Breastfeeding Premature Babies: Nursing & Pumping Guidelines

Preemie babies born between 34 and 38 weeks (referred to as late preterm babies) require a totally different approach to getting a good start with breastfeeding. Moms wanting to exclusively breastfeed their preterm newborn will need to do a little extra work to make it happen, but if you follow these feeding and pumping guidelines in this article, you’ll have a much better chance at success!

These tips were well researched and are backed by lactation experts. This is a condensed version of multiple different expert sources.

Feeding Challenges in the Late Preterm Baby

When babies make it to full gestation (38-40 weeks), they are ready and eager to start suckling on Mommy’s breast. They use their own hunger cues and nurse until they are full. Late preterm babies differ in this way since they haven’t quite developed all of those sensory and cognitive mechanisms. For this reason Mom will need to carefully track the time between feedings, wake up her baby for breastfeeding sessions, as well as use a breast pump to stimulate her milk production.

Late preterm babies, who would still be napping ’round the clock in the womb, tend to fall asleep very easily. For that reason, they may not wake as frequently for feedings, nor empty a breast or eat to their fill. Lactation experts usually recommend pumping additional breast milk after each feeding and trying to get baby to drink that milk from a bottle as well.

As I always say, your milk supply depends heavily on what I call, the demand-and-supply system. The more you nurse your baby or use your breast pump, the more milk your body will produce. So rule number one for moms who have just given birth to a premature baby is to start pumping now!

Pumping Tips & Facts

Now that you’re pumping frequently (about 8-12 times each day), you’ll be getting an idea of how much milk you’re producing. Don’t get discouraged if you’re barely producing anything for the first few weeks! It takes around two weeks for a mother’s milk to reach a healthy supply, and that’s if she is able to breastfeed her baby every 2-3 hours. For premature babies, especially those in the NICU, feedings can be a challenge. Between latch troubles, sluggishness and any health concerns, the amount of time it takes a Mom to produce milk will vary. But rest assured, even if it takes a tad bit longer, you will build a milk supply and your supply will in time level out to meet your baby’s nutritional needs.

Pumping is much less effective at getting breast milk than the sucking action of a baby, so you may be pumping half an ounce but baby might actually be able to pull double that! With both of my own, there were times I barely pumped anything, even though my baby certainly seemed to be getting much more. Remember that your pumping in this time period is mainly meant to communicate to your body that baby is still breastfeeding and to keep producing milk.

Again, if your preemie baby is breastfeeding every 2-3 hours, then you should only need to pump after each session, just for a few extra minutes. If your little one isn’t quite nursing that frequently, then make sure you pump every 2-3 hours, for 5-10 minutes longer than baby would (somewhere around 20-30 minutes total).

Breastfeeding late preterm baby

Why Breast Milk is Better for the Premature Baby

Dr. Mizuno, a pediatrician who has done extensive research on breastfeeding and breast milk’s benefits for premature babies, encourages Moms and health professionals to make breastfeeding a priority for late preterm babies.

His findings, and others, have proven that a Mother’s breast milk alone can provide the critical immunoglobulins, DHA, digestive enzymes and antibodies that preemies need, but formulas lack. And that premature babies who are breastfed tend to be discharged from the hospital quicker than those who are formula fed. Furthermore, preemies who are given breast milk are 19% less like to develop sepsis.

Knowing these facts can help you stay motivated and dedicated to breastfeeding your preemie.

The Truth About Weighted Feedings

In some cases, health or lactation professionals will suggest weighted feedings to check that your preemie is getting enough milk. The idea of weighted feedings is to check baby’s weight before a breastfeeding session and then again afterward in order to assess how effective baby is at eating breast milk. This way of monitoring a baby’s intake, however, is not to be heavily relied on, according to medical researchers. I’ve gone into further detail on this topic and the accuracy (or lack of) of weighted feedings as found in medical studies in this post.

But weighing your premature baby at home simply to track weekly growth is highly useful! Check out that same post just mentioned for details about baby weight gain standards and how to track newborn weight gain.

More tips for Breastfeeding Preemie Babies

Ultimately, if your late preterm baby is struggling to breastfeed or you’re concerned about your ability to produce milk, it really comes down to demand. As long as your nursing or pumping every few hours, and even pumping after each nursing session, your body will produce milk.

And for preemies who struggle to get a good latch, experts say just let them keep practicing. It will take plenty of nursing sessions to build muscle tone of the lips, jaws and tongue, but he’ll get there. In some cases, giving breast milk in other ways, such as spoon feeding or tube feeding may be a good call. Certainly discuss all options with your baby’s pediatrician.

According to lactation consultants at La Leche League GB, Moms and babies have an easier time breastfeeding when they are belly to belly. They refer to this as the layed back nursing style and say this helps a preterm baby stay latched more easily.

Based on stories other Moms have shared, it’s an uphill battle to establish good breastfeeding routines with a premature baby. But, they encourage fellow breastfeeding warriors to keep at it! Keep offering the breast at every cue. And, as hard as it might be, don’t allow stress and negative emotions to come into your nursing sessions. Be as positive, warm and welcoming as you can and your baby will mirror that and find a groove that works for him.

A lot of my readers have found success when they take a Lying-In Period. This is a period of time dedicated solely to establishing or reestablishing a breast milk supply. Give it a try!

Unfortunately, the pressures and struggles of breastfeeding a late preterm baby make it so much harder to succeed. And it’s not uncommon at all for breastfeeding to quickly end before it even begins. But have no fear! You can breastfeed again one week, one month, even six months after stopping! I offer several tips for switching from formula back to breast milk in this post.

Of course, no matter the circumstance, having a happy, healthy, thriving baby is all a mother could ask for. Breastfeeding is just one amazing and very rewarding way to get there!


La Leche League GB, Breastfeeding Your Premature Baby

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