You’ve decorated your nursery, read the pregnancy ‘bible’ What to Expect When You’re Expecting, and attended all the prenatal classes you’ve signed up for. What you didn’t expect was to have a premature baby.

At first look, you may be amazed and even shocked at how small and fragile your preemie is. With an array of tubes, catheters, and electrical leads taped to his tiny body in the neonatal intensive care unit (NICU), you may even be fearful of holding or cuddling your child. Holding a breast pump in your hands instead of the healthy, lively baby you envisaged months ago, doubt starts to kick in. Will I be able to produce enough milk to sustain my preemie? What happens if he can’t latch on? Is breastfeeding really worth all the heartache?



With the emotional roller-coaster that preemie moms experience, it is not unusual that many of them are ready to throw in the towel when it comes to breastfeeding. Instead of having constant access to their newborn babies, preemie moms have to pump in isolation, then travel back and forth several times a day to the NICU to bring their milk to their infants.

As they are still going through hormonal changes and recovering from childbirth, this logistical challenge can wear out even the fittest mom and lead to decreased milk production. Yet, there is nothing more valuable that a mother can provide for her preemie than breast milk.

Research has shown that the milk produced by the mother of a pre-term infant is initially higher in nutrients—protein, fat, free amino acids, and sodium—than the milk produced by the mother of a term infant.

In this respect, nature has provided a natural safety net for preemies. With this enhanced breast milk, a breastfed preemie is less likely to develop infections that are common to babies given formula milk. Not only that, he will be protected by the immunities in his mother’s milk even as his own immature immune system is developing.

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Ling Chang Choo, a Lactation Consultant at Mount Elizabeth Hospital, tells us that while breastfeeding can be especially challenging for mothers of preemies, it is all the more important for them to persevere for the sake of their babies.

“The premature babies’ gut is not well developed,” Ling says. “Hence it is critical for preemies to receive human milk, which has the ingredients to stimulate the growth, movement, and enhance the maturity of the gastrointestinal (GI) tract. Human milk also decreases the risk of necrotizing enterocolitis (NEC) which is a serious condition where the guts die due to infection and diminished blood supply, as well as other infections of the GI tract.”

There are also many benefits to breastfeeding when carried out in conjunction with “Kangaroo care”, where babies have skin-to-skin contact with their mothers. Premature babies’ heart rate and breathing tend to be calmer when they experience their mother’s warmth. “Kangaroo care” can also help them stabilise their organ function and self-regulation abilities, facilitate better sleep patterns, avoid infections, and enjoy a shorter hospital stay.

In her eight years as a lactation consultant, Ling has seen many preemies thriving exclusively on breast milk. Often in these cases, the mother has received good support from the hospital. An involved paediatrician whom the mother can trust will also help to monitor the baby’s breast milk intake and requirements.

During the crucial first weeks, support from family members is especially important. Stress and anxiety lowers the production of breast milk and increases the likelihood of post-partum depression. If the mother can get help with housework or with the care of an older sibling, she can focus on getting her much needed rest, eating well, and being in the right frame of mind to care for her preemie.

Ling advises preemie moms to start breast stimulation immediately after delivery by doing regular pumping. This can be as frequent as every two to three hours for 15 minutes on each breast for stimulation.

Small newborn getting suckled

The preemie mom should then hand express the colostrum and extract it with a syringe for baby consumption. Once the milk supply is established, it is important to learn the good practices of storing and defrosting breast milk for feeding. A good hospital should be equipped with breast pumps, a refrigerator, and a freezer to store breast milk.

Getting the preemie to latch on successfully can be a major battle so it is with good humour that we remind all preemie moms that “patience is the mother of all virtues”.

With the nurses’ help, the preemie mom needs to learn how to position a small-sized infant for breastfeeding. Online resources such as La Leche League’s website also provide step-by-step instructions on breastfeeding positions. However, if the baby is unable to latch onto the breast, the mother may need to continue feeding via a syringe or cup. In such cases, the lactation consultant would sometimes recommend the use of an artificial nipple such as the Calmita, which trains the preemie to suck, swallow, pause, and breathe while feeding.

Ling encourages mothers to feed on demand instead of following a schedule. “Don’t wait till baby cries as it is a late sign of hunger,” she cautions. “When the baby is impatient, this may cause difficulty in breastfeeding.”

Most maternity hospitals offer free telephone consultation or even face-to-face sessions. The Breastfeeding Mothers’ Support Group (BMSG), a non-profit organisation in Singapore, also provides support through their helpline, workshops, talks, and social gatherings facilitated by breastfeeding counsellors. More information can be found on their website or by calling 6339 3558.

It is easy to feel discouraged and isolated in the care of your preemie, especially after the little one leaves the confines of the hospital. But remember, many have succeeded with the right support and mindset. As Lauri Houpy, a preemie mom and La Leche League member writes, “Breastfeeding can be hard work for both baby and mother, but the rewards far outweigh the trials.”

For more information about the maternity ward services at Mount Elizabeth Hospital and to book a maternity tour, please call (+65) 6731 2000 or visit www.mountematernity.sg. A virtual tour of the rooms is available here.

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