Your premature baby needs to be feeding well before she will be discharged. The road to feeding your premature baby effectively starts early.
If your baby is ill or born very early, she may be given essential hydration and nutrients via nasogastric tube or even a drip in the early days. In time the NG tube will be used to feed her breast milk or formula until she can suck.
The sucking reflex needs to be established and encouraged by non-nutritive sucking. Your baby can suck a premature baby dummy, your clean finger or her thumb. Offering your emptied (expressed) breast will help her develop the coordination of sucking without having to cope with coordinating swallowing milk and breathing too. Offer non-nutritive sucking while she is feeding from an NG tube and after a feed as well as when she is distressed and for at least 10 minutes a day when she is in the drowsy or awake states.
Express your first breast milk as soon as possible after the birth of your baby (preferably within four hours). Colostrum and early milk is particularly enriched with calories and antibodies. Although it may be some time before your baby can drink your expressed breast milk, you can freeze the milk for when she can tolerate milk in a tube feed or bottle.
Keep these tips in mind:
- Have a lactation consultant to assist you.
- Before expressing apply warmth (heated wet towels or a happy hugger) and massage your breast to release colostrum.
- Initially expect a few drops to a teaspoon or two.
- Hand expressing, if you have the knack, is the most effective way of extracting your milk until more volume comes in on day 3 or 4. If there is no one to help you hand express comfortably then pump two to four hourly.
- Using a double electric breast pump works most efficiently.
- Express for five to ten minutes every two to four hours until your milk comes in.
- Once your milk comes in, continue to express until the breast milk flow slows right down, after 10 to 15 minutes per side.
- You shouldn’t need to express for more than 30 minutes at a time, if you are single pumping or 15 to 20 minutes if you are double pumping. Breast compression while pumping increases the volume expressed.
- Limit wake ups during the night to express – you need your rest. Pump before going to sleep and once between 2 and 4 am and again on waking.
- It’s important not to exceed six-hour stretches between emptying your breasts in the first six weeks, as you establish your milk supply.
- Try to express with a picture of your baby in front of you or where you can see her; this will help with the release of let down hormones.
- After a week or so of expressing, you will find you can express much more milk in each sitting.
- Most women need to express seven times a day to produce a full milk supply, which adds up to three hourly between 7 am and 7 pm, plus two expressings between 7 pm and 7 am.
If your baby is not ready to start breastfeeding you may offer milk to her in a cup (you can use the sterilized cap of a bottle). Place the cap near her lips so that she learns to lap the milk, much like a kitten.
Breast or bottle feeds
Once your baby can coordinate swallowing and breathing while sucking and can maintain an awake state, she will be ready to start having breast or bottle feeds. This usually happens from around 28 weeks (gestational age) although many premature babies only manage this after 32 weeks. Breast milk is essential for premature babies as it protects their digestive tract in a way that formula cannot. If you are finding breastfeeding a challenge, get help from a lactation consultant. If you would prefer to bottle feed and cannot express, it is worth getting breast milk from a breast milk bank for the premature period so that your newborn has the benefit of the protective and nutrient qualities of breast milk.
Is my baby ready to feed?
It is important to wait until your baby is ready to start feeding by sucking. Your team will guide you on when to start but here are a few guidelines:
- Your baby must be medically well and stable
- Her heart rate and breathing will be regular and stable
- Your baby can maintain the calm alert state for long enough to feed
- She has started licking and mouthing movements of her tongue