Breastfeeding a Premature Baby: Best Practices
Breast milk provides important health benefits for premature babies, so whether you decide to express milk for a short time or breastfeed for several months, your milk will be an important part of your baby's treatment plan. Many people think that giving birth prematurely limits a mother's ability to make enough milk, but don’t worry – it’s not true! The extra stress, discomfort, and fatigue that come with the birth of a preemie can cause a slow start with milk production, but this slow start usually gives way to an adequate milk supply by the fifth or sixth day after birth. Answers to the following common questions will help you get started with milk expression for your premature baby.
What type of breast pump should I use?
Studies show that moms who are expressing milk to feed a premature baby should start with a hospital-grade (multi-user) double electric breast pump, so that both breasts can be emptied at the same time. This type of breast pump is the most effective in stimulating release of the milk-making hormone, prolactin, which results in the greatest amount of milk. While you may have a personal-use breast pump from your insurance or baby shower, these are best for moms who are doing a combination of pumping and nursing daily and aren’t guaranteed to provide enough stimulation to establish and maintain a good milk supply for a mother who is pumping for a premature baby. You can use your personal-use breast pump once baby is home and feeding well from the breast, but to give you both the best start, plan to use or rent a hospital-grade (multi-user) double electric breast pump like Medela’s Symphony PLUS® while in the NICU.
Moms also have a convenient rent-to-home option when it comes to Symphony PLUS, which allows you to rent the breast pump for at-home use as long as you choose. When used soon after birth, Symphony PLUS can significantly increase breast milk production and help moms like you initiate, build, and maintain breast milk supply through research-based Initiation Technology™.
How often should I pump?
During the first week or two you should pump about as often as a healthy, full-term baby would breastfeed – 8-10 times daily. This stimulates prolactin, which signals your body to make more milk. And don't be discouraged if you only get a few drops of that liquid gold per pumping session at first. Your body takes time to initiate and build a supply, and you'll see your output grow as time goes on! As a final tip, don't set an alarm to pump in the middle of the night. Use this time to relax, recharge, and help your body heal itself. If you naturally wake up in the middle of the night, you can pump before going back to bed, but don't add stress to yourself by forcing too strict of a schedule.
How long should a pumping session last?
In the first few days after birth, most mothers express very small amounts of milk – from a few drops to a few teaspoons – at each pumping session. During this time, a pumping session should last from 10-15 minutes, which is enough time to stimulate the release of prolactin. However, after the milk has "come in" several days later, and you begin producing more than half an ounce each session, start using the breast pump until your milk has stopped flowing for at least 1-2 minutes. The last droplets of milk released during pumping contain very high levels of fat, which provides most of the calories in breast milk that your preemie needs to heal and grow. Those calories are essential for premature baby feedings, and continuing to pump signals your body that more milk is needed than it's produced so that your supply will grow. As a general rule, you shouldn’t pump for more than 30 minutes, and if your milk does flow for that long consistently, you won't need to pump as frequently as a mother who can express her breasts in less time.
Can I Do Anything to Increase Milk Supply?
Fatigue, pain, and stress – all of which are common among moms of preemies – cause the body to release a substance that interferes with prolactin. While it may be difficult to overcome these barriers, most of these do diminish or become more manageable over time. Here are some tips that can help you manage your supply:
Try to spend as much time in the nursery with your baby as possible during the early days. Family members often feel that mothers should stay at home and rest after giving birth prematurely, but some mothers report that being separated from their babies causes even greater stress.
When in the nursery, request a comfortable chair and use the breast pump at your baby's bedside where you can see and touch the baby. When not in the nursery, it's helpful to look at a picture of your baby while you're pumping.
If baby is healthy and stable enough, you can ask to hold baby in Kangaroo Care, also known as skin-to-skin.
Don’t be afraid to take pain medications that the doctor has prescribed, as pain relief is important to milk production.
For additional questions and help in transitioning a baby to the breast when the baby is ready, talk to your doctor, the NICU nurses at your hospital, or an International Board Certified Lactation Consultant (IBCLC).