Your baby is here! She is beautiful, but she was born a bit earlier than expected. Depending on the gestational age of your premature baby, breastfeeding can either go well or be challenging. If she is only a couple of weeks early (37 weeks), she is considered "late preterm" or "near term." Quite often, late preterm babies are treated like full-term and can go home two or three days after birth. Typically, your baby will come home around the time that you were given as your due date. So if your baby is born prior to 37 weeks, he will stay in the hospital until that time.
Babies born very early may have disorganized sucking patterns and they are easily fatigued, posing breastfeeding problems. So it is important to work on this issue. It takes persistence and consistency on your part. Babies who arrive too early don't get the appropriate nutrients that they would if they were still inside of you. Breast milk provides many important nutrients but often needs to be supplemented in the more preterm babies (less than 2000 grams) with human milk fortifiers, which contain protein, fat, and carbohydrates, and a variety of vitamins and minerals including vitamin D and iron. Preemies need to be supplemented with vitamin D just like full-term babies. In addition, iron supplementation is recommended because much of the iron transfer occurs in the "missed" third trimester. The more premature, the more supplementation that is needed.
Late preterms are much like full-term babies and usually breastfeed just as well. Some do continue to have some feeding issues once they're home. So how can you relax knowing all of this? Here are some guidelines to set your mind at ease...
How do I know my preterm baby is getting enough to eat?
Generally speaking, babies need to eat 8 to 12 times within a 24-hour period. Preterm babies don't always show hunger cues. They may never seem hungry and, happily for their exhausted parents, sleep a lot. Here is what you need to do to ensure your baby is getting plenty to eat:
- Keep your baby close by and feed him immediately upon waking up. It's a sign of maturity if he wakes on his own rather than having to be woken up.
- Be aware of hunger cues. If your baby starts to fuss, to smack his lips and lick, or attempt to eat his hands, that's the time to put him to the breast. Crying is a late cue and it is difficult to feed a crying baby. Try to avoid that stage.
- If your baby is not waking herself every 2 to 3 hours, feel free to wake her up (at the later end of the range), place her skin to skin, and hang out. When she begins to stir, and hopefully root toward the breast, be ready to feed.
- Observe and take note of the baby's sucking and swallowing patterns. If your baby has not gotten the hang of breastfeeding yet, you will have to supplement him with your expressed milk by cup or syringe. Once he is a bit stronger and has put an acceptable amount of weight on, you can drop the amount of supplemented milk.
- As preterm babies edge closer to their expected due date, their behaviors change (for the better). You may notice that your baby is starting to nurse frequently. Don't worry that this is a milk supply problem. It simply means that your baby is maturing.
What does it mean to place my baby "skin to skin"?
Gone are the days where a preterm baby stayed in the incubator all day long with no physical contact. Early babies thrive off of being next to mommy. Skin to skin contact simply means having your baby undressed (keep the diaper on, though) next to your bare chest. Your baby will have your combined body heat to stay warm and you will both feel a sense of calm. If it is cool in the room, feel free to use a thin blanket over both of you to maintain that body heat. Because of this relaxation and warmth, your baby will be more apt to breastfeed and benefit from your milk. This will also help you maintain a strong milk supply. Hold your baby upright with her tummy against you. Studies have shown that your breathing helps keep your baby breathing. If you are the type that can't sit for long, you can still use skin to skin contact standing up by putting your baby inside a tank top to support his head and wearing a large button-down shirt over that, tying the ends in a knot under your baby's tush.
What will happen with my milk supply if my baby isn't feeding well?
Premature babies often have problems latching on and breastfeeding properly. If this is the case, it is important that you pump to stimulate and maintain your milk supply until your baby is feeding more effectively. So, immediately after birth, when you are still in the colostrum stages, it is easier to hand-express. This important first milk is thick, rich and concentrated. So it is difficult to express by pump. You can hand-express every couple of hours onto a spoon and feed it directly to the baby. Over the next few days, your milk will become more plentiful. So continue with your pumping or hand-expression routine every 3 hours to keep your supply strong. Even if your baby is being fed intravenously, you can swab the colostrum inside her cheeks. (Studies have shown that preterm babies who receive colostrum make their way out of the NICU faster than those who don't). If she is fed by gavage (a tube that runs through the nose into the stomach), your breast milk can be given as well. Once you feel that your milk supply is strong and, equally as important, your baby is gaining weight properly, you can cut down the middle of the night pumpings. But be mindful of your supply. Having a lactation consultant help you out will really make a difference.
If you have a late preterm baby and he is home from the hospital, you should plan to see your pediatrician for a weight check about 2 or 3 days later. You will also want to go for weight checks once a week until your official due date has passed.
Journal of Human Lactation. Volume 23, November 2007. Pages 305-392.