Working with premies, I would first attempt to latch him onto the breast as
usual using the football hold.  If unable to latch, then I would use a nipple
shield.  Sometimes premies are unable to maintain the negative pressure to
stay latched on to the breast and the shield facilitates this.  Before
latching onto the breast, I'd use a BabyWeigh Scale to weigh him before and
after the feeding at the breast so that accurate measurement of intake can be
obtained and supplementation done accordingly.  While mom is supporting her
breast with the C hold, I encourage her to do some breast compression with
her thumb, and to support the baby under his chin with her forefinger, gently
prodding his throat area if he needs reminders to keep suckling.  Now, the
breast compression encourages the baby to continue to suckle too because it
facilitates the delivery of some milk into the baby's mouth from the ductal
system of the breast.
In the event that the baby has received many bottles and refuses to
participate at the breast, often times I find finger-feeding helpful to
return the baby to the feel of the breast.  In the event that the baby
becomes sleepy at the breast and refuses to participate at some point in the
feeding, then I supplement at that point.  A preterm infant has higher
caloric needs and less reserve than a full-term infant, so I am cautious
about expending extra minutes at the breast without adequate latch-on to be
considered eating.  However, between feedings, I encourage kangaroo care to
help mom's milk production and to teach baby mom's touch of her skin and her
smell.  This baby has had quite an extensive amount of aversive, painful
procedures in his little lifetime (I'd assume), so empowering this mother to
hold her baby and educating her that she is doing a valuable thing of
reprogramming her baby's brain to warmth and security to replace the
aversions can really enhance the bonding relationship of this mother and her
baby.
Lastly, and of course, I'd actually do this first, but I offer this mother
emotional support.  I educate her ahead of time that some feedings will be
great and some feedings will not.  Or, that if baby is not able to latch
immediately, that we will get him to the breast with patience and time.  If
mom is committed to the breast, the baby will get there.  This mom needs
extra TLC because many times she is feeling inadequate as a mother and as a
milk provider for her infant.
Sorry for being long.....hope this helps!
Carol Chamblin, RN, MS, IBCLC
Geneva, Il

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