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Sunday, March 9, 2014
Breastfeeding My Premie
Can I breastfeed my premature infant? My daughter was born 2 weeks ago at 31 weeks. She is still in the NICU. I have been trying to breastfeed her now for the past 4 days. I live 40 minutes away, so can only visit her once per day. Everytime I try to breastfeed her, she sucks for less than 5 minutes on one breast and then falls asleep. The nurses tell me that is normal, but I am concerned that it is too much work for her and it could cause her damage. Should I just keep pumping and not continue to try to breastfeed her until she comes home and is stronger? They hope she can come home in about 10-14 days. Thank you.
Thank you for your question. First of all, congratulations on the birth of your daughter. Having a premature baby at 31 weeks gestation can be very stressful but from what you have said she seems to be making good progress. It sounds as if your daughter is behaving `typically` for a baby at 33 weeks who still is needing some extra oxygen. In fact, sucking for 5 minutes is quite an accomplishment for her--some infants will just want to nuzzle and lick the breast during these early feedings so the fact that she is latching on and sucking is very good. I assume she is still receiving your breast milk through the tube into her stomach and she may need this for a few more weeks. The purpose of the early breastfeedings are for her (and you) to get used to latching and learning to stay latched on while sucking. Once she can do this you will get evidence that she is transfering milk--either by the nurses test-weighing her before and after feedings (the most accurate way of knowing) or by you feeling your milk `let-down` and seeing some milk in her mouth. While it is common that most premature infants don`t accomplish full breastfeeding until after they go home and are close to their due date, I would encourage you to keep breastfeeding her whenever you visit so that she gets used to it. If the nurses can hold off offering bottles until she is accomplished at brestfeeding that would be best, but there is no good evidence that getting a bottle will necessarily interfere with long term breastfeeding. The fact that she is learning breastfeeding first will help a great deal. It is common for people to think that breastfeeding is more work for the premature infant but all of the research that has been done has shown that premature infants breath more and maintain their oxygen levels better during breastfeeding when compared to bottle feeding. The main differences between the two feeding methods are that milk is immediately available to the baby during bottle feeding (instant reward!) and that the baby uses different sucking mechanisms to get milk during breastfeeding. Some infants do like the instant reward of bottle feeding and get upset when switched back and forth between the two methods, while other infants don`t seem to mind. You will get to know something about your daughters personality as she progresses in learning to feed orally. I do have some suggestions for you-first--keep pumping at least 6-8 times a day. We know how difficult this can be but it will help you maintain your milk supply which is essential. Next, find out if there are any lactation consultants available in your NICU. They can help with suggestions as to how to help your daughter be successful at transfering milk and prove support to you once she goes home. The best time to breastfeed her is when she is hungry and she will show better hunger behaviors as she gets older. If you can room in before discharge you can start breastfeeding her when she is hungry rather than on a fixed scedule, but with some rules--the nurses and doctors will tell you how often (usually at least 6-8 times a day) and how much she should be getting. They will help you know how to supplement your breastfeeding--she may not need supplementation at some feedings but will certainly need some in the first weeks at home and it will be necessary for you to continue pumping during that time. There are scales designed for mothers to use at home to determine intake during breastfeeding and the lactation consultants can help you get one if you wish--researchers have found that when mothers use test weighing at home and have guidelines for how much milk their baby needs in a 24 hour period, they are able to manage the supplementation of breastfeeding very well. Of course you will need to stay in contact with you pediatrician to make sure that your daughter`s weight gain is adequate. Breastfeeding a premature infant takes a special committment on the part of the mother--it may be a few weeks before you see progress but persistence--along with the supports I`ve mentioned--should have a positive outcome--what is most important is that you feel good about your ability to care for your daughter. I wish you good luck.
Donna Dowling, PhD,RN
Associate Professor of Nursing
Frances Payne Bolton School of Nursing
Case Western Reserve University