Breastfeeding a prem baby

Breastfeeding a premature baby can be challenging. Getting it right is important though, because mom becomes a key player in her baby’s recovery and survival. Here’s a guide to help you. By Francois Gallet


Breastmilk – we know it’s a superfood, but for a premature baby, it raises the odds of survival significantly. Colostrum, the first milk that is produced, is the most potent natural immune system booster known to science, asserts a 2013 report by UK charity, Save the Children Fund.

Breastfeeding hurdles

Probably the most profound initial challenge is the emotional cocktail of anxiety at having a baby in a neonatal unit, and feelings of failure about not having carried to term. In addition to the emotional stress, the mother is usually in need of breastfeeding educational input, yet they don’t always get this support, and moms often feel helpless, suggests Louise Goosen, an International Board Certified Lactation Consultant (IBCLC).

Getting breastfeeding established

You don’t need to carry your baby to term to lactate – your breasts are physically capable of producing milk from about 20 weeks into your pregnancy, and the delivery of your placenta is their ultimate cue to begin.

Furthermore, oxytocin, also known as the love hormone, and prolactin, are the two hormones you need coursing through your body to produce milk. The good news is that there’s a lot you can do to help your body produce oxytocin.

Louise suggests the following:

  • As soon as possible, reunite with your baby. Seeing her will spark the production of oxytocin.
  • Even better is touch, and skin-to-skin (Kangaroo Mother Care) contact. This will further enhance the production of oxytocin and prolactin.
  • Now, make yourself comfortable, and if possible, position yourself close to your baby.
  • If this isn’t possible, look at a photo of your baby.
  • Allow yourself to feel cared for – get a loved one to massage your neck and shoulders.
  • Have a cup of tea at hand.
  • Place a warm cloth over your breast.
  • Let yourself relax and feel love towards your baby.

How to express

  • You’re now ready to begin expressing – a process that is ideally initiated within hours after your baby is born, if you are physically capable. But if that’s not possible, it’s never too late to begin – simply keep expressing and stimulating your breasts.
  • To do this, start by gently massaging your breast generally, and then after a few minutes, place your forefinger and thumb on opposite sides of your breast. Your thumb should rest a couple of centimetres away from the areola at 12 o’clock. Meanwhile, your index finger (with the other three fingers) should rest at 6 o’clock.
  • Begin to squeeze your fingers together to palpate the knobbly breast tissue, and then roll them forward towards the areola. Imagine that you’re squeezing toothpaste out of tube. This process should not be painful.
  • Once you’ve reached the nipple, release the pressure from your fingers and roll them back to the first position. Squeeze your fingers together again and roll forwards, repeating as a rhythmic massage action, explains Louise.

Get a rhythm

It’s important to get a rhythm to the movement of your fingers, as this is how a baby suckles. Let this rhythm be your focus rather than trying to squeeze harder. Also, express regularly at short intervals rather than for long periods at a time.

It’s helpful to have someone to hold a teaspoon, syringe or tiny cup to catch the drops of milk. Alternatively, hold your container at the nipple edge with your other hand.

When the flow of drops slows down, you need to change your hand position so that your thumb and index finger are positioned at three o’clock and nine o’clock.

A word of caution from Louise, “Don’t let other people hurt you.”

Switch breasts

Once the production of colostrum seems to slow down – and this may be no longer than 10 minutes into the process – then switch to the other breast.

If you’re really struggling to express even a few drops, you can try using a breast pump to stimulate the breast. Don’t get discouraged, though. The technique takes time and patience to master, urges Louise.

Janelle Maginnis, whose baby was born at 33 weeks, describes her triumph in persisting, “Managing only to get tiny bits of colostrum out, I persisted. Within two days, I was expressing enough to feed two babies!”

Once your milk comes in on about day three, you can switch to a breast pump if you’re still struggling with the hand technique.

Colostrum is liquid gold – it’s nutrient-rich and packed with immune-system-boosting components that stimulate immunity in your newborn. Colostrum also helps the infant’s intestines to function effectively, and to mature, and the protective substances that it contains make it more difficult for bacteria and allergens to attack the baby’s throat, lungs and intestines, asserts a 2002 study titled ‘Colostrum and its benefits’ in the journal Nutrition Research.


Your supply is triggered by demand. Initially, aim to express every two hours in the day, and every three hours at night, explains Louise.

Eventually, you can try 12 times a day (no less than eight). If you do experience a drop in supply, express more regularly. Doing Kangaroo Mother Care and putting your baby to the breast, even if she can’t suckle, will boost supply.

Getting your preemie to latch

When your baby is physically able to be placed at your breast, allow her to access it without expecting a latch.

“As preemies, they get tired quickly, so take it slow,” explains Charme Kriel, whose baby, born at 28 weeks, initially started breastfeeding with one or two small, disinterested sucks, until at 34 weeks, she started sucking for longer.

Pay attention to how you position her for latching. Ana Frawley, from Ithemba Lethu Milk Bank (IBCLC), describes a good latch as:

  • Tummy-to-tummy: Hold her close to your body, with her tummy facing yours.
  • In line: Ensure that her ear, shoulder and hip are in line so that her neck isn’t twisted, bent forward or too far back.
  • Shoulder support: Support her at the neck and shoulders with your forearm and/or hand, taking care not to put pressure behind her head.
  • Face the breast to her nose: Allow her to point her nose to your nipple.
  • Pain-free: There should be no nipple pain.
  • Swallowing: You should hear baby swallowing.

Milk banks and breastfeeding support

*Originally published in February 2015

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