Premature babies need extra medical care, which can interfere with plans to exclusively breastfeed: Here’s what moms need to know about transitioning once baby comes home

Bringing home a new baby can be nerve-wracking for any new mom: suddenly you and your partner are singularly responsible for your baby’s care.. But for moms bringing home babies who were born prematurely, and may have spent time in the NICU, the transition can be especially stressful. Unlike moms who have the option to exclusively breastfeed their babies from day one, premature babies receiving extra medical care are often bottle fed expressed breast milk by necessity. For this month’s Ask the IBCLC, our resident IBCLC Katie McGee answers questions about the transition to breastfeeding after premature delivery.

How does breast milk help premature babies?

Breast milk can be lifesaving for premature babies. Babies born prematurely face an increased rate of death and serious complications due to their immature organ systems. The gastrointestinal tract of a premature infant is especially vulnerable to invading pathogens or germs. Colostrum coats and protects the digestive system, helping mature and protect the gastrointestinal tract. For this reason, premature babies’ receiving only their mothers’ own milk, especially for the first weeks and months,  are at a drastically reduced risk of this deadly complication compared with formula-fed preemies.  This is just one of the multiple ways breast milk helps to “finish” what would have been completed in the womb had the baby been born on or around his due date. Neurological development and eye development are greatly enhanced, and the risk of extended or re-hospitalization is decreased, when a premature infant receives only his mother’s own milk.

Amazingly, the milk composition is altered in many specific ways when a mother delivers prematurely.  The early days and weeks are the most important time for a premature infant to receive only his mother’s colostrum and milk. Receiving it in its freshly pumped form is ideal, as this preserves the live cells that are so beneficial to the baby. Refrigerating and freezing milk causes some of these live cells to die off. Just as a new mother and baby remain a close unit, a new mother’s body knows when she has delivered early, and production of this very specialized nutrition for her baby begins.

Should I change my diet in any way? Do I need to fortify my milk?

Eating a well-balanced diet is important for all nursing mothers.  There is really no need to change your diet as your body pulls from your stored vitamins and minerals to make perfect milk for your baby. There is little you can do to change the composition of your milk with dietary changes. There is one component, DHA, a healthy fatty acid essential for brain development that moves from the mother’s system to the breast milk. Seek out foods high in DHA, such as salmon or DHA-fortified eggs or yogurt.

Milk fortification depends on the level of prematurity of the infant. Yes, breast milk is perfect, but premature infants miss out on some of the end-of-pregnancy bone mineralization. Your baby’s medical team may decide that adding fortified minerals to your breast milk is appropriate for your baby.

Do I need to keep pumping once my baby starts breastfeeding?

Yes. The premature infant starts nursing typically with what we call non –nutritive feedings. This means that the baby is practicing breastfeeding, often on a recently pumped breast, but is not transferring much or any milk.  Often these feedings can take place 6-7 weeks before the due date. Of course, other factors such as the infant’s cardiac and respiratory status are considered first. At 5-6 weeks before the due date, the baby may start showing increased feeding cues. They are often slight and brief. However, the premature baby may begin to transfer small amounts of milk at this time, often with the help of a nipple shield.  All the while, it is critical that the mother maintain her supply with effective and frequent pumping for milk removal. There is a period of weeks or months (depending on degree of prematurity, other complications etc.) during which the mother is pumping to maintain supply and starting to breastfeed. It is a very busy time for a mother with a premature infant. However, the reward is great with the increased health of the premature infant given his own mother’s milk, and eventual achievement of lactation goals.


At Ashland Health, working with moms to ensure their breastfeeding experiences are successful is our top priority. That’s why our team is committed to securing the right pump for every mom, and to providing additional support along the way. Our staff IBCLCs are available to answer all your questions, and we also provide in-home lactation consulting. Contact us today to see how we can help make your breastfeeding journey better.