact they are hungry. This means that they may have to be put onto a feeding schedule to ensure that they are gaining weight. It could mean that your baby will have to have extra milk from either what you’ve expressed or from formula. Remember this – that when your baby comes home they will be feeding more frequently than the four hour schedule in the hospital and these back up feeds are just the extra calories that your baby needs to help them get big and strong. One of things that your baby will need to do before coming home is show signs that they recognize that they are getting hungry, that they are moving towards responsive feeding away from scheduled feeds.

Looking after your own heath and wellbeing

You will be recovering from pregnancy and birth, and may be experiencing additional health problems. It is important to remember to look after yourself – the more smoothly your recovery goes, the more strength and energy you will have to become more and more involved in your baby’s care. If you have older children at home, you may be struggling to balance meeting their needs with being present with your newborn. Many mothers have to leave hospital long before their baby is ready to come home and have to travel back and forwards to be with their baby. This is a time to say yes to as many offers of help as you possibly can. If someone can provide a lift, deliver a meal, entertain an older child or do a load of washing – or just sit with you to talk things over in the hospital cafe – these may make life a little easier for you and help you to keep going at a difficult time.

You may be taking medications yourself and be concerned about them passing through your milk. Discuss your concerns with your and your baby’s medical teams. They may be able to reassure you or find suitable alternatives. Please let me know if you have concerns and I will refer you to an IBCLC.

Taking your breastfed baby home

It can be scary to make the transition from caring for your baby in hospital with a team of staff around you, to being at home. Your healthcare professionals are likely to make extra visits to support you and to keep an eye on your baby’s weight gain. You may find that being home together, able to stay together all the time, and in a comfortable environment, you rapidly get to know and understand your baby more easily and become more confident in your mothering skills.

For more on why this is so important to me, please read the blog I wrote about the birth of my oldest daughter.

The above link is my page on paced bottle feeding.