Breastfeeding the Premature Baby

4. Myth -- Mothers of premature babies need to use nipple shields to get their babies latched on well and getting milk well...
This is certainly not true most of the time from my experience in Africa (actually, we never used nipple shields in Africa) and the experience of the NICU's in other countries such as Sweden. The second article by Nyqvist had babies born as small as 26 weeks gestation and up to 31 weeks gestation and only a small minority ever used a nipple shield. Yet, unlike what happens generally in North American NICU's from which very few babies leave the hospital breastfeeding (at best they are getting breastmilk in the bottle and frequently the mother is not putting the baby to the breast), almost all the babies actually left the hospital breastfeeding.

The key is to take time to get the baby to take the breast well. This does take extra time compared to using a nipple shield with the mother, but in the long run the result is worth it. Nipple shields eventually lead to a decrease in the milk supply which makes getting off the nipple shield very difficult (see the information sheet The Baby Who Does Not Yet Latch On).

The way to get the premature baby latched on is not essentially different from the baby who was born at term. See the information sheet When Latching and the video clips at the website nbci.ca. These video clips do not show premature babies but the principles of a good latch are the same.

5. Myth -- Premature babies need to learn to take a bottle which teaches them how to suck...
Well, I don't know what to say about this. It's just not true. Premature babies can learn to suck without getting bottles as shown, once again, from experience elsewhere in the world. Too often, mothers and babies are hurried out of hospital with the "advice" that the baby will be discharged earlier if he starts taking a bottle.

This is not a way to help the mother and baby. In any case it would not be true that the baby needs a bottle to learn. Kangaroo Mother Care and getting the baby to the breast before the "magic" 34 weeks gestation would do a lot to avoid this situation. Furthermore, as different muscles are used when bottle-feeding vs. breastfeeding, bottle-feeding teaches baby poor sucking skills and these can sometimes be extremely difficult to unteach.

6. Myth -- Premature babies get tired at the breast...
This is believed to be true because babies, not only premature babies, tend to fall asleep at the breast when the flow of milk is slow especially in the first few weeks. The baby is given a bottle and because the flow of milk is rapid, the baby wakes up and sucks forcefully. The false conclusion? The baby tired out at the breast because it's hard work and the bottle is easier.

Premature babies often do not latch on well, partly because we teach latching on so poorly. With a good latch, the use of breast compression and, if necessary, using a lactation aid at the breast to supplement if necessary, the baby will get good flow and not fall asleep at the breast. Get that flow increased and you will see that breastfeeding is neither difficult for the baby nor tiring for him.

7. Myth -- Test weighing (weighing the baby before and after a feeding) is a good way of knowing how much milk the baby got at a feeding...
Test weighing presupposes that we know what a breastfed baby is supposed to get. How can we know since the rules that say a baby of this weight and this age should get x amount of milk are based on babies fed formula by bottle? And how can we say how much the baby would have gotten if he had been well latched on, with the mother using compression, especially if the breastfeeding is limited to a particular time or schedule like 10 or 20 minutes (because of the concern that the baby will tire out)?

The best way to know if a baby is getting milk well from the breast is to watch the baby at the breast. See the video clips at the website nbci.ca.