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After a tough and stressful start, your preterm baby is “graduating” from the hospital and you can finally bring her home. Now what?
Breastfeeding and breastmilk are even more important for preterm infants than full-term infants, yet many mothers leave the hospital poorly prepared to face the challenges of breastfeeding or pumping for their preterm babies.
We hope that someday all moms of preterm babies will get the guidance and support they need to successfully transition from hospital to home; but until then, here are 8 tips for making breastfeeding or pumping work with a premature baby.
1) Meet with a lactation consultant before you leave the hospital (if possible). Hopefully, your hospital will offer a breastfeeding consult prior to discharge but if they do not, be sure to request a meeting with a lactation consultant to ask for help in designing a plan to meet your breastfeeding goals. For example, if your goal is full breastfeeding but your baby is having difficulty latching, ask her to design a plan around that goal. Or, if you are pumping and want to sustain your milk supply over the long term, ask for guidance on how to do that. Find out if she will be available to see or speak with you again once you're home.
2) If you aren't able to meet with a lactation consultant before discharge, be sure to consult with one shortly after returning home.Using ILCA's lactation consultant searchable directory, see if you can find an IBCLC who has experience working with NICU graduates and if possible, plan to check in with her on a regular basis. A long term relationship with an IBCLC who can see you through the ups and downs of your breastfeeding journey is invaluable.
3) Use skin-to-skin, Laid-back Breastfeeding, and Baby-led Breastfeeding. We can't say it enough: skin-to-skin contact is critical to preterm babies' breastfeeding success. The benefits of skin-to-skin contact are too numerous to mention here (see this list), but believe us when we say it's your one of your best tools for making breastfeeding work. Skin-to-skin contact keeps your baby in her natural environment (you), stimulates instinctual feeding behaviors, and gives her ample opportunity to feed on cue. It helps you observe her feeding cues and stimulates the milk-making hormones that will help you to build and sustain your milk supply. Laid-back Breastfeeding positions also help to stimulate natural feeding behaviors, and for non-latching babies is an important tool. Baby-led Breastfeeding is particularly useful for babies who are non-latching.
4) Preemies are different: have patience. You've probably already learned many of the challenges unique to preterm babies: how quickly they tire out, how some have difficulty latching or coordinating suck-swallow-breathe, and how frequently they need to feed, to name a few. These may continue to be challenging at home, and the earlier your baby's gestational age at birth the longer it may take for her to get the hang of it all. Our best advice given these challenges is shared above: connect with a lactation consultant who can stick with you through thick and thin. We also want to emphasize that breastfeeding a preterm baby requires a lot of patience with both your baby and yourself. Remember that both of you are learning as quickly as you can.
5) Protect your milk supply while your baby matures. Chances are you will be discharged with a baby who is doing well but can be challenging to feed. He may fall asleep quickly at the breast, need to be wakened for feedings, or have to be coaxed to latch-on. Maybe he isn't latching at all and you are pumping your milk. If any of these situations are the case, it's important to be vigilant about your milk supply. If you're doing a lot of pumping, use a hospital grade pump. There are many things you can try to establish and maintain your supply when your baby is an inconsistent nurser.
6) Call on others for support. What you are doing is hard. You may be stuck in an endless cycle of pump-feed-supplement-pump with barely a moment to sleep – and all while caring for other kids! If there was ever a time to call in reinforcements, it's now. Ask family and friends to help with meals, shopping, cleaning, and any other things you need to neglect in the service of caring for your baby. If you can afford it, consider hiring a postpartum doula who can offer additional support.
7) Connect with other moms. Sisterhood is powerful! Connect with other moms via La Leche League or Breastfeeding USA, through a hospital or pediatric support groups, or through WIC.
8) Consider taking a breastfeeding supplement.