For all of the planning and dreaming we might do, birth is never quite what we think it will be. When the unexpected brings baby out sooner, plans can change in dramatic ways. The good news is, the milk you make for a pre-term baby is just as good as for one born closer to term. Actually, it’s even better.
Breastfeeding a pre-term baby has its challenges, and it might not even look like normal breastfeeding for awhile. But the antibodies and nutrients that your milk provides are life-saving.
Early Days with a Pre-Term Baby
Premature birth happens for a number of different reasons, which means that every case will be different. Technically, a baby is pre-term before 37 weeks gestation. But there are definite differences between a baby born at 36 weeks and a baby born at 30. Plus, each little one is different. One later pre-term baby might need some extra care, while one born a week or two earlier could be ready to go home in a couple of days. Your circumstances will be as unique as your little one.
With that said, we know that pre-term babies often struggle with latch and suckling, even when they are closer to 37 weeks. It may take some time with creative feeding methods or even a feeding tube before it’s safe to practice breastfeeding.
That’s okay. Baby needs to eat something, even when they are that tiny, and your breastmilk is the best thing for him. Babies who are fed pumped colostrum and milk are not only given more nutrients but also better antibodies, which is important for a hospital stay.
Right after your pre-term baby is born, you may not be able to hold him skin-to-skin, depending on his immediate needs. Whether or not you had an idea it was happening and had time to prepare for it, there will be an adjustment period as you learn what baby’s needs are and recover from the birth, any special circumstances surrounding it, and the adrenaline of the situation.
But as soon as it’s safe, you can walk or be wheeled to where baby is. In most cases, you’ll be able to hold your pre-term baby under your shirt, on your chest, skin-to-skin. This is called kangaroo care, and it’s one of the best things for a pre-term baby. Your body will help regulate his body temperature; he’ll hear your heart and feel you breathing rhythms; and you’ll find it’s an excellent trigger for oxytocin, prolactin, and the hormones needed to increase your milk supply.
You will need to pump to get your supply up and keep it there, as well as to provide milk for the hospital to feed the baby. That means lots of Let There Be Milk, hydration and nutrition for you. It's hard to keep up with all of this while visiting baby and managing your life and recovery. Enlist people around you to help as much as possible with whatever you don't have to do.
Breastfeeding a Pre-Term Baby
Even before you can latch, breastfeeding pre-term happens in creative ways. It might go into the feeding tube, from a spoon, from a cup, through a Supplemental Nursing System (tubing that brings milk to baby while at your breast), or even just off of the tip of a finger. For you, that means lots of pumping. You’ll need to eat good foods and drink plenty of water, because pumping around the clock is a serious job. The payoffs are more than worth it—babies who are fed breastmilk in the NICU have better outcomes, period.
If you can’t quite get the supply that you need, donor milk is the next best option. Keep in mind, though, that a donor’s milk has to be heat treated to make sure it’s sterile, which will probably damage the delicate balance of nutrients. Even so, it’s definitely the next best option before formula.
Once you can try nursing, know that pre-term babies often have a slower suckling reflex. That’s okay. It’s less stressful for him to take his time at the breast than to bottle feed, and it will help you both to catch up on bonding time after the special start.
To help your pre-term baby get the best latch, it's important to make sure you are belly to belly with her. If she's turned with her belly up, she won't be able to control her latch as well. This is true for any baby, but premies need all the care and attention they can get. Use a C hold with the hand nearest the breast and hold baby's head with the opposite hand.
It will help to hold both in this way through much of the nursing session until baby gets big enough to control her head and latch better on her own.
Be patient with yourself and your baby as you work through latch issues and settling into your new routine. A lactation consultant, your midwife, or a La Leche League Leader will be important contacts to save and reach out to as you go through the ups and downs of breastfeeding a pre-term baby.
Remember, your baby has done a lot of active work outside of the womb that she expected to do passively before birth. She's a fighter, and so are you! There will be bumps in the road, but with some support and determination, you'll be breastfeeding and growing in no time.