Lactation care of the late preterm baby is different

We've got to spread the word

When we think about supporting exclusive breastfeeding in healthy term babies, we start from the default that exclusive breastfeeding works, that most people make all the milk that they need, that there are a set of practices that we do to make sure that happens, and there are the outcomes we look for to make sure that everything's going well. We observe and pay attention to ensure that, and we stand ready to assist if a problem arises.

However, for a certain subset of babies, that’s not a smart plan. If we lump the late preterm baby in with healthy, term babies and wait to see if problems show themselves, it puts these babies at more risk. They may not be getting enough milk. They may not be waking up enough to eat more. They may not be draining the breast well enough to protect milk production. We really can't take a wait and see attitude with these “early birds.” They need a separate set of practices to protect them and to protect the dyad’s capacity to continue lactation for as long as they choose.

Resetting how people think about late preterm babies has been a huge goal for me for many years now. It's about changing our own mindset so that we can support parents to approach this in the most prepared way: with the understanding that initiating lactation and breastfeeding with a late preterm baby is extra work.

It takes extra work at the outset, but that's not a forever thing. When people have that knowledge from the beginning, it can make it easier for them to manage early lactation so that it doesn't feel like this overwhelming burden.

Let’s talk about a mother I recently spoke with. She came to our service requesting help with making more milk. She was putting her baby on the breast frequently. She was pumping multiple times a day. She was bottle feeding her baby. She was using a pacifier and she was exhausted. What she was experiencing looked to her just like the same complicated lactation journey that many of the people that she knows have been on.

What I was able to share with her was that she was NOT experiencing the same scenario as her friends. With a new perspective, she was able to better understand the context of why her baby needed extra support to breastfeed and what to expect in terms of improvement and transition into uncomplicated breastfeeding and milk expression.

Many people have found themselves in that same situation when they were unsupported on their lactation journey or lacked the prenatal education about breastfeeding that would have helped them have a smoother start. Many choose to stop or discontinue breastfeeding and/or pumping under all that stress. And the mother I’ve described would have thought that she was just like everybody else, and was faced with the same choices.

But she's not like them. And neither is her baby. Families of late preterm babies can think that what's happening to them is just like what happened to all their friends, but they actually have a different situation because their baby is different.

If we look at early lactation support for the late preterm dyad as a special opportunity to intervene, then we can help this population to see why how the extra tasks and work they do now really can set them up to meet their personal lactation goals despite the early birth.

It’s so easy for everyone to understand that a preterm baby will require extra care and even extra work for feeding, but the late preterm baby’s needs may be overlooked, to the detriment of their parents, who can be left thinking that their baby’s feeding difficulties are their fault.

Families and friends usually do not realize that these circumstances are truly not the same as what happens with healthy, term babies, and lactating parents can end up being discouraged from breastfeeding or expressing milk under the guise of protecting them from the extra work.

In another case, as I worked with the mother of a late preterm baby and helped her create a lactation care plan to protect her milk production, keep her baby fed, and practice breastfeeding despite her baby’s seeming lack of ability to stay awake for full feedings, she went to her midwife for post-birth care.

Unfortunately, her midwife was not well-versed in the lactation needs of the late preterm baby, and she discouraged the mother from following our carefully constructed lactation care plan, telling her instead to “just keep putting the baby to breast, you don’t need to do all that extra stuff.” That’s risky for a late preterm baby, and it risks compromising milk production as well.

All of us who work with pregnancy, birth, and lactation need to be on the same page about lactation care of the late preterm dyad. It’s different, and it’s critical that we facilitate a wider understanding of this to offer these babies and their parents the ability to experience lactation.

Without this crucial shift in thinking, we are failing these dyads. Together, we can ensure that late preterm dyads get the right lactation care at the right time. I’ve got plenty more to come on this topic - stick around!