Are you a mom who is breastfeeding late preterm baby? If yes, this is the right article for you.
First let’s define a late preterm baby. According to studies, it is a baby born between 34 and 36 weeks of pregnancy.
They may appear larger and more full-term than premature babies. However late preterm babies may still be born with health issues that needs special care. At birth, their brain, lungs, nervous system and muscles are still developing. And this may greatly affect their ability to breastfeed.
Most often than not, they are confined in the Neonatal Intensive Care Unit (NICU) or Special Care Nursery after being born.
Here are other characteristics of a late preterm baby:
- Frequently sleepy and have fewer and shorter awake periods
- Sucking ability is still weak that makes it more difficult to breastfeed
- Has also difficulties to coordinate swallowing and breathing
- Does not always show feeding cues
- Can sleep long period without feeding
- Easily becomes tired and has tendency to fall asleep while feeding, which may not mean they are full
Yes, breastfeeding late preterm baby is possible when they are born, but there are moms still who needs assistance to do it.
If your newborn is a late preterm baby, here are some information on how to manage breastfeeding with their condition.
You may read first our Breastfeeding 101 module for the basics of breastfeeding, then continue with this Breastfeeding late preterm baby article to know more about it.
How important is breastfeeding for my late preterm baby?
For the first six months, breastmilk can be your baby’s main source of food.
More so for late preterm babies. Breastmilk is very important for their delicate condition. Breastfeeding aids their growth and brain development, including their special needs. It also helps in forming their antibodies to fight infection.
Breastfeeding is a good option. In doing so, your baby will be able to get Colostrum from your breastmilk.
It is the first milk you produce after a few days you gave birth, which is yellow-colored and nutrient-rich that can boost your baby’s immune system.
Breastfed babies have lower risk of the following:
- Getting illnesses like asthma, allergies, ear infections, respiratory illnesses, diarrhea and diabetes
- Abnormal weight gain
- SIDS (sudden infant death syndrome) and malnutrition
New mothers also benefit from doing breastfeeding.
- Helps reduce postpartum bleeding
- Lowers risk of getting breast and ovarian cancer, and osteoporosis
- Aids in burning extra calories from pregnancy weight
- Promotes mother-and-child bonding
- Practical and convenient
- Works as a natural contraceptive. Breastfeeding would delay your menstrual period.
What can I do while waiting for breastfeeding my late preterm baby?
While you are still waiting for your baby to learn how to breastfeed, you must to do frequent skin-to skin or Kangaroo care.
Here is how to do it:
- Let your baby lie down in an upright position on top of your bare chest and tummy
- The baby’s arms and hands must not be tucked under and the baby’s head must be sideways to allow breathing
- Your skin must touch your baby’s skin as much as possible
- Then ask to for a blanket to cover you both
- Do this for 60 minutes or more and as many times as you can
Benefits of skin-to skin or Kangaroo care are the following:
- Makes your baby feel calm, relaxed and warmer
- Helps your baby to breathe properly while getting ready for the first breastfeeding experience
- Aids in stabilizing your baby’s heart rate
- Gives your baby comfort
- Promotes bonding
- Can improve your milk supply
- Helps you develop special immunity against germs found in the NICU. This is then passed to your baby through your breast milk that can protect your baby from infection
In some studies doing skin-to skin or Kangaroo care has said to have helped in decreasing the dependency of late preterm babies in NICU or Special Care Nursery.
Note that your partner may also do skin-to skin or Kangaroo care to your baby.
Aside from skin-to skin or Kangaroo care, you may also ask your doctor about non-nutritive sucking.
It is when your baby sucks without receiving nutrition. Most babies do this when they feel the urge latch.
Benefits of non-nutritive sucking:
- It may help your baby learn how to coordinate sucking and breathing
- Stimulate stomach to improve digestion
- Soothes your baby especially when undergoing tests and procedures
- Produces a calming effect
- Good preparation for breastfeeding
If your baby experience this, you can offer your breast and let your baby feel it .
You can also do this right after you have expressed your milk. Other methods of non-nutritive sucking include using your finger or a pacifier, but make sure you speak to your doctor in using pacifiers.
How can I produce milk in breastfeeding my late preterm baby?
When you were pregnant, your body has been preparing for producing milk for breastfeeding.
Prolactin and Oxytocin are the hormones involved in breastfeeding.
Prolactin is the one responsible for milk production. To increase your Prolactin, you may do the following:
- Breastfeed your baby frequently
- Stimulate your breast either by breastfeeding, hand expressing or pumping 8 times within 24 hours
Oxytocin helps in the let-down process or the releasing your milk from your breast.
It is formed when you breastfeed, hand express or pump. When you let-down your milk, you may experience the following:
- Tingling in your breast
- Milk leaking from one or both breasts
- Feel contractions or cramps
Another way to release your breastmilk is by doing reverse pressure softening. Here are the steps:
- place your fingers lightly on each side of your areola
- push it towards your ribs then hold for a minute
- rotate the position of your fingers then repeat
Reverse pressure softening will help soften your areola for better latching of your baby.
Hand- expressing or pumping you milk for your preterm baby
While your baby is not yet ready to breastfeed, you can either hand express or pump your milk.
It’s ok to do it as often as you can because your baby should feed at least 8 times or more within 24 hours.
Here is a step-by-step guide to hand express your milk:
- Wash your hands properly
- Go to a spot where you a comfortable and relaxed
- Do a soft massage on your breast, from the chest wall going to your nipple
- You may also try putting a warm towel on your breast for a few minutes
- Using your one hand, place your fingers in a compressing position, with your thumb and fingers opposite at each other
- Gently press your breast inwards going to your chest
- Compress your breast softly, but avoid rubbing the skin
- Pause to relax your fingers than repeat. Remember not to squeeze the base your nipple as it could stop the milk flow and cause your breast to sore
- Continue until your milk is no longer flowing
- Moving your fingers around your breast will help you to express from your whole breast
- You can switch hands and hand express with both breasts
- If in case you cannot feed your baby directly from your breast, you may collect the milk using a small spoon or cup
You may also use breast pump to release milk from your breasts.
Ask assistance from a NICU personnel as to where you can avail of a hospital-grade pump.
There commercially sold breast pumps, however it is advisable to seek for doctor’s advice before getting one.
Below are some tips when pumping breastmilk:
- Wash your hands with soap and water or use antiseptic to clean your hands
- You should pump in a comfortable place
- Pump and/or hand express 8 times or more within 24 hours
- Massage your breasts prior and while pumping
- You may use warm compress
- Pump at least once at night as Prolactin levels are at its highest at night
- You must have at least 4 hours of sleep when pumping at night
- Do a hand express after pumping to release excess milk
- Try doing “hands-on pumping” technique by massaging and compressing your breast while pumping
- Do double pumping or pumping your two breasts at the same time. Use two pumping kits at around 15 minutes. Ask assistance from the hospital to do this.
- Clean your pump after use and store it in a clean and dry place
- Make a milk supply journal to monitor how many times you expressed milk
Your milk supply will increase when you frequently express your milk.
If you experience any issues with your breast or your body while breastfeeding, you may refer to “What issues would I encounter during Breastfeeding?” in our Breastfeeding 101 module.
You need to store your pumped breastmilk properly. Here are some guidelines on how to store your breastmilk while in the hospital:
- Ask your hospital on their storage time
- You must only use sterile containers recommended by the hospital
- Always clearly label your containers as instructed. Don’t forget to include your baby’s name, and time your breastmilk was collected.
- Put your expressed milk in the fridge right after pumping. For those that will not be consumed yet within 24-28 hrs., it must be placed in a freezer.
- Use a new container for each pumped breastmilk. Do not mix your newly pumped milk with an old one.
Your breastmilk must be delivered to NICU as soon as possible. Use a clean bag or an insulated cooler or container with a freezer pack.
Will my baby learn to breastfeed?
For late preterm babies, learning to breastfeed would be a learning process.
It would require you to stay with your baby as often as possible to support him/her as our baby would go through different stages before he/she can fully breastfeed.
Doing skin-to-skin or Kangaroo care is the first step to encourage breastfeeding behavior.
While doing this, you must observe if your baby is already showing feeding cues or signs of hunger.
If yes, you may introduce your breast little by little by letting your baby’s mouth feel your breasts.
You can also express a few drops of breastmilk and rub it on your baby’s lips to help your baby be familiar with the smell and taste of your milk.
At a certain point, your baby will be able to latch on your breast.
He/She can now suck and swallow your milk. It is advisable then to express your milk quickly before breastfeeding your baby because your milk may have a sudden flow that could overwhelm your baby.
The frequency of your breastfeeding sessions with your baby will eventually increase until you reach the stage of exclusive breastfeeding.
If you’re considering bottle feeding, make sure you are informed of the risks and how it can affect breastfeeding.
Consult your physician before doing bottle-feeding.
How can my baby still get milk even if he/she is not yet ready to breastfeed?
There are different supplemental feeding methods on how your breastmilk can be fed to your baby. However, it is important that you and your doctor discuss before deciding.
Your baby’s safety is the top priority before deciding what the suitable method is for your late preterm baby.
Here the supplemental feeding methods you may consider:
- Sipping through a small cup. Remember, you should follow your baby’s sipping rhythm and avoid pouring the milk into your baby’s mouth
- Using a dropper, syringe or spoon to give few drops of breastmilk
- Finger feeding – a feeding tube connected to a container with breastmilk will be attached to your finger. Your baby will suck your finger and the milk will flow through the tube
- Naso-gastric or oro-gastric tube – a tube that will be placed in your baby’s nose (naso-gastric tube) or mouth (oro-gastric tube) that will go into his/her stomach
- Lactation aid – when your baby breastfeeds, a tube connected to a container with breastmilk will go into your baby’s mouth with your nipple. In this way your baby feeds both from your breast and the breastmilk from the container
- Nipple shields – a flexible silicone nipple that can be attached to your nipple. It can make suction easier for your baby.
- Donor milk from milk banks that store pasteurized donor breast milk. You don’t have to worry about the quality of milk from milk banks as the donors were screened properly. Ask the hospital on their procedure on how you can get donor milks.
Things to do when your baby is out of NICU
When it’s time for your baby to be discharged from NICU since he/she no longer need specialized care, you must prepare yourself since this may be a stressful time for both of you.
Coordinate with your doctor on how you can cope with the new arrangement.
If transferring to a regular room, it would be better if you continue to stay with him/her day and night.
Talk to the new staff in charge to let them know that you would want to be involved in taking care of your baby.
Inform them of your baby’s feeding sessions and that you will do skin-to-skin or Kangaroo care for prolonged period.
Finally, if your baby is allowed to go home with you, the hospital will surely advise you of a feeding plan that you should strictly follow for your baby to breastfeed successfully.
You may need to continue hand expressing or using pumps to release milk at home. Below are additional tips on how to store your expressed milk properly:
- Use clean containers that are BPA free as much as possible.
- Shelf life of breastmilk may vary on how it is stored
– room temperature : 3 to 4 hours (fresh milk); 1 to 2 hours (chilled milk)
– bowl of cold water at room temperature: 10 to 12 hours
– icebox or cooler : 24 to 28 hours
– refrigerator: 3 to 5 days
– freezer ( 2-door refrigerator): 3 to 6 months
– chest freezer: up to 12 months
- Put label indicating the date and time you collected the milk
- Try to collect the quantity your baby can only consume
- Refrigerate breastmilk immediately after expressing. For the excess milk, put it in the freezer
- Place the milk in the coldest part of the freezer or ref. If storing in an ice box, make sure the ice is in contact with the milk
- Do not re-thaw or re-freeze breastmilk
- Never add warm milk to frozen milk. Only chilled milk can be added to frozen milk
- Thaw frozen breastmilk inside the fridge or under a running warm water
- Do not microwave frozen milk
You must also ensure that the pumps you are using are well-kept.
Use hot water to wash it and make sure it is rinsed well.
Follow the manufacture’s instruction on how to sterilize your pumps. Always use a clean towel to wipe and store in a clean storage.