Congratulations on making the decision to breastfeed your infant. Late preterm babies born at 34 to 38 weeks gestation do need more attention from moms in the first few weeks but it is only a short time period that the pumping and breastfeeding phase will last. Your commitment to this routine will help your baby’s health now and in the future.
Healthy, full term babies are pretty good at letting us know when they are hungry and when they’ve had enough to eat. They try to suck on their fists or search around for the breast and then afterwards are relaxed and, often, sleepy.
Babies born before 38 weeks gestation (called late preterm infants) may look like healthy full term babies, but they do not have the same feeding behaviors. Late preterm infants 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. When the breast is not fully emptied, you will not produce as much milk.
To help your late preterm term baby eat enough and to keep your milk supply high, you will need to pump to make your breasts think that your baby fed longer than he actually did. Your baby will need to get that extra pumped milk after the feeding at the breast. You need to make plenty of milk. If you have not already been pumping we would like you to begin. This will ensure that you make plenty of milk and your baby will gain weight quickly.
Mothers’ milk supplies vary greatly. The range is anywhere between 16 ounces (480 ml) to 34 ounces (1,020 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 breastfeeding session or in place of a breastfeeding session. You should have at least 6 to 8 pumping sessions in 24 hours. If you pump after breastfeeding the baby you may get ½ to 1 ounce. If you pump instead of breastfeeding you may get between 2 to 4 ounces.
Using a hospital-grade double electric pump will save you time and effort. You can rent one from CHOP or your birth hospital. If you are returning to work and are interested in buying a pump, please consider your options carefully. Pumps that are electric and allow you to pump both breasts at once will be the most effective. For more information, see pump rentals.
Offer the baby the breast every time he shows interest, but at least every 2-3 hours. You may need to wake your baby for feeds. The baby probably will not feed from both breasts during a feeding session. Try not to have the baby spend more than 30 minutes at the breast.
Using a nipple shield may help your baby get more milk from the breast. It fits over your nipple while you are breastfeeding the baby. The shield will help your baby stay latched onto the breast and will help increase the amount of milk he or she can take from the breast. The nurse or lactation consultant will show you how to use it.
Some women continue to use the shield until the baby’s due date or a few weeks beyond it. Once the baby can take all feeds from the breast with the shield then you can begin to wean the baby off of the shield. Some babies may need to use the shield until they stop breastfeeding.
It is important to know how much your baby takes from the breast during a feeding session. In the Hospital, we can weigh the baby before and after breastfeeding 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. For example: If your baby weighs 60 grams more after a feeding, it means he took 60 ml of breast milk, or 2 ounces. (30 ml = 1 ounce)
This can be done in your primary care office if they have a scale that is accurate within 2 grams.
You can rent a scale to use at home so that you know exactly how much the baby is taking from the breast. Then you will know how much more to give your baby in a bottle. As the baby gets better at breastfeeding, you will be able to decrease the bottle feeds and stop pumping. You can rent a scale from CHOP or from another Medela® vendor. For more information about renting a scale or pump, see pump rentals.
After each breastfeeding session, you should pump your breasts. You can have a helper feed this pumped milk after each breastfeeding session. If you are by yourself, you can breastfeed and give the bottle, then pump. If you are not making enough milk by breastfeeding and pumping (at least 16 ounces/480 ml in a 24 hour period). Talk to your lactation consultant or breastfeeding resource nurse about the best solution for your individual situation.
To be sure your baby is doing well, you should count the baby’s wet diapers to make sure he has at least six every day. He should have at least four yellow stools daily. Go to your pediatrician or healthcare provider for follow-up visits for weight checks. Your baby should be gaining 4 to 7 ounces per week.
Congratulations again on your decision to breastfeed your baby. If you have any questions, call CHOP's breastfeeding and lactation team at 215-590-4442.
Reviewed by: Diane L. Spatz, PhD, RN-BC, FAAN
Date: December 2009