Breast milk is more than food for your premature or ill baby.
Breast milk:
- is gentle on your baby's tiny tummy and easy to digest
- protects your baby from infections, especially life-threatening gut infections
- improves your baby's brain development and vision
- provides antibodies to build your baby’s immune system
The first milk you produce is called colostrum. It is full of nutrients and antibodies for your premature baby. Every drop of colostrum makes a difference to your baby.
Babies who are fed breast milk generally spend less time in the hospital. Breastfeeding also helps you to bond with your baby.
Expressing breast milk
You may not be able to feed your baby at your breast if your baby is:
- very premature
- unwell
- separated from you
But you can express your breast milk for your baby. Your midwife will talk to you about how to do this.
Expressing breast milk for a premature or ill baby
Getting ready to breastfeed
Before your baby is ready to feed by mouth, they may get feeds through a feeding tube. You can give them expressed breast milk through the tube.
When your baby is strong enough, you can try skin-to-skin contact. Doing this with your baby will help them get ready for feeding by mouth.
When your baby has skin-to-skin contact at your breast, they can begin to lick and feel your nipple. This is called non-nutritive sucking (NNS).
NNS means sucking without getting milk. It is the first step to breastfeeding and will help your milk supply increase. NNS at your breast helps your baby link your breast with feeding.
If your baby is very premature
If your baby is very premature, express your breast milk before putting your baby to your breast.
This helps to soften the breast for an easy latch. It also reduces your milk flow. A slower milk flow makes it easier for your baby to coordinate sucking, swallowing and breathing.
As your baby grows and learns how to coordinate sucking, swallowing and breathing, they may show signs they are ready to feed by mouth. The best time for your baby is when they are awake and active, and showing interest in the breast.
The staff caring for your baby will help you to recognise these signs. They will help and support you with the first feeds. You may notice an increase in your milk supply.
At the start, your baby may only feed for a few minutes. It will take time for them to feed for longer. Express your milk after each feed. This will drain your breasts and protect your supply.
Recognising your baby's feeding cues
Touching and holding your premature baby
Starting to breastfeed
- Before they are due to feed, hold your baby skin-to-skin.
- Massage your breasts and express a little milk onto your nipples.
- Support your baby in a position that will help them attach to your breast.
- Make sure your baby is attached to your breast and feeding well.
If you can feel sucking and hear swallowing, they are actively feeding. Let your baby feed for as long as they are actively feeding.
At the start, your baby may only take small drops of milk. They may only feed for a few minutes before they get tired. Feeds will get longer as your baby gets stronger.
Expressing milk after the feed
If your baby does not feed fully at your breast:
- offer extra expressed milk from a bottle after the feed
- express your milk after the feeds to protect your supply
As your baby feeds more at the breast, you can gradually reduce the amount of expressed milk. It may take many weeks before all their feeds are at your breast. Your baby may not be fully feeding at your breast when you leave the hospital.
Some premature or sick babies learn the skill of breastfeeding quickly. Other babies take longer, but persistence and support will help.
Your baby's 'go' and 'stop' signals
Look out for your baby's 'stop' and 'go' signals when breastfeeding.
Go signals
Continue to attempt breastfeeding if your baby:
- is wake and alert
- is smiling or licking
- is rooting (searching for your breast)
- sucks on your fingers or a soother
- is holding or clenching your hand close to their mouth
- is squeezing, scratching or pressing on your breast or nipple
- is awake and calm during feeding
- has a steady suck, swallow and breathing rhythm
- can feed, take a break and feed again ('self-pacing')
- has steady heartbeat and oxygen levels
- has a normal colour and muscle tone during feeding
Stop signals
Pause your breastfeeding attempt and ask for help from staff if your baby:
- is sleepy, limp or floppy during feeding
- becomes agitated or makes crying noises
- is not sucking or opening their mouth, or is refusing the breast
- is gagging or coughing, or their breathing changes
- has low oxygen levels, or changes in lip and nail bed colour - for example, a pale or bluish colour
- has an increased or decreased heartbeat (staff can tell you if this is significant for your baby)
- comes easily off the breast, or pushes your nipple out
- has irregular or long pauses between sucking
- is drooling milk
Breastfeeding positions
There are many breastfeeding positions. Your nurse or midwife will help you find a comfortable position that works for you and your baby. There are very few rules about how to hold your baby when breastfeeding.
Examples of recommended breastfeeding positions for premature babies include:
Breastfeeding premature twins and other multiples
If you have twins, triplets or more, they may need care from a neonatal unit. This is because these babies are more likely to arrive early.
If your babies are being cared for in a neonatal unit, skin-to-skin contact is important as soon as each baby is well enough.
Skin-to-skin contact helps you feel close to your babies. It gives them the best chance to grow and recover if they have had a difficult start. You can hold 1 baby at a time or both together, but you may need some help.
Try to get your breast milk supply going soon after birth and feed your babies at the breast. If your babies cannot feed at your breast yet, you can express milk for them until they are ready.
Skin-to-skin contact with newborns
Feed one baby at a time to start
It might be easier to feed 1 baby at a time at the start. You can learn how to position and attach each baby.
When you are confident with breastfeeding each baby, you can try to feed both babies together. When the first baby is feeding well, ask for help to attach the second baby.
Breastfeeding and giving breast milk to twins or other multiples can be difficult. But it is very important for keeping your babies healthy.
Breastfeeding twins or triplets
Before going home
It can take time before your baby is feeding well and ready to go home.
Try and be present for as many feeds as possible in the days and weeks leading to discharge.
It's best to follow your baby's feeding cues, instead of having a strict feeding routine. Your baby's cues and feeding patterns will begin to change as they get older.
It will help if you are confident you can feed your baby at home. This takes time and practice in neonatal care with your team.
Bringing your premature baby home
Hospital staff will assess your baby and let you know when they are ready to go home.
They are there to answer any questions you have before you take your baby home. They can help you build your confidence in caring for your baby.
Both you and your baby are still learning new skills. It can take time to adjust to consistent breastfeeding after you go home.
When you are at home, continue to have regular skin-to-skin contact with your baby.
Coming home from a neonatal or special care unit
Feeding your premature baby when they come home
Information and support
Staff at the hospital will give you information and support on breastfeeding. You can also contact a local support group before you leave the hospital.
When you get home, your public health nurse (PHN) and GP can help. Many babies will have follow-up appointments with the hospital.
Support groups
Breastfeeding support groups are a great place to get advice on breastfeeding and meet other mothers.
Breastfeeding support groups are run by:
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