How to breastfeed your preemie

Breastfeeding your preemie can be challenging at first – but practice makes perfect! Probably the most profound initial challenge is the emotional cocktail of anxiety at having a baby in a neonatal unit, and feelings of failure about not having carried to term. In addition to the emotional stress, you might need help to breastfeed as well.

Getting breastfeeding established

You don’t need to carry your baby to term to lactate – your breasts are physically capable of producing milk from about 20 weeks into your pregnancy, and the delivery of your placenta is their ultimate cue to begin. Furthermore, oxytocin, also known as the love hormone, and prolactin, are the two hormones you need coursing through your body to produce milk. The good news is that there’s a lot you can do to help your body produce oxytocin.

Louise Goosen, an International Board Certified Lactation Consultant (IBCLC) and the chairperson of Milk Matters, suggests the following:

• As soon as possible, reunite with your baby. Seeing her will spark the production of oxytocin.
• Even better is touch and skin-to-skin (Kangaroo Mother Care) contact. This will further enhance the production of oxytocin and prolactin.
• Now, make yourself comfortable, and if possible, position yourself close to your baby. If this isn’t possible, look at a photo of your baby.
• Have a cup of tea at hand.
• Place a warm cloth over your breast.
• Let yourself relax and feel love towards your baby.

How to express

• You’re now ready to begin expressing – a process that is ideally initiated within hours after your baby is born if you are physically capable. But if that’s not possible, it’s never too late to begin – simply keep expressing and stimulating your breasts.
• To do this, start by gently massaging your breast generally, and then after a few minutes, place your forefinger and thumb on opposite sides of your breast. Your thumb should rest a couple of centimetres away from the areola at 12 o’clock. Meanwhile, your index finger (with the other three fingers) should rest at 6 o’clock.
• Begin to squeeze your fingers together to palpate the knobbly breast tissue, and then roll them forward towards the areola. Imagine that you’re squeezing toothpaste out of the tube. This process should not be painful.
• Once you’ve reached the nipple, release the pressure from your fingers and roll them back to the first position. Squeeze your fingers together again and roll forwards, repeating as a rhythmic massage action, explains Louise.

Get a rhythm: It’s important to get a rhythm to the movement of your fingers, as this is how a baby suckles. Let this rhythm be your focus rather than trying to squeeze harder. Also, express regularly at short intervals rather than for long periods at a time. It’s helpful to have someone to hold a teaspoon, syringe or tiny cup to catch the drops of milk. Alternatively, hold your container at the nipple edge with your other hand. When the flow of drops slows down, you need to change your hand position so that your thumb and index finger are positioned at three o’clock and nine o’clock.

Switch breasts: Once the production of colostrum seems to slow down – and this may be no longer than 10 minutes into the process – then switch to the other breast. If you’re really struggling to express even a few drops, you can try using a breast pump to stimulate the breast. Don’t get discouraged, though. The technique takes time and patience to master.

Supply: Your supply is triggered by demand. Initially, aim to express every two hours in the day, and every three hours at night. Eventually, you can try 12 times a day (no less than eight). If you do experience a drop in supply, express more regularly. Doing Kangaroo Mother Care and putting your baby to the breast, even if she can’t suckle, will boost supply.

Getting your preemie to latch: When your baby is physically able to be placed at your breast, allow her to access it without expecting a latch. As preemies, they get tired quickly, so take it slow.

Best positions to get your preemie to latch:

• Tummy-to-tummy: Hold her close to your body, with her tummy facing yours
• Position: Ensure that her ear, shoulder, and hip are in line so that her neck isn’t twisted, bent forward, or too far back
• Shoulder support: Support her at the neck and shoulders with your forearm and/or hand, taking care not to put pressure behind her head
• Face the breast to her nose: Allow her to point her nose to your nipple
• Pain-free: There should be no nipple pain
• Swallowing: You should hear your baby swallowing