Breastfeeding Your Premature Baby

The benefits of breastfeeding are well known, but its advantages for premature babies are sometimes overlooked. With a preemie in the NICU or recently settled at home, you may have been too tired or stressed to give much thought to nursing your baby. But breastfeeding offers significant health benefits, and it’s not too late (or too early) to start.

Studies have shown that human breast milk carries antibodies that protect babies from infections, which is especially important for preemies with weak or compromised immune systems. Breast milk also contains natural proteins, fats, and sugars that are easier to digest than those in premature baby formula. Breast milk has also been shown to promote brain development. Last but not least, nursing fosters a special bond between you and your baby.

To aid breastfeeding, particularly for a preemie who might not be strong enough to nurse at first, you may need to pump breast milk. That’s why we’ll talk a little about pumping, before getting into direct nursing later on.

What You’ll Need to Pump Breast Milk

Sometimes directly breastfeeding a preemie isn’t possible at first. This can be because your preemie hasn’t yet developed the ability to coordinate the sucking, swallowing, and breathing needed during feeding, or the strength required to nurse. Alternatively, you may need to pump to encourage milk to flow and to keep supply up so that you have ample milk expressed for your baby.

Here’s what you’ll need to pump breast milk:

• Breast pump. You'll need a hospital-quality, fully automatic electric pump. The NICU will have breast pumps you can use while your baby is there; ask the staff about renting one for home use. You can also ask your doctor about local resources. For example, if you have a local WIC office, you can ask them about rentals. You can purchase a lightweight, portable model if you’ll need it later when you return to work. A double-port pump stimulates your breasts simultaneously and is more efficient at extracting milk than a single-port system.
• Breast pump accessory kit with double cups and tubing to fit the pump
• Small, sterile preemie baby bottles with screw-on tops/nipples supplied by the hospital
• Small, clean towel
• Small cooler to transport frozen milk
• Nursing bras
• Nursing pads (either disposable or washable)
• Healthy snacks and lots of water

Pumping Step-by-Step Guide

Begin pumping as soon as possible after giving birth with the help of a nurse or lactation consultant in the hospital. These early pumping sessions will produce a substance called colostrum, which is a high-quality milk that provides essential nutrition for your baby’s first few days of life. You’ll want to pump milk for your premature baby about every three hours, and after a few weeks, you’ll likely be producing about 25 ounces of milk each day.

Here are some easy-to-follow steps for when you settle down to pump some breast milk:

1. Find a regular place to pump that is private, clean, comfortable, and preferably near a sink. The hospital nursery usually has a designated room, or find a quiet place in your home.
2. Wash your hands, and relax with soothing music and a picture of your baby.
3. Massage your breasts to help get the milk flow started.
4. Connect the machine, tubing, double cups, and sterile bottles. Place a cup on each breast, and pump both breasts simultaneously for 10 to 15 minutes. Start at low power, and then move up to full power when the milk is flowing well. You’ll feel a tingle or brief burning as the milk starts to flow.
5. Remove the bottles from the tubing. Divide the milk into separate, sterile bottles of one ounce each (that’s all your baby needs for each feeding in these early days).
6. Label all the bottles with your baby’s name or hospital record number. Check your hospital nursery’s policy on labeling to prevent milk from being discarded.
7. Clean the pump cups, and wash your hands again.

Storing, Transporting, and Feeding

You can give your nurses fresh milk for your baby’s feedings whenever possible; ask them, or your lactation consultant, about the best way to store milk at home and how to bring milk to the NICU. Premature baby feeding usually starts with gavage feeding, in which the baby is fed small amounts through a tube from the mouth or nose to the stomach. Ask the nurses for advice about giving your baby some oral stimulation with a rubber nipple or finger as well as some skin-to-skin contact with you during these feedings. Simulating breastfeeding in this way may make the transition easier for you both later on.

Directly Breastfeeding Premature Infants

When your medical staff decides you’re ready to begin direct nursing, congratulations! It’s a sign that your baby is making good, healthy progress in his development. The staff has been monitoring your preemie to ensure he’s in a stable condition, is able to breathe well, and is showing oral feeding cues. You can also read more about the various tests your baby has been undergoing in our guide to NICU tests.

Massage your breast to get the milk flow started, and then ask your nurse or lactation consultant to help you get the baby to latch onto your nipple. Be aware that if the flow of milk is too strong, it may be overwhelming for your little one, causing him to sputter. If this happens, pump a little first to slow the flow to a rate he can handle. Enjoy the skin-to-skin contact during this time, as it helps maintain your baby’s body temperature, improves your milk production, and fosters that unique bond between the two of you.

Your Nutrition Matters

Continue the same healthy diet you had when you were pregnant, but drink twice as much fluid. After a few weeks of lactation, your appetite will increase, and you may need to add an additional healthy snack or meal.

All of this may seem challenging just when you and your partner are already dealing with the demands of a premature baby. But making the choice to breastfeed and following through with the pumping and feeding routine will be rewarded. You’ll start to see your baby gain weight and grow strong and healthy right before your eyes. In addition to breastfeeding, another way you can bond with your preemie and support his development is by practicing skin-to-skin contact. Read more about how to practice kangaroo care, and find out about some of its benefits for preemies.