Breast/chestfeeding Your Late Preterm Baby

Important information:

Congratulations on making the decision to breast/chestfeed your infant. Term infants are born between 37 and 42 weeks gestation. Late preterm babies are born at 34 to 37 weeks gestation. Because these babies are early, their brains have not fully developed during pregnancy. Because of this, they may be less alert, have less strength to breast/chestfeed and may have a difficult time keeping a latch on the breast. This can affect their ability to transfer milk from the breast.

Healthy, term babies are good at letting us know when they are hungry and when they have had enough to eat. Healthy term babies will show feeding cues; suck effectively until they are full. At the end of the feeding session, they are relaxed and sleepy.

Babies born late preterm do not have the same feeding behaviors. They may not wake up for feeds, or they may stop eating before they are full. They fall asleep easily at the breast. Since they cannot feed like a healthy term baby, they may not take enough in from the breast. If the breast is not effectively stimulated and emptied immediately after delivery, your milk production will be decreased or not fully established. The first two weeks after birth are the most critical time for establishing a complete milk supply. If you have not already started pumping, we would like you to begin now.

Instructions:

Pumping
Daily milk production varies greatly. The range is between 16 ounces (480 ml) and 34 ounces (1020 ml). By a week or so after giving birth, you should be making at least 16 ounces (480 ml) in a 24-hour period. We recommend that you pump after every breast/chestfeeding session or in place of a session until breast/chestfeeding is well established. You should have at least eight breast/chestfeeding or pumping sessions in 24 hours. If you pump after breast/chestfeeding the baby, you may express an additional ½ to 1 ounce of milk. If you pump instead of breastfeeding, you may express 2 to 4 ounces. Using a good quality personal or rental double electric pump will save you time and effort. Electric pumps allow you to pump both breasts at once. This method is the most effective.

Breast/chestfeeding
Offer the baby the breast every time they show interest, at least every 2 to 3 hours. You may need to wake your baby to feed. The baby might not feed from both breasts during a feeding session. Try not to have the baby spend more than 15-20 minutes at each breast. Your baby needs to practice latching and breast/chestfeeding to develop the skills they need to effectively drink milk. Be patient!  As your baby gets older and stronger breast/chestfeeding will become easier for both of you. If you feel you are not making progress, get help from a lactation consultant.

Skin-to-skin contact
Hold your baby skin-to-skin as much as possible. The baby should be in a diaper and on your chest directly (no bra or clothing). You can put a blanket over the baby or in a wrap to increase skin-to-skin contact. Skin-to-skin contact may improve milk production and with the infant on your chest, they will smell your milk. This method naturally encourages direct breast/chestfeeding.

Pre and post-weights (test-weights)
It may be important to know how much your baby takes from the breast during a feeding session. If your baby is not gaining weight or there is concern about their ability to transfer milk, pre- and post-weights may be used. In the hospital, the baby can be weighed before and after breast/chestfeeding to see how much the baby ate. This is called test-weighing:

• The baby’s weight gain in grams is how many milliliters(mls) the baby took from the breast.

• 30 ml = 1 ounce

• For example; if your baby weighs 30 grams more after a feeding, it means they took 30 ml (1 ounce) of breastmilk.

• The baby must be wearing the same clothes and diaper before and after breast/chestfeeding. The only difference between the pre and post weight is the milk your baby drank.

This can be done in the pediatric care office if they have a scale that is accurate within 2 grams.

Having a scale at home will allow you to know exactly how much the baby is taking from the breast. This will ensure that the baby is getting what they need. If the baby is not getting enough of your milk, the scale will allow you to know how much to supplement. As the baby becomes more efficient at breast/chestfeeding, you will be able to decrease the bottle feeds and reduce or stop pumping.

Electronic infant scales for pre and post weights can be rented or purchased. A scale must be accurate to 2-5 grams to be sensitive enough to measure how much the baby drank.

Supplementing
If your baby is not getting enough milk when they breast/chestfeed they will need to supplement. The best milk for supplementing is your expressed milk. This can be fed to the baby after breast/chestfeeding. You can also replace a breast/chestfeeding session with a bottle if your baby is too sleepy or not latching onto the breast. If you are not producing enough milk to meet your baby’s needs, you may need to feed your baby formula.

At home and follow-up visits
A good way to know your baby is getting all the milk they need is to count your baby’s diapers. They should have at least six wet diapers every day. They should have at least four yellow stools daily. You also will watch your baby’s weight gain to make sure they are getting enough to eat. Go to your pediatric health care provider for weight checks. Your baby should gain 4 to 7 ounces per week.
If you have questions, concerns or are experiencing pain, ask to speak to a provider who specializes in lactation support.

Reviewed June 2024 by Lauren Davidheiser, MS, RDN, IBCLC, LDN and Meghan Devine, BSN, RN, IBCLC