Breastfeeding a Preemie: thoughts from a mom who has been there!

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.Newborn baby boy covered in vertix inside incubator

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.Mother breast feeding her baby with closed eyes

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.Mother Breastfeeding her newborn

4. Bradys

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 near mother's breast

From The Mom in Me, MD



When breastfeeding doesn’t go your way…

Seeing other moms discretely breastfeed their babies while sipping lattes, answering text messages, and having in-depth conversations with their friends left me wondering what I was doing wrong. Why couldn’t I make breast-feeding look this easy? I wanted to sit at Starbucks perfectly covered by a pretty, Petunia Pickle Bottom nursing cover! Instead, I was still working on getting my baby to latch correctly without biting off my boob in the process. Would it ever get easier?SCARSDALE, NY - SEPTEMBER 15, 2013: A tall Starbucks coffee in f

I know that you are all expecting me to say, “Yes, my daughter became a model breastfeeder! I was sipping my own lattes at Starbucks in no time.” But, the reality of the situation was that breastfeeding was always a challenge for me. My daughter eventually figured out how to latch correctly, but then she decided to start biting me! YES, BITING! After we had a pretty heated chat about how naughty it was to bite mommy, she then decided that home was the only place she liked to nurse. Each month it seemed like a new breastfeeding challenge arose. Each month, we muddled our way through.Mother breast feeding her baby with closed eyes

I was determined to breastfeed for at least a year. And, although I loved the bonding that breastfeeding brought, I couldn’t help counting down the days until her first birthday. Because she was a preemie, I still had to pump in order to give her fortified bottles with breast milk. The extra step of pumping several times a day in addition to nursing left me feeling akin to a dairy cow. I was exhausted, moody, and sometimes downright irritable.Cute Baby At Hands Of The Mother In An Embrace, Monochrome

Would I do it all over again? Absolutely! Reminiscing about my love-hate relationship with breastfeeding reminds me that most things worth doing are challenging. Although breastfeeding doesn’t always get easier for some of us, neither does motherhood! Poopy diapers, skinned knees, toddler melt-downs, teenage rebellion…as moms, we are in it for the tough stuff. Although I love the beautiful moments that motherhood brings such as cuddle time, kisses on my nose, and a little hand to hold; I’m also grateful for the challenges. These remind me of what I’m made of…or at least what I’m becoming…someone a little less selfish, a little more genuine, and a lot more determined to be the best at my biggest title…MOMMY!

From The Mom in Me, MD



If you can pee on a tree…I can breastfeed on a park bench!

mother breast feeding her childMen always seem to have this innate desire to be one with nature. Camping, chopping wood, and yes, even peeing on a tree seems to top their list of liberating activities. And, while peeing on a tree should probably be reserved for certain times and places…breastfeeding should not! Nothing is as natural as a mother nursing her newborn baby. And, while I don’t endorse an exhibitionist lifestyle for men or women, sometimes a little boob is gonna show!

As a first time mom (to a preemie), and a first time breastfeeder I was determined to make it work. Nursing without any additional complications can be challenging enough. Add in a tiny mouth that needs a lot of help latching correctly, and what should seem natural becomes a production. At home, I had my routine…a zillion pillows in just the right positions, my Boppy angled at just the right degree, and my feet propped to just the right height. But, nursing in public was a whole different story! My daughter hated the nursing cover. Actually, she despised it. I tried to convince her that Petunia Pickle Bottom was all the rage for covers (only the best for her), but every time the cover went down her scream reached new heights. If I was finally able to clam her down, I then had the complicated job of getting her to correctly latch so that she would get milk without biting off my boob in the process. Trying to stay covered while getting a preemie to latch correctly is like playing Twister naked with only a towel for cover…good luck!Happy Mother Breast Feeding Her Baby Infant

Since nursing with a cover always ended up with my baby (and me) in a meltdown, I resorted to finding “private” places to nurse such as bathrooms, designated nursing rooms, and the car. I quickly crossed bathrooms off of my list! Disgusting! I don’t ever eat in a bathroom…why should my baby have to? With limited options, and my frustration rising, I came to the conclusion that I just couldn’t leave the house, or if I wanted to leave I would have to pump and give her a bottle (pumping is no mother’s preference). My baby just wouldn’t breastfeed in public!

Looking back I now realize that my baby wasn’t the problem…my comfort level with openly nursing my daughter was the problem. If I had been willing to show a little boob, she would have nursed just fine. What was it that made me feel so uncomfortable breastfeeding without a cover? Was it my own sense of modesty? Was it my concern that I might offend someone or cause a vulnerable man to have “inappropriate” thoughts? Was it our culture that promotes larger than life Victoria’s Secret advertisements but is appalled by a breastfeeding mother showing any part of her breast? Honestly, probably all of the above.Young Mother Breastfeeding A Baby In Nature

Whether or not I will ever have another infant to breastfeed, I’m not sure; But, I’ve decided to change my opinion and my regard for what is currently, culturally acceptable and what I’m comfortable with. Most cultures around the world are comfortable with open breastfeeding. Many cultures rely upon breastfeeding as the safest source of nutrition for infants since clean water is scarce. Although the United States has established laws guaranteeing that nursing mothers can breastfeed in public, the fact that laws are necessary to ensure that a mother can feed her infant is disturbing. Isn’t it a little ironic that many developing countries are more advanced in their view of breastfeeding than those of us in the “first” world.

As women, our bodies were made to breastfeed. What could be more natural? Breastfeeding isn’t a sexual display or even a women’s lib movement. Instead, it is one of the best ways that a mother can nourish, protect, and bond with her infant. While I don’t think that nursing moms should walk around in public completely topless (although I’m all for it at home), I do think that breastfeeding moms should have the freedom to feed their babies where, when, and how it works best for their infant. If that means you need to plop down on a park bench with an exposed boob, so be it! If anyone has a problem with that…you can tell them to, “Go pee on a tree!”

P.S. For all of you mom’s who couldn’t or chose not to nurse, you are still amazing moms! Although I advocate for breastfeeding, every mom has to choose what works best for her and her infant.

From The Mom in Me, MD