Breastfeeding your premature baby

This article is based on our booklet Breastfeeding Your Premature Baby. The booklet contains valuable information from research on breastfeeding premature infants, as well as experiences of other parents of premature babies to inform, reassure and encourage you. If your baby has been, or is about to be born prematurely, we recommend that you purchase the booklet, which will provide much more information to help you deal with the challenges of breastfeeding and parenting your baby. 

Why is breastmilk important for my baby?

Breastmilk is the normal and natural food for any human baby. For a premature baby, breastmilk is especially important to prevent damage to baby's immature digestive system. Premature babies who are formula fed are much more likely to get necrotising enterocolitis (a condition where part of the bowel undergoes necrosis (tissue death)). Breastfeeding can be a challenge if your baby is very small, or has other health problems but with perseverance, knowledge and help, you and your baby will soon learn all the skills you need. Breastfeeding or breastmilk feeding will also save you from the ongoing expense of buying formula for your baby. The many reasons why breastmilk is important are detailed in the Australian Breastfeeding Association booklets Breastfeeding Your Premature Baby and Breastfeeding: an introduction.

Your feelings

It may feel a bit unreal at first - suddenly your life seems out of control. All the plans for your pregnancy, birth and your newborn baby have evaporated. Many parents of a premature baby are not at all ready for the arrival of their baby - some mothers hardly have time to even look or feel pregnant before their babies are born. Instead of cuddling and breastfeeding your newborn baby, you may have to wait hours even to see her. You may be extremely worried about her survival. Maybe you have been moved to a different hospital in an unfamiliar city. You may also be recovering from surgery or the results of a stressful birth experience. Perhaps you have no idea of where the special care nursery is, or who is looking after your baby.

You may also find yourself wondering what you are doing on the maternity ward. Many mothers of a premature baby find it hard to be on the same ward or in the same room as other mothers with their full-term babies. Some mothers experience feelings of shock, disappointment, guilt, grief or even anger. Mothers are often released from hospital before their baby is ready to go home with them. This can be a very stressful time, especially if the hospital is not near your home.

All the time my baby was in hospital I didn't feel part of reality. I was expected to carry on life as if it was normal but all the time I was away from the hospital, there was a part of me in the special care nursery with my baby.

One thing only a mother can do

Providing your breastmilk is one thing only you can do for your baby. You are the only one who can provide this important nutrition for your baby. Providing this vital part of her care can be a positive outlet for all the feelings a mother has when her baby is born prematurely. It is not always an easy road to travel, but have confidence in your ability and think positively about all the other mothers who have succeeded.

Why breastfeeding is recommended by your baby's medical team

In most neonatal intensive care units and special care nurseries, staff are aware of the importance of breastmilk and they will encourage you to provide your own milk for your baby. This is because the medical research into the health and survival of a premature baby is showing that, as for all babies, breastmilk is vital. Breastmilk is so important for premature babies that some hospitals are now establishing human milk banks to ensure that our most vulnerable infants receive human milk.

Doctors and scientists recommend breastmilk feeding for the following reasons:

  • Your breastmilk is specifically tailored for your baby.
  • It is easy to digest, so the premature baby will gain the most nutrients with the least effort, even with her immature digestive capabilities.
  • There is little waste with breastmilk and the elimination of this waste will not overtax immature kidneys.
  • Breastmilk, especially the first milk (colostrum), is very important because it increases the baby's resistance to many infections and diseases.
  • The milk from mothers of preterm babies has special qualities which allow for optimum growth and development. 'Preterm' milk, although similar in many respects to full-term milk, contains higher concentrations of protein and some immunological components and minerals.
  • Even the tiniest amounts of breastmilk contain very concentrated amounts of nutrients and immune components, so even if a mother is able to produce only a trickle of breastmilk, the baby still benefits.

Kangaroo Care

Many hospitals around the world are using a method of care for premature babies called 'kangaroo care'. Kangaroo care is offered to a stable premature baby, usually for a few hours a day, and sometimes for much longer periods of time. Some hospitals offer this skin-to-skin contact even to a baby still attached to the ventilator, depending on his medical condition. The baby, wearing only a nappy and a hat, is placed against the mother's skin underneath her clothing, so he has unrestricted access to the mother's breasts. A baby cared for in this way maintains his body temperature, conserves energy (because these babies cry less and sleep more), and can often begin breastfeeding much earlier than a baby cared for in the traditional manner. These babies tend to be more content at home, too. Partners can also be involved in kangaroo care by this skin-to-skin contact with their premature baby.

We had been told we wouldn't be able to hold Madeline until she was more stable. So I was really surprised when the nurse offered me a cuddle on day 4. Madeline was so small (940 g) and I was so nervous but when they gave her to me I felt like a mother for the first time. I didn't want to put her back. Madeline's heart rate would drop down every time I held her. She would just be so completely relaxed. She'd look me in the eye for the first 5 minutes, then drop off to sleep. Her 'sats' (oxygen levels) were always great in kangaroo care and she never missed a beat.

This method of interaction with a premature baby has been found to increase the mother's expressed breastmilk supply by an average of 50%. The baby also shows an improved suckling ability, which is thought to be due to the stimulation of being near his mother's breasts. It enhances the bonding between the baby and his parents, and the parents feel more confident caring for their baby.

Your baby's hospital may not use this method of care, but perhaps by speaking with the staff, you may be able to at least hold your baby more often once his condition is stable enough. You, your baby and your milk supply will all benefit if you can have as much contact with your premature baby as possible.

Research has shown that breastfeeding is less stressful for the premature baby than bottle-feeding. Even a very small premature baby has been shown to tolerate long periods at the breast without distress. The baby stays warm, and the oxygen levels in his blood remain normal during and after feeds. A premature baby at the breast has long periods of interaction with the mother, including touching and eye-to-eye contact. During this time there are periods of sucking and resting. This means that the baby should have as much time as he needs for a breastfeed, except where there is a medical problem that limits time at the breast.

Things a mother can do

  • Start expressing as soon as possible after the birth of your baby. For more information refer to the Breastfeeding: expressing and storing breastmilk booklet.
  • It may help your baby to get the idea if you hold him in the breastfeeding position, while being tube-fed. Some mothers place a cottonwool ball soaked in her breastmilk into the baby's isolette to let him get to know the smell of his mother's milk, particularly when being tube-fed.
  • You may like to experiment with different positions at the breast, always making sure your baby is attached properly. A premature baby may feed well in the twin position, that is, tucked under your arm with his body supported by a pillow.
  • You may be able to start your let-down reflex working before putting your baby to the breast by massage, hand expressing or putting a warm cloth or warm heat pack on your breast. This will make it easier for your baby and increases the amount of milk taken even though the period of sucking may be short.
  • Don't be too concerned about your baby's sucking during early attempts at breastfeeding. The fact that you and your baby are getting to know each other in this way is more important than the volume of milk consumed. As your baby grows and becomes stronger you will see him begin to take more and suckle for longer.

Home at last

After perhaps weeks of expressing and visiting the hospital to see, hold and feed your baby, you are finally home as a family. Your joy may be tempered by feelings of apprehension. You and your baby are faced with a whole new pattern of being together. Take time to relax and concentrate on helping your baby adjust to this new environment. You, as his mother, need to breastfeed your baby for as long and as often as he needs so your supply will adjust to meet your baby's needs. Ensure you get lots of rest and accept all offers of help with household tasks.

Many Australian Breastfeeding Association groups hire electric breast pumps (with ongoing counsellor support if required). This can be useful if your baby is not yet taking all feeds at the breast and you still need to express.

It can also be a great help to keep in contact with other parents of premature babies. Support groups especially for the families of premature babies are often in major cities, and online. Your local Australian Breastfeeding Association group can also be a source of information, support and encouragement. Many of our counsellors, community educators and members have children who were born prematurely and are happy to support, encourage and share their own experiences with other parents. Do not hesitate to call or email a breastfeeding counsellor for reassurance and further information.

There are also many helpful articles elsewhere on the Association website as well as in our range of booklets and our informative and easy to read book Breastfeeding …naturally.

© Australian Breastfeeding Association Reviewed March 2015