Breastfeeding your premature baby

Be encouraged. With perseverance, knowledge and help, you and your premmie baby will soon learn all the breastfeeding skills you need.

Breastmilk is important for premmie babies

Breastmilk is the normal and natural food for any baby and promotes normal growth and development. It is especially important for premature babies as all their body systems are immature.

Breastmilk is important for premature babies for many reasons:

Compared to the breastmilk of mums with term babies, the milk of mums with premature babies is higher in sodium, chloride, protein and fat. It also has many immune factors that provide protection for these tiny babies.
Breastmilk is easy to digest, so babies can get the food they need without using a lot of energy. There is little waste with breastmilk so your baby's immature kidneys won't be stressed.
Breastmilk is full of live cells and immune factors that protect them from infections.
Premature babies who are formula fed and don’t receive breastmilk are more likely to get a life-threatening bowel condition called necrotising enterocolitis or NEC.
Growth factors in breastmilk may also help the lining of your baby’s intestines to mature more quickly. The first milk you make, in very small amounts, is called colostrum. It is a very concentrated source of growth factors, immune factors and important nutrients.
Even the tiniest amounts of breastmilk contain very concentrated amounts of nutrients and immune components, so even if you can only produce a trickle of breastmilk, your baby still benefits.

Breastfeeding is recommended by your baby's medical team

In most neonatal intensive care units and special care nurseries, staff are aware of the importance of breastmilk. They will encourage you to provide your own milk for your baby. This is because the medical research into the health and survival of a premature baby is showing that, as for all babies, breastmilk is vital.

Providing your breastmilk is a positive way that you can be involved in your baby's care. Breastmilk is so important for premature babies that some hospitals have human milk banks. This makes sure that our most at-risk infants receive donor human milk as the next best thing after their mother's milk. If you can’t breastfeed or express, ask if your hospital has a milk bank.

Skin-to-skin contact helps your baby by:

saving energy because baby cries less and sleeps more
helping to keep baby's body temperature, breathing and heart rate steady
increasing your expressed breastmilk supply by an average of 50%.
improving baby’s suckling ability, because of the stimulation of being near your breasts
increasing bonding between you and your baby and making you feel more confident caring for your baby.

If your baby's hospital doesn’t use this method of care, perhaps speak with the staff, and arrange to at least hold your baby more often once their condition is stable enough. You, your baby and your milk supply will all benefit if you can have as much skin-to-skin contact with your premature baby as possible.

Breastfeeding is less stressful for premature babies than bottle-feeding. Even a very small baby can cope with long periods at the breast without distress. They stay warm, and the oxygen levels in their blood remain normal during and after feeds.

A premature baby at the breast has long periods of interaction with their mother, including touching and eye-to-eye contact. During this time there are periods of sucking and resting.

This means your baby should have as much time as they need for a breastfeed, unless there is a medical problem that prevents feeding for long.

Start expressing as soon as possible after the birth of your baby.
Help your baby get used to the idea by holding them in the breastfeeding position, while you tube-feed them. You can also place a cottonwool ball soaked in your breastmilk into baby's isolette so they get to know the smell of your milk, particularly when being tube-fed.
Try out different positions at the breast, always making sure your baby is attached properly. Your baby may feed well in the twin position, that is, tucked under your arm with their body supported by a pillow.
You may be able to start your milk flow before putting your baby to the breast. Try stroking towards the nipple, hand expressing or briefly putting a warm cloth on your breast. This will make it easier for your baby and may help them get more milk.
When you first start, your baby may only suck for short times and may not be very effective. As they grow and become stronger, they will take more and breastfeed for longer.

If your baby can't breastfeed yet

Your expressed breastmilk can be given to your baby in various ways. Some babies will be tube-fed. Others can be taught to suck using a lactation aid or using finger feeding. Some will be fed by cup. Talk with hospital staff about your options.

Your feelings

It may feel a bit unreal at first - suddenly your life seems out of control and you may not feel ready for the arrival of your baby. Everything you imagined for your pregnancy, birth and your newborn baby is different. You may not have had time to even look or feel pregnant. Instead of cuddling and breastfeeding your newborn baby, you may have to wait hours even to see them.

You may also be recovering from surgery or the results of a stressful birth. You may be extremely worried about their survival and separated from your baby. Perhaps you have no idea of where the special care nursery is, or your baby may even be in another hospital.

You may also find it hard to be on the same ward or in the same room as other mothers with their full-term babies. You may experience feelings of shock, disappointment, guilt, grief or even anger.

Many mums are discharged from hospital before their baby is ready to go home, and this can be very stressful, especially if the hospital is not near home.

One mum's memory of that time

All the time my baby was in hospital I didn't feel part of reality. I was expected to carry on life as if it was normal but all the time I was away from the hospital, there was a part of me in the special care nursery with my baby.

Home at last

After perhaps weeks of expressing and visiting the hospital to see, hold and feed your baby, you are finally home as a family. Your joy may be mixed with feelings of apprehension. You and your baby are faced with a whole new pattern of being together.

Take time to relax and concentrate on helping your baby adjust to this new environment. You will need to breastfeed your baby for as long and as often as they need so your supply will adjust to meet your baby's needs. Ensure you get lots of rest and accept all offers of help with household tasks.

ABA hires electric breast pumps (with ongoing counsellor support if required). This can be useful if your baby is not yet taking all feeds at the breast and you still need to express.

It can also be a great help to keep in contact with other parents of premature babies. Support groups especially for the families of premature babies are often in major cities, and online.

Your local ABA group can also be a source of information, support and encouragement. Many of our counsellors, community educators and members have children who were born prematurely and are happy to support, encourage and share their own experiences with other parents.

The information on this website does not replace advice from your health care provider.

References

Baley, J., & Committee on Fetus and Newborn. (2015). Skin-to-skin care for term and preterm infants in the neonatal ICU. Pediatrics, 136(3), 596–599.

Bergman, N. J., Linley, L. L., & Fawcus, S. R. (2004). Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns. Acta Paediatrica, 93(6), 779–785.

Jurek, B., & Neumann, I. D. (2018). The oxytocin receptor: From intracellular signaling to behavior. Physiological Reviews, 98(3), 1805–1908.

Kennell, J., & McGrath, S. (2005). Starting the process of mother–infant bonding. Acta Paediatrica, 94(6), 775–777.

Noble, L. M., Okogbule-Wonodi, A. C., & Young, M. A. (2018). ABM Clinical Protocol #12: Transitioning the breastfeeding preterm infant from the neonatal intensive care unit to home, Revised 2018. Breastfeeding Medicine, 13(4), 230–236.

Wang, Y., Zhao, T., Zhang, Y., Li, S., & Cong, X. (2021). Positive effects of kangaroo mother care on longterm breastfeeding rates, growth, and neurodevelopment in preterm infants. Breastfeeding Medicine, 16(4), 282–291.

WHO Immediate KMC Study Group, Arya, S., Naburi, H., Kawaza, K., Newton, S., Anyabolu, C. H., Bergman, N., Rao, S. P. N., Mittal, P., Assenga, E., Gadama, L., Larsen-Reindorf, R., Kuti, O., Linnér, A., Yoshida, S., Chopra, N., Ngarina, M., Msusa, A. T., Boakye-Yiadom, A., Kuti, B. P., … Massawe, A. (2021). Immediate "kangaroo mother care" and survival of infants with low birth weight. The New England Journal of Medicine, 384(21), 2028–2038.

World Health Organization. (2022). WHO recommendations for care of the preterm or low birth weight infant. https://www.who.int/publications/i/item/9789240058262

Expressing for your newborn

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Breastfeeding your premature baby

Be encouraged. With perseverance, knowledge and help, you and your premmie baby will soon learn all the breastfeeding skills you need.

Breastmilk is important for premmie babies