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  • Writer's pictureLiz Thomas

Mama, you can breastfeed a preemie


I hadn’t given much thought to breastfeeding during my pregnancy. I knew I would try it but if I’m being honest that was primarily because it’s free. If I’m being really honest, it was also because I thought it would help me shift the pregnancy weight (it might even have worked if I had stopped gorging!).

I didn’t know a lot about the magic of breastfeeding.

I knew it was supposed to be good for the baby but not a lot more, because, who learns about breastfeeding pre-birth. Really? The laissez-faire attitude was not because I didn’t care, it was because I am the kind of person who needs a deadline and at six months pregnant – no deadline was looming.

But when I was 29 weeks and one day pregnant my waters broke.

It happened suddenly in the middle of Hong Kong, a city I had moved to only 4 weeks earlier, some 6000 miles from my home near London. My daughter was born in a public hospital almost 24 hours later – she was not breathing and weighed just 1.09kg. She was almost small enough to lay in the palm of my hand with her legs dangling onto my wrist (so I learned later when I eventually held her).

So there I was, suddenly a mum three months earlier than anticipated in a country that was not yet my home with no support network to speak off (aside from my wonderful husband). I lived a taxi, ferry and bus ride away from my baby on a different island to the hospital.  There were no facilities for me to stay with her and NICU visiting hours are limited.  Fortunately, the medical care they gave was absolutely incredible.

In those early days, my little girl was full of wires and needles, intubated with machines breathing for her, wrapped in cling film inside a humidifier. The precision and skill they use to save these tiny little beings with the smallest medical tools and needles you have ever seen is fantastic, but the emotional support for mothers is not.

There is no acknowledgement of how your heart aches to be with your baby or to touch them. I felt like a useless empty vessel that had simply carried her and the guilt of feeling that I had not done that very well, was an additional burden.

Those days felt like the longest I’d ever lived through.

I spent every second waiting (impatiently) and praying (religious or not, you pray) that today would be the day that my baby would come home. I have a particularly acute memory of sitting in my bath, milk leaking from my breasts, tears pouring down my face as I cried and repeated over and over: “This is not how it was meant to be”.

I was not allowed to soothe, change or bath her. There was almost nothing I was allowed to do for her.

Almost nothing… except for my one superpower: MAKING BREASTMILK!

My teeny tiny nugget was being pumped with fluids to emulate what she would have in the womb but since she was already in the outside world, she needed to eat and only I could give her exactly what she needed.

My baby couldn’t direct feed from me so I had to learn to hand express. I spent the next few days squeezing my nipples, pinching and bruising my breasts all over with my terrible technique whilst my husband sat armed with the tiniest syringe ready to collect any colostrum I could get out.

In the first few days, we needed just 0.2- 0.5ml per feed – basically a drop or two.

My body, however, didn’t make that easy and it seemed an impossible task. To their credit, the hospital was keen to help me exclusively breastfeed and so, with medical backing and my husband cheering me on we got through those first few days of milking.

As painful as it was (partly due to my awful technique) the knowledge this was something my baby needed that only I could give was my key motivation to try and try again.

It became a mantra, an act of true love from me to my baby girl.

I can’t remember exactly how many days it took, but approximately four to five days after I gave birth, my milk came in and I woke up with cleavage like (glamour model) Katie Price circa 2007. Except that I seemed to have sprung a leak – over myself and over the bed. I had no idea that the really challenging part was only just beginning…  I was full of milk with no baby to drink it.

How and when you can breastfeed a premature baby will depend on:

  • their size,

  • their medical condition

  • their corrected age,

  • their ability to breathe, suck and swallow at the same time.

My little girl could not breathe on her own and I could not touch her or take her out of the incubator for the first week of her life. Plus her mouth was far too small to feed directly and latterly she suffered from apnoea and often just stopped breathing! This would happen particularly at night or during feeding for many months.

Preemies commonly struggle to breathe and drink at the same time. My little one would often choose to feed rather than breathe when it came down to it (a girl after my own heart).

So for the first month of breastfeeding, my daughter received my breastmilk via a feeding tube into her stomach.

She only needed small quantities but I had to keep my supply up as her tolerance for milk was growing quickly and I had to pump a full 24 hours’ worth of milk each time I visited the hospital as my commute in high temperatures didn’t make transporting milk feasible.

In order to get my body to produce those quantities in that window of time, I had to pump, a lot! The best thing I did was to hire a hospital-grade pump.  I pumped every 2-3 hours around the clock. Looking back I should have let myself get a bit more sleep as rest and food are key to getting good milk but in my mind, any other new mum would be up every 2-3 hours so that’s what I did.

When she was strong enough for me to hold I thought my heart would burst.

We began kangaroo care when she was around 2 weeks old – no mean feat as we had so many wires and tubes to consider – but we were able to tuck her inside our tops and get her used to the smell of us and the sound of our heartbeats while milk was fed into her stomach via the tube.  We spent weeks just reading to our girl, cuddling her at every opportunity, letting her feel our warmth and hear our voices. Eventually, we started to get her ready for oral feeding by dipping a cotton bud into my expressed milk and letting her suck on it.

Finally, when she was around 5 weeks old, I put her to my breast.

My nipple looked huge next to her tiny mouth and I had no idea how I would get her to latch. It took us a while to make it work.  She was so small she got tired very quickly but my word there was no doubt she had the suck of a Dyson and she was keen to learn. Once we got going our journey was much the same as a full-term baby in most respects, though the apnoea played an additional role and she had nasty reflux that required hospital meds to control.

The honest truth is that once on the breast she didn’t gain weight at first and it was a slog.

She fed slowly, sometimes taking up to 40 minutes – one nursing session seemed to melt into the next as she fed every two hours. Then there was the endless nappy changes and winding to reduce the reflux – plus the fact that I needed to pump so that we could bottle feed her my milk with added fortifier to help her gain weight. This was my life 24/7 for weeks.

Did I consider giving up at points? Absolutely.

Did I cry over her weight? Definitely!

I was heartbroken when at almost 2 months old she dropped below 2kg again and I thought we might have another hospital stay, but I never stopped believing that breastfeeding was the best thing I could do for her.

I was lucky to have a guardian angel in the form of a private midwife who came for home visits and had enough confidence for both of us.  Sometimes that is all you need – a strong friend who believes in you to keep you on your path and it worked.

I fed T until she was 22 months old, only stopping as I was 5 months pregnant with my 2nd daughter and as a high-risk pregnancy I was advised not to feed into the 3rd trimester.

Giving up breastfeeding didn’t stop my second daughter though and she also arrived prematurely – a few weeks later. She was 31 weeks and four days gestation and weighed 1.7kg.

I was more confident I could handle things the second time around.

M was a little bigger so we were able to direct nurse from very early on. I also learned to accept help when I needed it. I mixed a few formula feeds into my second daughters’ diet in the early hospital days because I needed some help and that is exactly what formula exists for, but with time and a fabulous pump, the right support and motivation I was able to exclusively breastfeed her after we left the hospital.

No matter how long it took to get them to latch, no matter how many times I tried syringe, cup or bottle feeding, I persevered with my nursing journey and we found a way through.

So while it might be daunting, it is possible to breastfeed a preemie.

My youngest daughter and I finished our breastfeeding journey recently. She was 2 years and 5 months old.  After 5 years of pregnancy and breastfeeding, I was ready for a rest. I already miss the special feeds and time we had together but I will treasure those magical breastfeeding years forever.

Today no one has any idea that my daughters were premature.  They have developed into beautiful, happy, strong little girls and I am so very proud of them and what they overcame in the first months of their life.

I am pretty proud of myself too.

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