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Kangaroo Care
By Robin H. Steinhorn, MD
Robin H. Steinhorn, MDQ. I'd like to eventually breastfeed my premature baby. What obstacles might I face, and what can I do to try and establish a nursing relationship?

A. Breastfeeding has many unique advantages for premature babies and their mothers. There is substantial research demonstrating that mother's milk may provide extra protection from infection and other problems (particularly serious intestinal problems) that are especially common among premature babies. Even small amounts of mother's milk in the early days or weeks after birth is likely to provide your premature baby with health benefits that last through later infancy and childhood.

It will definitely take more time, patience and equipment to breastfeed your premature baby, especially during the baby's hospital stay and the early weeks at home. However, virtually every mother in my practice feels that the rewards far outweigh the extra effort.

Most premature babies born before 34 weeks are not ready to feed at the breast immediately after birth. However, you still need to initiate the breastfeeding process shortly after delivery. To accomplish this, you will need to use a breast pump. Be sure to use a medical grade electrical breast pump, and preferably one that allows you to pump both breasts at the same time. The right kind of pump will be available in the hospital, and you can rent an electric breast pump to use at home. Hospital-grade electric pumps are available for rental from hospitals, pharmacies, medical supply companies, and breastfeeding specialists throughout the United States. Since your baby was born prematurely, the costs of the pump rental are often be covered by insurance. Be sure to ask your nurse or lactation consultant for help in using and renting the pump, and in properly storing your milk.

You may find that after several weeks of pumping, your milk supply begins to decrease. Be sure to talk to your physician or the lactation consultant if this happens. Sometimes increased rest, fluid intake, or food intake is needed. There is also medication that can be prescribed by your obstetrician that may help restore your milk supply.

Some premature babies do not gain weight quickly enough when fed with breast milk. Most babies born before 32 weeks will need additional calories. These calories are often provided in the form of a fortifier that is made especially for preemies, and is mixed with mother's milk. You may also be asked to separate out your hindmilk: this is the milk that flows near the end of the feeding or pumping that is richer in fat and calories than the milk that flows earlier in the feeding.

Later on, you will face the challenge of teaching your baby to breastfeed. Learning to latch on and nurse can be difficult for any baby, but may be especially challenging for your premature baby. Remember that most premature babies don't develop the suck-swallow-breathe reflex that is critical for feeding until 32 weeks gestation, and many develop this milestone even later. Be sure to have an experienced nurse or lactation consultant help you at first. Successful nursing often requires patience and persistence.

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You should plan to keep the rental pump until your baby has been home for at least 2 to 3 weeks. This is because a premature baby's suck may not be strong enough to remove all of the milk from the breasts at the time of hospital discharge. If this milk is not removed, your body gets the message that some of it isn't needed, and your breasts will produce less milk than before. Using a breast pump several times a day, even after you bring your baby home, will stimulate your breasts to make plenty of milk to meet your premature baby's needs.

In addition, your premature baby needs lots of milk as he or she is recovering. Often supplementing with a bottle is necessary for several weeks before and after discharge from the hospital to make sure that there is adequate intake of calories. Be sure to talk with your pediatrician about the frequency of weight checks recommended during this transition period.

Nearly all mothers of premature babies have times when they feel discouraged with the progress of breastfeeding - especially during milk expression and when beginning breastfeeding in the hospital. Stay positive and remember that you are making an investment of time and energy that will pay rich rewards for many months to come. Once you and your baby get past these milestones, both of you can enjoy the unique benefits that breastfeeding provides for weeks and months to come.

Recommended reading includes Breastfeeding the Pre-Term Infant by Marsha Walker.

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