Can I breastfeed my premature baby?
When you have your baby early, you may not even have thought about how you will feed your baby. After your baby is born you will be asked the question by many people and may feel pressure to choose breastfeeding. It is important to make a truly informed decision. It is a long journey and you will need positive motivation to keep going. Having the right information will help you to feel good about your decision. There are also several podcasts on our website about breastfeeding premature infants. The good news is that you don’t have to make long term decisions right away. If you aren’t sure, then get started and learn as you go along. Talk with your baby’s nurses and doctors about it. Take it one day at a time.
The first step is to start to stimulate the breast to produce milk. To get your milk supply started and keep it up, you want to pump your breasts as often as your baby would feed, at least 8 times a day. This doesn’t have to be exactly every 3 hours. It may help to plan your pumping times around your daily routine. There may be times when you have to pump after only 2 hours, and others when you go longer. In the morning, your hormone levels are higher, and you will make more milk. Pump more frequently early in the day. Hospitals usually have higher quality breast pumps. Plan to pump more often when you are at the hospital. Take advantage of time with your baby. Any time you have contact with your baby, your body will make more milk. Pump both before and after spending time with your baby, especially skin to skin time.
Both mom and dad and any other people who support you can be involved in this journey. The role of support people is very important. They can encourage and praise mom for her efforts, help mom to find the time and space to pump, and help with milk storage and transport to the hospital.
What if I am taking Medicine?
Many mothers need medicine for their own health. It is important to talk to your own healthcare provider about what you are taking. You can read an info sheet from the International Breastfeeding Centre about medication and breastfeeding here: https://ibconline.ca/information-sheets/breastfeeding-and-medications/
You can also consult the website “MotherToBaby” (https://mothertobaby.org/) for more information.
Keeping Up Milk Supply
It is very common for a mother’s milk supply to decrease when they have been pumping for many weeks. It is important to not get upset about it. There are a few key elements to keeping up your supply. The first is a good pump. Generally a full sized electric breast pump is going to be the most reliable. The more often you pump, the more milk you will produce at each pumping session. Pump until the milk flow stops, and then just a bit longer. If you massage your breasts before pumping and express by hand for 5 minutes after pumping, you can also boost your supply.
Review your milk volumes every day, and keep track of how often and how long you are pumping. If you are finding that the milk stops flowing sooner, keep the pump on for a longer time. Find ways to fit extra pumping times into your day and night. As you recover from the birth, it may get easier to get up at night to pump.
You can try “power pumping” once a day. It takes one hour. Pump for 20 minutes, rest for 10 minutes, pump for 10 minutes, rest for 10 minutes and finally pump for 10 minutes.
There are some herbal and prescription medicines that can help increase milk supply. They are not magic. If you had a full supply and then it dropped off, you are more likely to respond to them. These other methods may bring back your supply without any other medicine. Talk to your nurse, doctor, nurse practitioner, midwife or lactation consultant about them before you start them.
Teaching Baby to Breastfeed
Your baby starts the journey to breastfeeding when you do. Babies each have their own rate of progress and development and it is important to work with your team to help them reach their goals. You can expect your baby to follow a pattern similar to the one outlined below:
Tube feeding with mom’s milk. Having positive contact with mom whenever possible. Small tastes of mom’s milk are often given during this stage.
Learning to suck. This starts with a soother given during tube feedings so that baby associated sucking with a full stomach. Have regular skin to skin time with mom and introduce baby to the breast to lick and gently suck. This is called a “non-nutritive suck” because baby is often too small or weak to get much milk out of the breast. It is important to make this a positive experience for both you and your baby.
Short breastfeeding practice sessions. These are often only 5-10 minutes long to make sure that baby doesn’t get too tired. There are optimal ways to support your baby at the breast that your baby’s nurse, a lactation consultant or an occupational therapist can teach you. The focus is on the quality of sucking not on the milk volume that baby takes.
Building up breastfeeding stamina and mom’s confidence. Follow baby’s cues for what they can handle and don’t push them too hard. It is very important to keep the sessions positive for both yourself and your baby. If your baby shows any signs of stress, stop the breastfeeding session and consider just holding your baby in skin to skin until they are calm. You can try again next time. Hospitals have different protocols for helping a premature baby transition to full breastfeeding. Talk with your baby’s nurse about theirs.
Full breastfeeding. Some premature babies achieve this before going home, while others continue to work towards this at home. Your team will help you determine the best way for you and your baby. Talk to them about the people who will support you in your community. It is more difficult to do this on your own, so don’t be afraid to call for help and advice. If you and your baby never achieve full breastfeeding remember, you are still a winner! The important thing is that you are doing the best you can for your baby.
Many of the doctors and Nurses who work in the NICU have extra education to help you with breastfeeding. There are also health professionals called Lactation Consultants who can help you specifically with breastfeeding in many cities and hospitals. If you don’t have those resources in your community there are online resources to help you. Below are some links you may want to try:
Breastfeeding Online: http://www.breastfeedingonline.com/
International Breastfeeding Centre (based in Toronto ON): https://ibconline.ca/
About Kids Health Breastfeeding Learning Hub : https://www.aboutkidshealth.ca/breastfeeding
For more information check the following booklets.
Some of the resources were written by Dr. Paula Meier, director for clinical research and lactation in the neonatal intensive care unit and professor of paediatrics at Rush University Medical Centre in Chicago. There might be some differences from your centre in the resources available.
This video series is presented by Katie James, a midwife, and lactation consultant, who answers the most frequently asked questions around breastfeeding in the first hours, days, and weeks after delivery.
How do I know my baby is getting enough milk?
What to do if my baby is not latching on at the breast
I have sore nipples, what should I do?
Feeding cues, how do I know when to feed my baby?
What to expect when you get home with your baby
What to expect in the first few hours after birth
What is normal breast fullness and what is engorgement?
Can I introduce an expressed milk bottle feed?
My baby has lost too much weight, what should I do?
If the milk is not coming in what should I do?
What if my baby is unable to breastfeed in the first hours or days after birth?
The lactation film to watch before birth!
The app helps you to monitor your breastfeeding and pumping sessions – plus, keep tabs on your baby’s height, weight, sleep, and diaper changes.
Thank you to Doris Sawatzky-Dickson - Certified Neonatal Nurse and Lactation Consultant - for reviewing this material.
Let's Talk about Breastfeeding is a six-part video series with Paula Meier, PHD, RN, who explains the impact that the first two weeks after birth on the breastfeeding experience. She reviews findings from her own and others' research and practice showing the correlation between milk supply building in the first two weeks and the ability to breastfeed for the weeks and months to come. These chats include key tips for getting breastfeeding off to a good start, discuss mother and baby conditions that can cause breastfeeding problems during this time, and provide helpful solutions for lactation professionals and parents to explore.