If your baby is between 3 - 5 weeks early, you may be able to breastfeed right away. Any earlier and your baby may be unable to nurse for a while yet, but you can pump milk in the meantime. A lot of premature babies (3 - 5 weeks early) tend to be really sleepy, so they may not be to enthusiastic when it comes to nursing. As mentioned in the Keeping Your Milk Supply Up post, on the 3rd day after birth, pump for 5 minutes on each breast right after each daytime and evening nursing. This should help keep your milk supply up (a sluggish eater may not be nursing enough which can have a bad effect on your milk production). The most common cause of a decreasing milk supply is pumping less than 8 times in 24 hours.
Expressing Milk:
- An automatic breast pump will be the best to use (I strongly recommend Medela).
- Start pumping shortly after delivery.
- Remember, your supply of milk depends on your frequent stimulation of your breasts.
- Pump at least 8 times in 24 hours, or more, depending on how often your baby would be hungry. You may be recommended to pump every 3 - 4 hours during the day and then sleep at night, but this may limit your supply (you may find it starting to dwindle). Figure out what works best for you, but be sure to get in at least those 8 pumpings. Ideally, you should try to pump more milk than your baby needs.
- Until your milk comes in (because at first all you'll get is colostrum), pump for 5 minutes on one breast, 5 minutes on the other, then return to the first breast and pump for a few more minutes, and repeat on the other side (so, maybe 15 - 20 minutes total).
- After your milk comes in, pump each breast until the flow starts to slow down. Return to each side for a few minutes. The whole process should take around 20 - 30 minutes. If you're using a double pump, it should take 10 - 15 minutes.
- You may want to try gently massaging each breast for a minute or two before you begin pumping and then while you are pumping, to help the let down.
- If you will be pumping for longer than 2 weeks be sure you are getting enough food, liquid, and rest.
- Keeping a picture next to you while you are pumping or even holding the baby while you are pumping can help get your supply going.
- You can keep your milk in the refrigerator for 24 - 48 hours or freeze it for up to 3 months.
Some premature babies need extra nutrients (like calcium and phosphorus) in addition to breast milk.
- Use a commercially prepared fortifier and mix it with the breast milk.
- Some babies need a more concentrated form of calories. You can collect your hind milk and give this to your baby. To do this, pump for about 2 minutes after your milk lets down, then stop pumping and seal up that bottle - this will be your foremilk. Continue pumping in another container to empty your breast of the rest of the milk - this will be your hind milk. Label your bottles. Give the hind milk and freeze your foremilk. Feeding this for a week or two can help your premature baby gain weight.
Eventually your baby might be able to try breastfeeding. The results will vary greatly from baby to baby and you'll probably need some initial guidance. During the first sessions, you'll want to make sure your baby is nice and alert and that your breast isn't too full. Undressing your baby and laying him/her against your skin will keep him/her warm. You can lay a blanket over your baby and your shoulder to limit the heat loss. The cross-over hold and the football hold seem to work the best for premature infants. Patience will be the key. The best way to determine if your baby is getting enough to eat is to keep a careful eye on the baby's weight. Until your baby is maintaining a good weight, you'll want to continue to pump and give supplemental feedings.
(Some information gathered from The Nursing Mother's Companion 4th revised edition by Kathleen Huggins, R.N., M.S.)
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