Breastfeeding Your Premature Baby

reastfeeding Your
BPremature Baby
Written by
Paula P. Meier,
DNSc, RN, FAAN

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eciding whether to
Dprovide your milk
for your baby
Giving birth to a premature baby
Perhaps you had expected to
is often a surprise to parents, and
breastfeed, but now that your
they must make many important
baby has been born early, you
decisions about their baby’s care
may not know how to get
in the first few days after birth.
started. Or perhaps you had
One of these decisions is whether
planned to bottle-feed, but
to provide mother’s milk for the
you now want your premature
baby’s feedings.
baby to receive the special health
benefits available only from
mother’s milk.
This booklet will help you decide
about providing milk for your
premature baby, and will give
you an overview about how to
express (remove), collect, and
store your milk. You also will find
suggestions for feeding your baby
at the breast during and after the
hospital stay. This information can
be used along with guidelines
you receive from the nurses
and physicians who care for
your baby in the hospital.
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Benefits for
carry their pregnancies to full
premature babies
term. This “premature milk”
Most parents are aware of
is especially protective for
the many advantages of
premature babies.
breastfeeding full-term babies.
However, you may not realize
Mother’s milk has special
that mother’s milk provides
substances called enzymes,
extra protection against some
which help the baby’s immature
of the problems that premature
stomach and intestines develop.
babies may develop. In fact,
These enzymes also break down
some researchers think that the
the nutritional parts of the milk
smallest premature babies
and reduce the chance that the
benefit the most from mother’s
baby will develop feeding intol-
milk—even small amounts for
erance, during which feedings
short periods of time. Mothers
must be stopped temporarily.
who deliver prematurely produce
milk that is slightly different
Another major benefit
from the milk of mothers who
of mother’s milk is that it
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provides protection from
substances in their milk, especially
infection. This is important
during the early days of milk
because premature babies have
production. Some substances
limited ability to fight bacteria
“paint” the inside of the baby’s
and viruses on their own, and
intestines and prevent bacteria
because they are exposed to
and viruses from being absorbed
many germs in the neonatal
into the bloodstream. Others
intensive care unit (NICU).
work directly to kill germs or stop
Mother’s milk has many special
them from growing. Some of the
defensive agents, including
nutrients in the milk serve two
antibodies, that work to protect
purposes. They make it difficult
premature babies from infection.
for germs to live and grow in the
baby’s intestines, and your baby
Mothers of premature babies
uses them as “fuel” for growth.
have higher amounts of these
Some of these agents are
absorbed into the baby’s
bloodstream and may
continue to protect against
infection even after the baby no
longer receives mother’s milk.
Mother’s milk also contains anti-
inflammatory agents, which help
protect the premature baby’s
fragile bowel tissues from swelling
and soreness. This reduces the
chance that harmful bacteria can
grow. These agents are thought
to help defend the baby against
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necrotizing enterocolitis (NEC), a
serious bowel condition.
Mother’s milk is also nutritious for
premature babies. The type of fats
in your milk may be especially
important. During the last weeks
of a full-term pregnancy, special
fats are transferred from the
mother’s body through the
placenta to the baby. Babies
who are born early stop receiving
these fats through the placenta.
However, they are present in
mother’s milk in higher
concentrations following a
premature birth. Many researchers
think these fats play a role in the
eye and brain development of
They said it helped create a
premature babies.
special connection with their
baby. Others felt that providing
Benefits for mothers
milk gave them some control
Mothers report that providing milk
over their infant’s outcome or
for their premature babies helps
condition. For many mothers,
them cope with stress and feelings
the special closeness of
of helplessness when their babies
breastfeeding helps to make
have to remain in the NICU. In
up for being separated from
studies, mothers said that
their premature baby in the
providing milk was the one thing
early days and weeks after
only they could do for their baby.
giving birth.
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ays of providing milk
Wfor your premature baby
Since even small amounts of your
Discuss your feeding plans
milk for a short time can make a
and questions with your family
significant contribution to your
and your baby’s health care
baby’s health, it’s important to
providers. You may decide to
begin expressing your milk as soon
continue pumping and
as possible after you give birth.
eventually feed at the breast,
Your body is naturally primed to
or you may decide to feed your
begin producing an abundant
baby expressed breast milk from
supply of milk at that time. If you
a bottle. If you decide to stop
are unsure how long you want to
expressing and collecting your
provide milk, you can make this
milk after a week or a month,
decision later in your baby’s
that is easily done. However, it
hospital stay.
can be difficult for you to start
making milk again at a later time.
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Collecting milk
pump to express your milk right
for your baby
from the start.
Most premature babies are not
ready to begin feeding at the
Being in close physical contact
breast immediately after birth.
with your baby will also help
You will need to remove, or
to stimulate your milk production
express, your milk with a
during these first few weeks. You
breast pump. This milk can
may be able to pump your milk
be refrigerated or frozen until
while sitting at your baby’s bedside
it is fed to your baby. Most
in the NICU. Ask your baby’s nurse
premature babies receive their
about the technique of “kangaroo
first feedings through tiny
care,” in which your baby is
feeding tubes. This type of
dressed only in a diaper and
feeding is called gavage feeding
held against your bare skin
and is given at regular times
(skin-to-skin) for warmth
during the day. Even if your baby
(see photo on page 19).
is not quite ready for gavage
feedings, you should remove
Renting a breast pump
the milk from your breasts early,
Mothers who are expressing milk
often, and completely, so that
for their premature babies should
your body gets the signal to
use a hospital-grade electric pump
produce an adequate supply.
with a double collecting kit so
both breasts can be emptied at the
The first 2 to 4 weeks of milk
same time. These breast pumps
removal are very important.
are fully automatic and are easy
During this so-called critical
and comfortable to use. They
period, the milk-making
provide the right amount of breast
hormones and breast tissues
stimulation to produce abundant
undergo changes that help to
milk. Electric pumps can be rented
ensure your ability to produce
from hospitals, pharmacies, and
enough milk for your baby in
lactation specialists in most
the weeks and months to come.
communities. Your baby’s nurse
Therefore, you need to plan to
can help you locate the most
rent and use an effective breast
convenient place to obtain one.
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is just as important as the type
of pump you use. In general, try
to express your milk about eight
times a day during the first
2 to 4 weeks after you give birth.
Frequent pumping is the only
signal that tells your body to
produce milk. Each time you use
the breast pump, large amounts
of the milk-making hormone,
prolactin, are released into your
bloodstream. This causes the
breasts to step up their
production of milk. The amount
of prolactin gradually returns to
Smaller electric or battery-
its original level over the next
operated pumps are ideal for
21/2 to 3 hours, and your body
mothers who are separated from
needs a new signal (another
their babies for part of the day—
pumping session) to release it
while at work, for example.
again. This release of prolactin in
But they seldom provide enough
response to regular pumping is
breast stimulation to create and
the mechanism that creates and
maintain an adequate milk supply
maintains milk production in
for a premature baby. This is
mothers of premature babies.
especially true during the critical
In the first week after your baby’s
first month after you give birth.
birth, try to use the breast pump
You may be able to use a smaller
every 2 to 3 hours during the
pump to remove extra milk after
daytime for about 15 minutes at
she* has come home and is
each pumping session. You do
feeding well at the breast.
not need to set an alarm to wake
up at night. However, if you
Using a breast pump
awaken on your own, you
The way you use a breast pump
probably will want to call the
*This booklet alternates between “she/her/hers” and “he/him/his” when referring to babies.
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NICU to check on your baby.
possible each time you pump
Then use the pump before you
signals your body that all of the
go back to sleep.
milk it produces is needed.
Complete and regular emptying
For the first day or two, you may
of the breasts is the only way
produce only a few drops of thin,
your body knows to continue
yellowish milk when you pump.
producing milk.
This early milk is called colostrum.
It contains large amounts of
Labeling, storing, and
substances that help protect
transporting your milk
your baby from infection. Even
Each NICU has policies about
very small amounts should be
handling mother’s milk for
collected for feedings. Over the
premature babies; ask your baby’s
next several days, these drops
nurse to explain them. However,
of milk will gradually become
some guidelines are common to all
measurable amounts, and the
color and consistency will change.
When you are expressing about
an ounce at each pumping
session, you are ready to change
from the 15-minute pumping
sessions to a pattern that fits your
individual milk-flow pattern. Once
you are collecting about an ounce
each time you pump, adjust your
schedule so that you use the
pump for 2 additional minutes
after the final drops of milk have
stopped flowing. For some
mothers, the drops of milk stop
after 10 minutes; for others, this
may take as long as 30 minutes.
Getting your breasts as empty as
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container with your baby’s
name, the date and time you
expressed the milk, and any
medications you are taking. All
NICUs have a policy about how,
and for how long, mother’s milk
should be stored. Talk with your
baby’s doctor or nurses about
whether you should refrigerate
or freeze the milk you collect at
home. Also, ask how much milk
you should put into each
container. This will decrease the
chance that any milk will be
nurseries. First, always wash your
discarded because your baby
hands carefully with soap and
could not receive the full
water before beginning to use the
amount within a particular
breast pump. Make sure you
time limit.
clean and dry your breast-pump
equipment according to the
Your milk can be transported
instructions you receive from your
from home to the NICU in any
baby’s nurse. Store your
container that keeps it cool or
milk in containers that are
frozen. An insulated lunch bag
recommended or provided by
or a cooler can be ideal for
the NICU. Use a clean storage
carrying your expressed milk.
container each time you pump—
Many NICUs provide special
even if you are expressing only
carrier bags for this purpose,
small amounts of milk. Label the
so be sure to ask.
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