#6 Babies born earlier than 38 weeks gestation may not breastfeed well initially.
When I went into labor 3 weeks early with my 5 child (3 baby boy) I thought to myself, "SCORE!" I had just "shaved off" that extremely uncomfortable last few weeks of pregnancy. At that time I'd been an L&D RN for 7 years helping hundreds of mothers begin to breastfeed their newborns, and I'd already breastfed my 4 other children. Because of all of my perceived experience I didn't see anything wrong with delivering my little caboose 3 weeks before his due date! Well, guess what I learned during that next 3-4 weeks? Just how important even those last 3 gestational weeks are to a baby's ability to breastfeed effectively! In fact, I realized I had not been truly preparing my patients who delivered Late preterm infants for supporting the breastfeeding process until their baby was closer to his/her due date.
Many times these babies come spontaneously & unexpectedly. Occasionally the mother's labor is induced due to medical complications with the pregnancy. In the medical world we call infants born between 35 0/7 weeks to 37 0/7 weeks "Late Preterm Infants." They often look just like a smaller version of a full term infant. Sometimes they are even the size of a full term infant, leading everyone to expect more from the baby then he/she is capable of! I call this the "3 year old who wears size 5 clothing." People may wonder why he is acting like a baby, wearing a diaper, etc? IT'S BECAUSE HE'S THREE!!! 😐 We must remember to treat Late preterm infants differently....They are not trying to be difficult with us, they are simply acting their gestational age.
Late Preterm infants "LPT" may struggle initially with respiratory distress, difficulty maintaining normal temperature, low blood glucose levels, high levels of jaundice requiring bili light therapy, and poor feeding requiring NICU admission. Thankfully a good majority are stable and remain with their mothers on the Mother/Well Baby floor, not requiring the help of the NICU. On the M/B floor, LPT infants biggest challenge is breast feeding by far! I'm usually summoned to a mother's hospital room when baby has a low blood sugar, and the RN cannot get the baby to breastfeed. But interestingly, I'm occasionally get a report from the RN caring for the couplet, or even another Lactation Consultant, who state, "He's only 36 weeks, but he just breastfed so well." I want to say (loudly), "YOU JUST FELL INTO THE LATE PRETERM TRAP!" But I restrain myself, 🙊 take a few deep breaths, and then calmly remind them that these babies may feed well initially, but they eventually hit their proverbial "brick wall," having have used up all their energy, and now they need our help more than ever!
Now that I have mentioned all of the complications LPT infants face; Mommas, please please please don't blame yourself if you have delivered a LPT infant. Most of the time we have no idea why labor commenced and you delivered your baby early. Once they're here we need to understand why they are are different from a full term baby, and how to support them.
According the the Obstetric world;
A full term infant is considered anything 37 0/7 weeks to 41 weeks gestation.
A Late Preterm infant is defined as 35/0 to 37 0/7 days.
In the breastfeeding world, we consider at least 38-41 weeks gestation full term, and necessary for baby to have developed the oral strength, stamina, and brain development needed to breastfeed effectively.
This March of Dimes diagram illustrates the obvious difference between the brain a LPT infant's brain size and development compared to the size and development of a full term infants brain (39-40 weeks.) Now, if your baby is born during this LPT phase (because let's face it, when they come, they come!) it is important to note this doesn't mean your baby's brain will always stay under developed! He/she will continue to grow and develop outside the uterus.
My main message is for mothers who have delivered between 34 and 37 6/7 weeks gestation; you will likely need to assist and support your baby during breastfeeding. Including limiting time at the breast to no more than 30 minutes, pumping after each feeding using a hospital grade pump rental, then supplementing expressed mother's milk and/or formula if necessary until the baby is closer to his/her due date.
As Lactation Consultants we refer to LPT infants as "The great pretenders" because they often "appear to be eating," when in fact they are only taking small amounts at the breast. These babies don't have the strength, stamina, and mouth musculature development to take enough milk directly from the breast. They may often need supplementation of mother's expressed milk, or when necessary formula if your milk is not yet in, or for a medical need like low blood sugar levels. You will need patience to support him/her while she learns to breastfeed effectively. Remember, keep your original due date as a guide for you to anticipate when baby will likely be strong enough to breastfeed on his/her own, without any the needs of any supportive interventions.
👩 For a mother it means she has an adequate to abundant milk supply, and enjoys comfortable latching.
👶 An infant effectively breastfeeds when he/she successfully latches deeply 8-12 times in 24 hours, actively sucks with swallows heard for at least 10-20 minutes or more total (may be one side alone, or may be a combination of both sides) Your baby acts content and satisfied after he/she is finished feeding. She/he may lose interest and fall asleep. (see my Babies can be really sleepy blog post!) Another good sign of effective breastfeeding is a weight gain 4-7 ozs per week (after the 2 week checkup with your pediatrician, when baby should at least be back to birth weight.) Babies born at 39 to 41 weeks gestation have more strength and stamina to suckle effectively, and to take the amount of their mother's milk to stimulate a good milk supply and gain weight.
With patience and vigilance, most mothers of LPT infants finally reach that point where they no longer need to help baby breastfeed, and no longer need to pump and supplement after each feeding.
If you feel you are not coping well, of need in person consultation, Look for referrals in your hospital teaching information or go HERE
💗 Jill Lancaster RN BSN IBCLC
Many times these babies come spontaneously & unexpectedly. Occasionally the mother's labor is induced due to medical complications with the pregnancy. In the medical world we call infants born between 35 0/7 weeks to 37 0/7 weeks "Late Preterm Infants." They often look just like a smaller version of a full term infant. Sometimes they are even the size of a full term infant, leading everyone to expect more from the baby then he/she is capable of! I call this the "3 year old who wears size 5 clothing." People may wonder why he is acting like a baby, wearing a diaper, etc? IT'S BECAUSE HE'S THREE!!! 😐 We must remember to treat Late preterm infants differently....They are not trying to be difficult with us, they are simply acting their gestational age.
Late Preterm infants "LPT" may struggle initially with respiratory distress, difficulty maintaining normal temperature, low blood glucose levels, high levels of jaundice requiring bili light therapy, and poor feeding requiring NICU admission. Thankfully a good majority are stable and remain with their mothers on the Mother/Well Baby floor, not requiring the help of the NICU. On the M/B floor, LPT infants biggest challenge is breast feeding by far! I'm usually summoned to a mother's hospital room when baby has a low blood sugar, and the RN cannot get the baby to breastfeed. But interestingly, I'm occasionally get a report from the RN caring for the couplet, or even another Lactation Consultant, who state, "He's only 36 weeks, but he just breastfed so well." I want to say (loudly), "YOU JUST FELL INTO THE LATE PRETERM TRAP!" But I restrain myself, 🙊 take a few deep breaths, and then calmly remind them that these babies may feed well initially, but they eventually hit their proverbial "brick wall," having have used up all their energy, and now they need our help more than ever!
Now that I have mentioned all of the complications LPT infants face; Mommas, please please please don't blame yourself if you have delivered a LPT infant. Most of the time we have no idea why labor commenced and you delivered your baby early. Once they're here we need to understand why they are are different from a full term baby, and how to support them.
According the the Obstetric world;
A full term infant is considered anything 37 0/7 weeks to 41 weeks gestation.
A Late Preterm infant is defined as 35/0 to 37 0/7 days.
In the breastfeeding world, we consider at least 38-41 weeks gestation full term, and necessary for baby to have developed the oral strength, stamina, and brain development needed to breastfeed effectively.
This March of Dimes diagram illustrates the obvious difference between the brain a LPT infant's brain size and development compared to the size and development of a full term infants brain (39-40 weeks.) Now, if your baby is born during this LPT phase (because let's face it, when they come, they come!) it is important to note this doesn't mean your baby's brain will always stay under developed! He/she will continue to grow and develop outside the uterus.
My main message is for mothers who have delivered between 34 and 37 6/7 weeks gestation; you will likely need to assist and support your baby during breastfeeding. Including limiting time at the breast to no more than 30 minutes, pumping after each feeding using a hospital grade pump rental, then supplementing expressed mother's milk and/or formula if necessary until the baby is closer to his/her due date.
As Lactation Consultants we refer to LPT infants as "The great pretenders" because they often "appear to be eating," when in fact they are only taking small amounts at the breast. These babies don't have the strength, stamina, and mouth musculature development to take enough milk directly from the breast. They may often need supplementation of mother's expressed milk, or when necessary formula if your milk is not yet in, or for a medical need like low blood sugar levels. You will need patience to support him/her while she learns to breastfeed effectively. Remember, keep your original due date as a guide for you to anticipate when baby will likely be strong enough to breastfeed on his/her own, without any the needs of any supportive interventions.
What do I mean by "Effective breastfeeding?"
👩 For a mother it means she has an adequate to abundant milk supply, and enjoys comfortable latching.
👶 An infant effectively breastfeeds when he/she successfully latches deeply 8-12 times in 24 hours, actively sucks with swallows heard for at least 10-20 minutes or more total (may be one side alone, or may be a combination of both sides) Your baby acts content and satisfied after he/she is finished feeding. She/he may lose interest and fall asleep. (see my Babies can be really sleepy blog post!) Another good sign of effective breastfeeding is a weight gain 4-7 ozs per week (after the 2 week checkup with your pediatrician, when baby should at least be back to birth weight.) Babies born at 39 to 41 weeks gestation have more strength and stamina to suckle effectively, and to take the amount of their mother's milk to stimulate a good milk supply and gain weight.
With patience and vigilance, most mothers of LPT infants finally reach that point where they no longer need to help baby breastfeed, and no longer need to pump and supplement after each feeding.
If you feel you are not coping well, of need in person consultation, Look for referrals in your hospital teaching information or go HERE
💗 Jill Lancaster RN BSN IBCLC
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