Premature babies can breastfeed, even those needing special care. Human milk is chock full of infection-fighting ingredients, making it the ideal food for babies, especially preemies. Human milk also adjusts to meet the individual needs of babies, including those born full term, near term, or preterm. Whether your baby breastfeeds directly from your breast or you give your baby your expressed milk through a tube, cup, or bottle, you can be confident in knowing that your milk contains all the nutrients your baby needs.
While breastfeeding a healthy, full-term baby can be challenging, breastfeeding a preemie, especially one born months early, can be overwhelming. Your baby’s health care provider can help you identify breastfeeding goals that are realistic for you and your baby.
Tips for feeding a baby who can’t breastfeed right away include:
- Express your milk as soon as possible after delivery, ideally within 24-48 hours after birth.
- Maximize the amount of milk expressed with "hands-on pumping"—a combination of hand expression and pumping with a fully automatic, electric pump.
- Babies who are unable to feed orally (by mouth) can still receive the benefits of their mothers’ milk through “oral care” procedures. Express and collect your colostrum (a mother’s first milk) and apply it to the inside of your baby’s mouth using a cotton swab. The ingredients in colostrum are especially beneficial for preemies.
- Once your baby is ready for oral feedings, you can offer your expressed milk through a small tube that is passed through your baby’s nose and into his stomach (gavage feeding).
- Hand express/pump your breasts at least 8 times in each 24-hour period. You may get only enough milk to cover the bottom of the collection container at first. Don’t panic! The amount of milk expressed will increase over time. After the first week, expect to get one ounce or more from each breast during each pumping session.
- Hand express/pump whenever your breasts feel full to avoid engorgement and increase production. If you are making more milk than your newborn needs, store and freeze your milk for later use.
- Store your milk at room temperature for up to 4 hours and in a refrigerator (which is preferable) for up to 4 days.
- Freezing milk can affect the anti-infective proprieties of breast milk, so it is best to give your preemie fresh milk each day, if possible.
- Store your milk in single-serving containers (½-2 ounces depending on your baby’s weight). Label each container with your name, your baby’s name, the date and time the milk was collected, and the name of any medication you are taking.
- As soon as your baby is stable enough to be held, hold him skin-to-skin against your chest for at least one hour each day. Babies who are held skin-to-skin (sometimes referred to as kangaroo care) gain weight faster, move into an open crib sooner, and go home from the hospital earlier. Skin-to-skin care also gives your baby a chance to feel safe and secure at your breast. Mothers often find that they are able to pump more milk after holding their babies skin-to-skin. Fathers can also provide skin-to-skin care!
Once your baby is ready to start breastfeeding, you will want to try a variety of positions to see which ones work best. Regardless of which positions you choose, make sure your baby’s back, shoulders, and head are well supported. For babies with weak muscles, you may want to support his chin with your thumb and forefinger forming a u-shape called the “dancer hand.”
At first, your baby may just lick and swallow your milk (as opposed to suckle and swallow). Eventually, your baby will learn to suckle and swallow as his muscles get stronger and he becomes more accustomed to breastfeeding. During each feeding, as your baby’s suckling slows down, you can massage or compress your breast to increase the flow of milk. This will also ensure that your baby gets the nutrients and calories he needs to grow.
It is important to give your baby a chance to breastfeed, but if you don’t hear him swallow, the nurse will give him your expressed milk through his feeding tube, while you hand express/pump to maintain your milk supply.
Your baby may be able to breastfeed only once a day at first, and the rest of his feedings will be through his feeding tube. Just remember, these first breastfeedings are a learning experience for both you and your baby, so relax and enjoy each moment. As your baby grows, so will his ability to breastfeed.
Expert tips from Amy Spangler’s BREASTFEEDING: A Parent’s Guide. Learn more about breastfeeding your preemie and get answers to other common breastfeeding questions and concerns in BREASTFEEDING: A Parent’s Guide.