Recently, a friend who is a retired OR nurse called me. She relayed three or four questions from her daughter who had just given birth to twins at 30 weeks gestation. I could mostly answer the questions she raised, but often, the “answers” depend on multiple facts and circumstances. My best contribution to the conversation was to help her and her daughter to ask many more questions about preterm babies and their care.
Premature, preterm, late preterm and other terms
- What are the different “degrees” of prematurity?
- What words do I need to learn in order to understand what the staff is telling me?
- Are there some acronyms which I will be hearing frequently?
General questions about preterm babies
- How soon will I be able see or hold my baby?
- When can I start being skin-to-skin with my baby?
- How long should I stay skin-to-skin with my baby at one sitting?
- What is more important at birth: gestational age, or body weight?
- How much weight should my baby (babies) gain?
- Do preterm babies get “growth spurts” like term babies?
- Is it OK to carry my baby in a carrier if he is premature?
Problems preterm infants often experience
- What is necrotizing enterocolitis? Should I be worried about it, and is there anything I can do so my baby will avoid it?
- What is poor muscle tone? How long will it be before the babies are not so hypotonic?
- What about swabbing my baby’s’ mouth with my colostrum?
- Is it true that infant massage helps preterm babies?
Feeding behaviors, needs and methods
- How can I read my baby’s feeding cues?
- How long will my baby need to have an OG or NG or tube?
- Is breastfeeding more “work” than bottle-feeding?
- Is formula supplementation OK?
- What about nipples atop bottles? Does it matter which one I use?
- What about using donor milk? Should I insist on this?
- What about human milk fortifier? What is that, and what use does it have?
Feeding at breast
- Should I try to feed both twins at the same time?
- Should I let one baby feed on the same side? Or make the baby take both sides at the same feeding?
- How long should a preterm baby be “allowed” to nurse?
- What nursing positions are more or less effective for a preterm infant?
- How can I tell if my preterm baby gets too tired while nursing?
Using a pump in a preterm situation
First, let’s set the record straight. Using a pump is not always the best way to go, especially in the early days of after a preterm birth. Hand expression is an excellent and often better alternative.
However, presuming that you are using a pump, here are some questions to raise:
- What about my flange? Does size matter?
- Should I aim to use the pump’s suction at max?
- What kind of a pump do I need?
- How long (how many minutes) should I pump?
- What is hands-on-pumping?
- Do I need to pump during the night?
Volume of milk, and making more milk
- How much milk should I make in the first few days?
- How much milk should I make by the end of the week?
- What are the three MOST important factors to help make more milk?
- Does warming the flange help to make more milk?
- What about having fenugreek? I’ve heard that helps to make more milk?
- Is the composition of preterm milk different from term milk?
- Is there a CD that would help me to produce more milk?
What about let-down?
- What are some simple tips that I can use to help with my let-down?
- Does stress inhibit my let down?
- What are the sensory triggers for a let-down?
- What else can I do to improve let-down?
Resources for mothers of preterm infants
- Are there any local support groups for mothers of premature twins?
- Is there anything online that would be helpful for me?
- What are some good books for mothers of preterm infants, and specifically, for nursing mothers of preterm infants?
I can feel myself wanting to answer all of these preterm questions! But some of these questions would require an entire post. I try not to exceed 700 words in one post, I’m already closing in on that!
Remember that some “answers” are true in all situations. Many are not. If you’re a mother, the most important thing is to ask the questions. Remember, you are your baby’s best advocate. Ask questions! If you’re not sure what something means, ask!
If you’re an IBLCE exam test-taker, how confident are you of your abilities to answer preterm questions — or anything else on the exam? Is it time for you to just get my Online Lactation Exam Review course? Or answer my 7 Discipline Drills or sweat over my Practice Exams? There’s no such a thing as being overprepared!
Did you have a preterm baby? What kinds of things do you wish you had asked? Tell me in the comments below!