Nursing a Preterm Baby

By Krista Gray, IBCLC. Last updated February 5, 2013.

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Babies who are preterm have unique nutritional needs and your breast milk could make the difference between life and death.  However, the “how’s” of nursing a preterm baby can be overwhelming, even for moms who have breastfed before.  If your baby is in the NICU, the most important thing you can do following birth is begin to express your milk.  At first you may not get anything, or just a few drops.  But this initial milk – colostrum – is the richest source of nutrition your baby could possibly have.  Unable to be replicated , different in composition from any other mammal, and different even to full-term colostrum, every drop is precious and should be saved for your baby.  In fact, even days later when you are pumping fresh milk for your baby, it is best to give any remaining amounts of colostrum first, and then your freshly-expressed milk.

There are several ways you can express your milk – by hand, with a hand pump, or a single or double electric pump.  For those first few drops of colostrum, hand expression is very effective and often preferred over a pump because every drop can be saved into a small container rather than going through the pump flange. (Click here for information on hand expression.)

If your preterm baby is going to be in the NICU for a few days or longer, check with your hospital about using a hospital grade double electric pump.  The most effective way to build a solid milk supply for your baby is twofold:  first, by pumping frequently – at least eight times every 24 hours; and second, by using breast compressions while pumping and finishing off with hand expression.

Let’s begin with pumping frequency.  Your goal is to be able to express at least 750 ml every 24 hours within 10 days following birth.  (If you have twins this amount should be doubled; for triplets, tripled; and so forth.)  In order to reach this goal, you should express on both sides for 15-20 minutes every three hours at a minimum.  If you begin expressing at 10 a.m. and finish at 10:30 a.m., you need to express again at 1:00 p.m. (not 1:30 p.m.).

Once you’ve reached your goal of 750 ml each woman’s pumping schedule should be tailor-made.  There are many things that come into play.  Every woman’s breast capacity is different.  Some women have a large breast capacity and could pump four or five times in a 24 hour period for just five minutes each time and have more than enough milk.  Other women have a much smaller breast capacity and must pump more frequently to attain the required volume.  Both women are fully able to produce enough milk for their baby!  But, a one-size-fits-all pumping schedule will not fit all women.

Not only is it important to frequently empty your breasts, but how you do this is also critical.  One study found that a good quality double electric breast pump was able to remove 99% of milk in the breasts within the first five minutes of pumping for most mothers. 1  It is important to make sure the vacuum is comfortable.  A strong vacuum that causes pain is not helpful to milk expression!  However, research also shows that using breast compressions while pumping will increase milk output.2  This is important to note since some moms notice a drop in their supply when they pump (versus nursing at the breast).  And this is critical for a mom of a preterm baby who is working to establish her supply.

Breast compressions can easily be done while pumping.  Either use a hands-free pump (you could even cut small holes in a nursing bra to allow your pump flange to be held in place by your bra) or sit high enough that your pumping bottles can rest on the counter while you use your hands for breast compressions.  As you are pumping, gently massage spots on your breast working from your chest forward to your areola.  Hold down until you feel the area soften with milk expression and then work on another area.  Continue breast compressions while you pump until your breasts feel very soft and no more milk is being collected by your pump.

If you are still concerned about the volume of milk you are expressing, following pumping with hand expression can further increase milk output.  In fact, Morton et al found a 48% increase in milk production when breast compressions while pumping followed by hand expression were incorporated!

I’ve shared my story here about pumping and building a milk supply for my preemie twins.

Show 2 footnotes

  1. Mitoulis LR, Lai CT, et al. (2002) Efficacy of breast milk expression using an electric breast pump Journal of Human Lactation 18(4):344-52
  2. Morton J, Hall JY, Wong RJ, et al. (2009) Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology. 29(11):757-64