Breastfeeding a premature baby or baby in special care

Tiny baby breastfeeding

If your baby is in special care, breastmilk can help them to strengthen their immune system and gain weight. If you had a premature birth or your baby is in a neonatal or special care baby unit for another reason, it might feel like the odds are stacked against you breastfeeding, but there’s lots you can do to ensure your baby gets the great start breastfeeding offers if you decide you want to give it a go

Can I breastfeed my premature baby?

Yes. It can be a tricky business at the start – babies born before 34 weeks gestation often have trouble sucking at first – but that doesn’t mean it can’t be done and if your baby was very small, very early, or both, the benefits of breastfeeding are even greater. If you want to breastfeed, let the unit staff know from the start, and keep reminding them to avoid confusion. You're not fussing; it's definitely worth the effort if this is something you feel strongly about.

For the most part, staff in neonatal units and SCBUs (special care baby units) will be only too pleased to do all they can to help. The Royal College of Midwives states that providing mothers with skilled support from staff to breastfeed and express helps promote breastfeeding in neonatal units. And that’s a benefit to everyone, so don’t be afraid to ask for and insist on help if you need it.

Why is breastfeeding so important for babies in special care?

Breastfeeding provides an excellent start for babies, particularly in the very beginning when they are getting the highly nutritious colostrum (the first, thick milk that arrives before your ‘normal’ milk comes in around about day three).

For babies that are born prematurely and may have related health issues, the fats, protein and minerals in breastmilk are especially important, and the antibodies it contains are enormously beneficial. Breastfeeding helps brain development, both in the short and the long term, and can help protect against infections in the gut and lungs, too. Prem babies are particularly susceptible to neonatal necrotising enterocolitis, when the intestine becomes inflamed and can perforate, allowing waste from the bowel into the bloodstream. It can be extremely serious but breastfeeding helps protect against it occurring.

How do I get breastfeeding started with a premature baby?

Establishing breastfeeding can be tough for any new mother and baby. Add in a premature birth and any of the health issues that go with that and it’s easy to see why it can feel very stressful when your baby’s in special care and possibly in an incubator.

Your baby might need to be given special newborn formula at first to 'top her up' and may need to be tube fed, too. Very tiny babies sometimes need an IV line but others will just need a feeding tube that goes to the stomach via the mouth or nose. Here are a few more things you can do to help get breastfeeding underway.
Premature baby holding on to a parent's finger

Kangaroo care

'Kangaroo care' when you have your baby close to you, skin-to-skin on your chest has many benefits for a premature baby, including:

  • Regulating her heart rate and temperature.
  • Helping to establish breastfeeding.
  • Helping her adapt to the world outside the womb.
  • Encouraging weight gain.

It also has benefits for mothers, such as:

  • Helping to prevent postnatal depression.
  • Encouraging the hormones that support milk production.
  • Increasing confidence.

Expressing milk for premature babies

Expressing milk kept me going, it wasn't exactly fun but it gave me a purpose, on the 'machine' – every four hours day and night until they could suckle.

Lots of very prem babies are too small to suck, so you may have to express and feed your baby using a cup or syringe to begin with. In the very early days, hand-expressing is often easier, especially when it comes to collecting colostrum (or 'liquid gold' as you’ll no doubt hear the neonatal nurses refer to it). Colostrum, and the milk when it comes in later, can be given to your baby using a cup or tube, too.

To keep your supply up, you need to express really regularly – at least eight to 10 times a day – and don’t go more than three hours in the day or five or six hours at night without expressing. Some hospitals will have breastpumps and may even be able to lend you one to have at home but there are lots of great breastpumps on the market too.

You can freeze any spare breastmilk you express and use it later when she’s got going, or it can be given to your baby when you’re not there for any reason.

Build up slowly

As time goes on your baby will find it easier to open her mouth and even perhaps suck at the breast. Start by expressing a little milk and putting a few drops on her lips when you’re having skin-to-skin time at the breast. She might just lick your nipple at first and eventually learn to suck a little and then latch on properly. The SCBU staff might advise you to try a first feed when she’s just had a small tube feed and you’ve expressed a little off the breast, so she isn’t suddenly surprised by your let down and spluttering on a big mouthful of milk.
Premature baby in incubator

Ask for help and support

If you want to breastfeed your baby in special care but feel you are being pressured to give formula when you don't want to, do ask for more help.

Support is essential, but the quality of support can vary greatly. Ask your partner or a relative to step in if you feel too emotional to fight your corner.

When do premature babies start to breastfeed properly?

My daughter was born at 35 weeks and I refused to let her have a bottle at all. Within three days all her tube feeds were my milk and she started to breastfeed on day seven. I made damned sure she gained weight by feeding her on demand, sometimes every 20 minutes. It was hard but worth it in the end.

Much depends on how many weeks early your baby was and whether she has any additional health issues as a result. Babies born before 34 weeks often can’t suck yet, so if you have a baby born at 30 weeks, for example, it might be four weeks before you’re able to breastfeed her directly.

If you’ve had trouble getting breastfeeding started, keep at it and take it one day at a time. If you can, keep your supply up by expressing and get as much skin-to-skin contact with your baby as you can – this not only helps get breastfeeding established but has been shown to regulate temperature and heartbeat in tiny babies.

Can I get donated breastmilk for my baby in special care?

If your milk doesn’t come in or you don’t manage to get feeding established, you can get breastmilk for your baby from a milk bank at some hospitals . Ask the midwives if this is available where you are or visit the charity UKAMB’s website where you can find out more about milk donors and your nearest milk bank.

Don’t, however, be tempted to buy milk over the internet. People do sell it online but you can’t really know what you’re getting.
Premature baby sleeping

Will we still get breastfeeding support when we go home from special care?

You’ll still be in touch with your health visitor and community midwives when you both go home from hospital, and you’ll also be able to get advice about breastfeeding your follow-up appointments at the neonatal clinic. Don’t forget about the wealth of breastfeeding support groups and organisations out there, too, from local peer-led support groups and breastfeeding cafes to organisations such as La Leche League.

If you’re breastfeeding twins you might want to seek a bit of specialised support and advice as all the usual breastfeeding problems you might encounter can feel doubly difficult when you’re doing it all twice. Organisations such as TAMBA Twins and Multiple Births Association) have lots of useful advice to offer.

What Mumsnetters say about breastfeeding a baby in special care

“I was given: a maternity assistant who was specially trained to help/teach women express, both by hand and by pump; two different pumps to try; an old-fashioned looking, but very efficient, machine (that we called Daisy) to take home for as long as our son was in SCBU; an amazing breastfeeding adviser in SCBU; a private consultation with a breastfeeding counsellor when I wanted to hurl the machine at the wall; NICU nurses who called colostrum 'liquid gold' and took great care that our son got it as soon as possible. "