My first son was born at 36 weeks and 4 days. He was almost a month early, not so early that he was a preemie. I found out later that he was a "late preterm baby." My son had a number of small issues that added up to being more of a challenge than I'd ever expected. I think if I'd known that breastfeeding a pre term baby meant coming up against some problems it would have been easier to face those little issues and not think it was me failing.
Pre Term Babies are More Prone to Jaundice
Even though full term babies often get jaundice, it's more prevalent in late pre term babies. Late preterm babies have less ability to process bilirubin so they get jaundiced more easily. You don't have to panic. You do not have to supplement with formula. In fact, the doctor on-call told me to supplement with formula, and it cut my milk supply and almost stopped us nursing entirely. I had to work with a lactation consultant and three weeks of scheduling and monitoring to get back to nursing exclusively.
There are other treatments for jaundice other than formula: lots of daylight, or even a blanket with lights that he can sleep in, to help him process the bilirubin. If a medical professional tells you to supplement with formula to get rid of jaundice, tell them to suck it (the American Academy of Pediatrics does NOT recommend interrupting breastfeeding to supplement with formula to resolve jaundice; any doctor that does has out of date information.)
Late Pre Term Babies are Bad Suckers
They are tired babies. They don't have great muscle control. They take forever to nurse, they fall asleep nursing, they have bad latches. This is NOT your fault, it is because they are little too early to have it all down. Be patient and work with a lactation consultant (a real one, one that has the letters IBCLC after their name) if you need to. Bottles in the first 6 weeks are a bad idea because late pre termers seem to get nipple confusion more than full term babies. Avoid pacifiers at first for the same reason. Be patient, you'll get it, just tell yourself you'll get help if you need it.
Late Pre Term Babies Have Bad Reflux
The little esophageal flap that keeps their milk down isn't as developed. Your baby is going to spit up a lot. I found keeping my baby upright for 20 minutes after a feed helped (like holding him or putting him in a bouncy chair.) And when baby spits up a lot, they want to nurse more. And when the reflux hurts, they'll want to nurse more. You're going to be nursing your baby a lot. You'll only have your baby once, settle in for long-term snuggling.
If You're Overwhelmed, or You Need Help, GET IT
Being a new mother is always overwhelming. If you need help, if you feel like something's wrong, if you can't figure out how to nurse your baby, there is help out there. Contact a lactation consultant (call a local hospital or your pediatrician and ask if they have a warm line or other community resource.) I used a book called The Nursing Mother's Companion Guide that really helped me figure out what to do; I can't recommend it more highly. There are other great books out there that can help. I lived by KellyMom.com's advice. My mother and friends helped me; they were encouraging and loving. People can't read your mind: learn to ask for help.
The great news is that my late pre term baby is now a noisy and normal nine-year-old. After those first few difficult weeks and months, he grew out of having to nurse constantly. He grew into a regular nursing schedule--and even nursed until he was two! I want to encourage you, to tell you that the hard work is worth it, the tears are worth it, you are a great mom. Good luck!
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