Rockville Lactation

Lynnette Hafken, MA, IBCLC

Lactation Consultant

text/call: (240) 888-2123   |   se habla español

[email protected]

Infection disease policy: I am fully vaccinated against COVID-19 and get annual flu shots. I am up to date on all available vaccinations. I ask that you and your family please follow the Montgomery County, MD mask guidelines while I am in your home.

Late preterm and early term babies (35–38 weeks)

These babies are often very sleepy, have poor stamina for breastfeeding effectively, and usually do not have the strength to adequately stimulate your breasts. The three most important things are to (a) feed them enough to manage their increased risk for complications such as low blood sugar and jaundice, (b) to give them the energy they need to feed well, and (c) to empty your breasts frequently and thoroughly; this buys you time for your baby to learn to breastfeed effectively, which may take until their expected due date.​ This is a marathon, not a sprint, so it is essential to have a plan to allow everyone in the family to get enough sleep.

Below is a suggested feeding plan (note that every family is different, and this is not a substitute for medical advice). 

Let’s start with frequency of feeding. Families of late preterm babies are often told to feed every two hours. This may not work, as these babies need uninterrupted sleep for brain growth, and are usually not willing to wake up and eat that frequently (again, if your doctor has given you a two-hour feeding schedule, there is probably a reason—such as maintaining stable blood sugar—so always run any feeding plan by your medical professional before making changes). Late preterm babies often feed more effectively if fed larger amounts every 3 hours.​

Second, let’s think about how much milk your baby needs calorie-wise. A general rule is that babies need 2.5 oz per pound of body weight. So if your baby is 5 lbs, they need about 12.5 oz; every 3 hours would be 8 feedings, so divide 12.5 by 8—your baby needs a little over an ounce and a half per feeding (or 45 ml). This is the minimal amount of milk your baby needs to be well-hydrated, maintain their body functions, and grow well.

Third, your breasts need appropriate stimulation in order to know how much milk to make. The way they figure that out is by how frequently and thoroughly they are emptied (the breasts are never truly empty, but for the purposes of this plan, consider them empty when you have extracted all the milk you are able to, until only little drops are coming out). Because your preterm baby does not have the energy and stamina to provide this stimulation, pumping will have to be part of your plan if exclusive breastfeeding is your goal.

To start, let’s make sure your breasts are emptied about 7–8 times/day. This is a lot of work, so please get help if you can; your support people can wash pump parts and feed your baby while you pump.* Having an extra kit to cut down on washing frequency also helps. Make sure you have a hands-free pumping bra. 

*Note that mothers who are pumping while others bottle feed the baby sometimes feel isolated and disconnected from their baby—it can feel like your only role is to be a milk provider while everyone else gets the fun and bonding. Make sure to personalize this plan so that you get time to snuggle and/or bottle feed. You are more important to your baby than the number of ounces of milk you produce.

That brings us to the next part of the plan—direct breastfeeding. Your baby will need practice at the breast in order to learn to transfer milk effectively, and you will need practice positioning and latching your baby. You can do this whenever you and your baby are awake and have the energy, but I recommend limiting the time to about 15 minutes so as to provide time to get the baby bottle fed and pump. It is not necessary to practice breastfeeding at every single feeding; for example at night, most families find it most efficient to bottle feed and pump only and then get back to sleep.

Feeding plan for late preterm/early term babies:

Every 3 hours:

(1) Wake baby and (if you are both up to it) practice breastfeeding for about 15 minutes.

(2) Partner bottle-feeds baby their full calorie needs (2.5 oz per pound of body weight, divided by 8 feedings).

(3) Mother pumps her breasts until the milk stops coming out, plus two minutes; this is usually around 15–20 minutes.

Feeding in this way is called “triple feeding,” because you are doing three things—breast, bottle, and pumping. It is a typical plan for babies who are not breastfeeding well, and/or mothers who have a low milk supply. It usually works very well for mothers who have no need for sleep or self care—in other words, almost no one—which is why you must customize this plan in order to get your own needs met. I suggest the following:

Once in 24 hours, mother gets a 5-hour chunk of uninterrupted sleep, while partner bottle-feeds baby. When mother wakes up after this, she power pumps for an hour. Power pumping is 20 minutes of pumping, 10 minutes rest, 10 min pumping 10 min rest, 10 min pumping.

I suggest trying this plan for 3 days, and if it is not working for you, get more individualized advice by scheduling an appointment. It is important to get your baby’s weight checked weekly or as recommended by your pediatrician, as you are transitioning from triple feeding to exclusively feeding at the breast.

Finally, your baby’s transition to exclusive breastfeeding needs to be customized based on how well your baby can transfer milk. It is necessary to evaluate that in person with a scale that can measure milk intake during breastfeeding; the scale must be accurate to 2 g or 0.1 oz. Most lactation consultants have this kind of scale, but be sure to confirm it, as less accurate scales are not sufficient. (Just because a scale can provide numbers at that level does not mean it is guaranteed accurate to that level.)

Through all of this, please be kind to yourself and do not put your own needs last. You are recovering from childbirth, which is one of the most physically grueling experiences a person can go through. You physically need sleep, rest, and enough food and drink.