Don’t be fooled by the title. This blog is helpful for all breastfeeding moms! I have been asked on several occasions now to touch on breastfeeding a preemie or a baby who is in the NICU. Mommies ask…I answer! While I’m not a lactation consultant, my role as breastfeeding mom to a preemie has given me quite an education. I’ve decided to address some of the common challenges that go along with breastfeeding a preemie. Some of these challenges also exist for non-preemie babies…so, all of you nursing moms may want to keep reading.
1. Not Yet Ready To Breastfeed
Many moms with preemies have a sense of helplessness. They want to protect and take care of their newborn, but this is incredibly challenging in the NICU setting. Breastfeeding is one significant way for moms to impact their preemie’s health. But, one of the major challenges of having a preemie or sick infant in the NICU is that they are not yet physically ready to breastfeed. Many little ones require a feeding tube and IV nutrition for their early meals. Eventually, many preemies will be ready to breastfeed, but in the meantime, moms can have an incredible impact on their preemie’s health by pumping breast milk to be given through the feeding tube. Research tells us that infants (specifically preemies) that receive breast milk have better outcomes. Since preemies are already at a disadvantage from day one, giving them any extra health benefits is MAJOR!
That being said, pumping often feels like a task rather than an opportunity. Having your breasts hooked up to a suction machine for thirty minutes, twelve times a day is far from pleasant. It doesn’t afford the same bonding that actual nursing creates, but don’t give up. Eventually your baby will be at the breast, and you will be able to pump much less frequently.
This is often a slow process and starts with nonnutritive feedings, where your preemie is simply put to the breast but not expected to actually transfer milk. Be patient. With time, your preemie will figure things out. In the meantime, I can’t say this too many times, pump, pump, pump. Be diligent in establishing a good milk supply from day one. Pumping every several hours for at least 20 minutes to start will help ensure a good supply. Being in the room with your preemie while pumping can also increase the amount of milk that you produce. The times that I sat looking at my preemie while pumping I often was able to pump at least an extra ounce of milk.
Getting enough sleep is also an important part of milk production. Once your milk supply has been established, allow yourself to go one somewhat longer stretch at night (not more than 6 hours-you don’t want to get engorged) without pumping. This extra sleep may help keep your supply up. Drinking enough water is another important component to an adequate supply. Water…Water…Water! Keep refilling your bottle.
2. Small Mouth
Most preemies have tiny mouths, making it difficult for them to latch correctly. Make sure that you are using the help of a lactation consultant when teaching your baby how to latch. They have amazing tricks for helping the little one open widely and latch deeply. If your baby is latched too shallowly not only will they be unable to get milk efficiently, they will also cause you incredible pain! You are not going to gag your baby! Sandwich your breast with your hand and shove your baby’s mouth as deeply as possible onto your breast. The angle of their mouth should line up as though they are taking a bite from a sandwich. If you are in extreme pain, simply slide your finger into the corner of your infants mouth to break the suction. Unlatch and try again. Don’t let your baby feed with an incorrect latch! Sometimes a nipple shield may be necessary as well.
3. Lazy Feeder/Tired
Many preemies are tired. They don’t have much of an energy reserve due to their small size and lack of body fat. Overdoing it can definitely tire them out. Don’t expect your new preemie to eat efficiently at the breast for some time. It will come eventually. Some tips to help your little one stay awake to feed include stripping them down to a diaper and tapping the soles of their feet or stroking them.
Many preemies will have bradycardic events (drop in heart rate) while breastfeeding. This is incredibly common. If this happens, take the baby off of the breast and stimulate them either by rubbing their back or the soles of their feet. Eating takes a lot of energy and sometimes if they are not yet efficient at handling milk flow, they may “choke” or “gag” resulting in a brady. Your nursing staff will help you know how to look for the warning signs before it happens. I always knew when I was nursing when my daughter was going to have a dip in her heart rate before it showed up on the monitor. She had the same tell every time where she acted like I was water boarding her with milk. If a very fast flow is an issue for your baby, you may need to pump for just a couple of minutes first to get the fast let down out of the way. This may benefit your preemie anyway, because they will be getting more of the hind milk which is richer in fat. If you notice that your baby is starting to struggle or gag, it may be a good idea to remove them from the breast for a moment and let them recover.
5. Poor Suck-Swallow-Breath reflex
Preemies have a lot to learn. Unlike other infants, they are expected to be high achievers before they were even supposed to enter the world. They shouldn’t have to breath air, suck a breast, or swallow milk yet. Expecting them to put all three of these activities together in a coordinated fashion is incredibly demanding. Most full-term infants are born with a suck-swallow-breath reflex. It happens naturally. For most preemies this is not the case. Give your baby time. Eventually they will figure this out. I was incredibly frustrated because I thought that my daughter would figure it out immediately. It took her nine weeks before this became natural.
The list of concerns and complications goes on and on when dealing with feeding a preemie. I have only touched on a few of the common issues. Please feel free to comment with questions, concerns, and your experiences.
From The Mom in Me, MD