I work in a hospital with a 40 bed NICU and a 20 bed step down unit. We have
been putting babies to breast prior to 33 weeks for almost 20 years. We do
not have a written policy and we evaluate each baby individually for signs of
readiness.  We start,  of course, with Kangaroo care. Then, when a baby is
showing readiness signs--wakefulness, rooting we work on latch. Sometimes
these babies are still on nasal cannula oxygen. Lactation consultants assist
mothers with the first breastfeeds, but our goal is to support the mother's
independence and to have the staff help as much as possible. When baby is
able to latch and sustain sucking and swallowing, we teach mother's how to do
test weights.  This definitely helps the staff to determine how much
supplement the baby needs and to show them that premies really do get milk
from the breast.

Many babies are ready for their first breastfeeding sessions at 32 weeks.
None are ready to take a full feeding from breast at that time, nor are they
able to go to breast for every feeding. But a good number of these small
babies can take a partial feeding from breast at this point.

One of the most important tenets of supporting breastfeeding in the NICU is
the establishment of breastfeeding before a bottle is ever introduced. There
is absolutely no reason that a 32-33 weeker needs to take a bottle. It is
very easy to maintain an indwelling gavage tube and these babies can receive
their mothers' milk by tube after they finish breastfeeding and in lieu of
breastfeeding.  This is most successful when mothers advocate for themselves
and their babies.  The lactation staff fully supports mothers in requesting
that their babies not get bottles. We get lots of eye rolling but our staff
will not go against a reasonable mother's request. Slowly, over many years,
we have gotten much of the staff on board. We still have a ways to go but
nobody blinks twice about putting a premie to breast.

As for bottles we try to hold them off as long as possible because our
premies can certainly devolop a preference for the fast flow of the bottle.
If they learn to breastfeed first this is not such a problem.  Most 34 week
babies are not able to totally breastfeed, but they certainly can partially
breastfeed.  In the best of worlds all of our babies could stay in the
hospital until they were totally breastfeeding, but insurance issues make
this impossible. When we have to introduce a bottle we try to do it at night
when mom is not there. This limits the number of bottles.

So, for a long answer to a short question: Yes 33-34 week babies can
breastfeed, but often not totally. Offering the breast at the baby's earliest
possible readiness and witholding bottles for as long as possible helps the
process.

Kathy Boggs, RN, IBCLC
Mountain View, CA

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