Delivering your infant prematurely is not planned. Therefore, preterm delivery often disrupts a mother's plans including whether she intends to breastfeed or not. Preterm delivery alters breastfeeding plans in two ways. For the mother who did not intend to breastfeed, the neonatology team will be asking this mother to pump her breast milk, while her infant is in the hospital, so that she can provide this excellent "medication" to her preterm infant. For the mother who intends to breastfeed, she also will be asked to pump her breast milk until her infant can receive adequate nutrition from the breast.
Breast milk as medicine
Infants do not develop the ability to take breast or bottle feeds until approximately 32-34 weeks gestational age (about 7 months of pregnancy). Until they reach that age, they receive mother's breast milk through a tube from the mouth or nose to the stomach. In addition, even when preterm infants develop the ability to breastfeed, they often require additional nutrition through at least 9 months of life. Breast milk is by far the best nutrition for preterm infants, but it is lacking in calcium, phosphorus, vitamin D, and protein for very preterm infants. The strong benefit of breast milk lies in its antibacterial and antiviral properties and its enzymes that help a baby's intestines absorb fats, carbohydrates, and protein. Breast milk even contains stem cells that likely help grow the infant's intestine! We call breast milk a "medication" because of the many benefits to protect the infant from infection and support growth of the body and the brain. Nonetheless, even for mothers who strongly desire to breastfeed their infants, providing breast milk to a preterm infant is not easy. To maintain a good milk supply, a mother must pump her breast 6-8 times a day. If a mother does not pump regularly and instead waits for her breast to feel full, her breast milk supply will decrease. Even if a mother pumps 6-8 times a day every day, maintaining milk supply still can be difficult.
Breastfeeding support
Fortunately, we do have some ways to support mothers' milk supply. One is "Kangaroo Care" which allows a mother to hold her infant directly on her chest for a few hours each day. For a mother who wants her infant to learn to breastfeed, we can position her infant on her chest to try some "non-nutritive suckling" where the infant gets the feel of suckling on the breast. When a preterm infant reaches the gestational age to try feeding at the breast, we have more ways to support mother and infant! Preterm infants often do not have much energy for feeding, so the neonatology team works hard with mother and infant to make it easier. To calculate how much milk a preterm infant takes at the breast, we have very precise scales to weigh the infant before and after a breastfeeding! We want to support mothers of preterm infants in all ways to help them succeed in providing breast milk for the infant and to breastfeed if desired. Breast milk is truly the best medicine for a preterm infant, and, therefore, is the greatest gift that a mother can give her preterm child. However, it is not easy, and the MUSC neonatology team greatly admires and appreciates the preterm infant mothers who work so hard to provide this resource to their infants.
by: Sarah Taylor, M.D.
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