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Breastfeeding a Premature Baby

Is it possible to provide your premature baby with breast milk? In most cases, yes. Research is starting to show that many preemies can put on enough weight with breast milk alone. If you run into challenges, just remember that help is available in many forms. For example, your preemie can still be bottle-fed with your breast milk if they are physically unable to nurse.


Ready or Not

In some cases, a mother knows ahead of time that her baby has a high risk of being born prematurely -- such as if she's having twins or if certain health issues, like preeclampsia, are developing. If this sounds like you, you may have a little more time to consider some of the problems you might run into with breastfeeding. On the other hand, sometimes babies surprise everyone and show up much sooner than they should, catching you off guard for how to handle breastfeeding a premature baby.
Whether you are prepared or not, there are some things to consider if you plan on breastfeeding your preemie. Nursing a premature baby is different from breastfeeding a full-term baby and comes with its own set of issues that you may want to be prepared for -- just in case!

Debunking the Myths

There are a number of myths about breastfeeding preemies, and many hospital procedures can make it difficult for mothers to breastfeed their preterm infants successfully. Unfortunately, many of these procedures were put in place back in the 1960s and 1970s, when breast milk wasn't necessarily the highest priority in neonatal intensive care units (NICUs). However, current research is starting to debunk some of the previous myths about caring for premature babies.
Baby Must Be in Incubator
One myth is that premature babies need to be in incubators. However, the World Health Organization (WHO) recently published research on a technique called Kangaroo Mother Care that debunks this myth.
This technique calls for the infant to be held skin-to-skin on the mother's chest. It helps keep the baby warm and facilitates breastfeeding. Because preterm infants lose heat rapidly, keeping them warm is especially important to help prevent illness, infection, and even death. In WHO's research, it is estimated that using the Kangaroo Mother Care technique could prevent 450,000 deaths annually.
Evidence has shown that premature babies, even very tiny ones, are often more stable metabolically when they are skin-to-skin with the mother. Also, the research has shown that their breathing is more normal, blood pressures are more stable, and their blood sugar levels are more controlled using the Kangaroo Mother Care method as opposed to an incubator.
These studies also showed that mothers using this technique produce more breast milk and can get the baby to the breast earlier than when an incubator is used. Because premature babies need breast milk even more than a full-term baby, using this technique can get the preemie those important nutrients only found in breast milk (see What's the Big Deal About Breastfeeding?). The Kangaroo Mother Care method is showing that essential newborn care doesn't necessarily mean the use of expensive, high-tech instruments.
My Preemie Will Need a Fortifier
The human body is a remarkable thing! In preparation for birth, a woman's body is hard at work in many ways, including preparing the exact ingredients a baby will need in the breast milk. As remarkable as it is, the breast milk produced for a premature baby is different than it would be if the baby was full-term. Getting this precious milk to your baby is crucial, and the sooner you can get it to your infant, the more benefits it can provide.
Even though you may not be able to breastfeed as soon as you would like with a premature baby, you can still express breast milk and feed it to your child in other ways. You can start expressing your milk as soon as you have delivered your child.
The first milk produced is called colostrum (also known as "liquid gold"). This substance is nutrient-packed and contains important antibodies and vitamins that no laboratory-made formula can mimic (see All About Colostrum). Although only a small amount of colostrum is produced for the first few days after your child is born, it is the perfect amount for your infant's tiny stomach.
Once your breast milk comes in over the next few days after birth, you can use a breast pump to help feed your preemie (see The Whys and Hows of Expressing Breast Milk). Although your premature infant may not be able to physically breastfeed (possibly due to not being physically mature enough to do so), you can still produce the breast milk to provide them with the nutrients they need most.
Studies have shown that if a mother is expressing enough milk, babies who weigh at least 1,500 grams (about 3.3 pounds) can grow sufficiently with breast milk only. The myth that premature babies "need" fortifiers comes from the belief that babies must grow at the same rate outside of the mother as they would have had they not been born prematurely. However, there is not enough evidence to show that this is true. There is evidence that babies who are at a certain weight and who have mothers producing enough breast milk will thrive on breast milk only.
There are times, however, when fortifiers are necessary, such as when the mother is unable to express enough breast milk or the baby is very tiny. However, many fortifiers are now manufactured from human milk rather than cow's milk. There may also be times when vitamin D, phosphorus, calcium, and certain proteins can be added to the mother's breast milk without using fortifiers.
Mothers of Preemies Should Use Nipple Shields
In many cases, nipple shields can be avoided even if your baby comes early. It may take some time and practice to get your premature infant to latch on and breastfeed well. This can take more time than many mothers or healthcare providers are willing to wait. If your infant is physically too young and the muscles haven't developed yet to achieve a good suction, then a nipple shield can help get the breast milk to the infant.
Using nipple shields wisely can help provide breast milk when other techniques have failed. However, there are several techniques that can help make nipple shields unnecessary, or that can wean the child from them quickly (see Ins and Outs of Nipple Shields).
Preemies Need a Bottle to Learn How to Suck
This is one of those myths that needs to completely go away, as it is simply untrue. Many times mothers are rushed by friends, family, and even some healthcare providers into thinking that their baby is just not getting enough milk at the breast and they must have a bottle.
However, this doesn't necessarily help the mother or the baby. In many cases, it just takes a little time and patience. This is where a lactation specialist can come in handy. Learning how to properly latch the baby and position him or her to get sufficient suction can make breastfeeding successful without the need for a bottle.
Although there are times when a bottle may be necessary, it is important to remember that the muscles your infant uses to suck from a bottle are different from those used to breastfeed. Therefore, a baby who starts taking a bottle may develop "nipple confusion," causing him or her to not want to breastfeed. Nipple confusion can be a difficult obstacle to overcome once a bottle has been introduced, as the baby will start to learn that it takes less effort to suck from a bottle and may not want to breastfeed again.
Do Not Breastfeed Babies Until They Are 34 Weeks Gestation
Research has shown that babies can take to the breast by 28 weeks gestation, with many able to latch on and breastfeed sufficiently by 30 weeks gestation. Using techniques like the Kangaroo Mother Care method can help make breastfeeding premature infants more effective.
That being said, there are times when babies have respiratory issues or other problems, and it may not be possible for them to physically breastfeed until 34 weeks gestation.
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