The benefits of breastfeeding healthy infants are well known, but the advantages for premature infants are sometimes overlooked. Nursing is occasionally considered too challenging for an already stressed new mother and a fragile baby. The truth is, breastfeeding the premature infant has significant health benefits and often helps parents deal with the challenges of the neonatal care unit.
Studies have shown that human breast milk carries antibodies or natural infection-fighting proteins that prevent or decrease the severity of life-threatening infections in the premature infant. In addition, the natural proteins, fats, and sugars found in breast milk are easier for premature babies to digest than commercial formulas. In other studies, premature babies fed breast milk were shown to have significantly better intellectual and motor development and better vision than babies fed commercial formulas.
The most important key to success is your own commitment to provide breast milk for your newborn. After that you'll need some equipment, instruction, and lots of support from family, friends, and nursing staff. In most cases, a very premature baby or a seriously ill full-term baby won't be strong enough to breastfeed initially. So you will need to start stimulating your breasts mechanically to start the flow of milk. Even if you can breastfeed your baby initially, you may still need to pump breast milk to leave for your baby when you go home from the hospital and your baby stays.
You should start pumping as soon as possible, even if you're lying down recovering from a C-section. Ask a nurse or lactation consultant to help you. You won't get much at first, but what you will get is colostrum, a very high-quality milk.
Your breasts will get very large in the first few days and then diminish somewhat in size. Wear a comfortable nursing bra with pads to absorb leakage. Pump about every three hours (you can go as long as five hours once during the night). When your milk supply is established, in one to two weeks, you should produce about 25 ounces of milk a day. This will be plenty to start feeding your baby, when your baby's doctor gives the okay.
How to Pump
Give the nurses fresh milk whenever possible for your baby's feedings. The immune components are best when the milk is fresh. You can keep the rest of the milk in sealed bottles in a cooler with ice or in the refrigerator. Place the extra milk into the freezer as soon as convenient.
Milk Storage Guidelines
For the very small baby, the first feedings will be by a small tube leading from the mouth or nose into the stomach or bowel. The first feedings may be only a few millilitersless than a teaspoonin some cases, as doctors observe how the milk is tolerated. During tube feeds, it is important for the baby to have some oral stimulation with a rubber nipple or finger and some skin-to-skin contact with a parent or a nurse, as tolerated. The closer the situation is to a regular feeding, the easier it will be to make the transition to direct breastfeeding later.
The first feedings will consist of breast milk with a special fortifier added to accommodate a premature infant's specialized nutritional needs. Nurses may want to skim off the upper layer of milk, which contains the most fat, in order to get the richest milk into the infant first (human milk isn't naturally homogenized).
Parents can certainly assist with feedings even if the milk is simply pushed through a tube. Be there. Do as much as you can. Your baby is learning about your smell, touch, and voice as part of the feeding. It's important to stay calm and quiet during this time, because it takes all your baby's concentration and energy to get this feeding thing started.
The medical staff of the hospital will decide when you should begin direct nursing. This decision is based on several factors, including the baby's ability to suck effectively without tiring and his ability to maintain his body temperature out of the incubator or isolette. Many babies are ready to nurse directly when they weigh about 1,500 grams or are about 32 to 34 weeks in gestational age. This varies a lot, however, and will depend on your infant's specific condition.
When you are ready for the first direct breastfeeding, have a nurse or lactation consultant help you. The nurse can create a semiprivate area around your baby's incubator. You may want to do some breastmassage at first to get the milk flow started. Have the nurse or lactation consultant help you the first few times to get the baby latched on to your nipple. Be aware that too rapid a flow may overwhelm a small infant, causing him to sputter and the milk to roll out of his mouth. If that happens, pump a little off first so the milk flow is at a rate he can handle.
At first, you may nurse directly one to two times a day, increasing as the baby tolerates the additional feeds. If your baby stops sucking quickly, you may want to pump the rest of the milk from your breasts in order to maintain your production. Keep pumping between feeds until your infant is a full-timer. Remember that skin-to-skin contact helps maintain your baby's temperature and improves your milk production.
The medical staff may check on the volume of milk the baby drinks by weighing him before and after a feeding. The amount will be small at first but will increase as he grows in strength, experience, and familiarity.
Continue the same healthy diet you had when you were pregnant, but drink twice as much fluid. After a few weeks of lactation your appetite will increase, and you may need to add an additional healthy snack or meal. This is not the time to diet! You should limit your intake of caffeine and alcohol and refrain from smoking.
This may seem challenging just when you and your partner are already dealing with the demands of an unexpectedly fragile newborn. But making the choice to breastfeed and following through with a pumping and feeding routine will be rewarded. Because of your commitment to breastfeeding, your baby will soon gain weight and grow strong and healthy right before your eyes! By spending more time at the baby's side and in the neonatal unit, you'll quickly become more at ease with the environment, the medical staff, and other parents who can be a great support.