Burping releases any air that has been swallowed during feeding. It’s unlikely that gas causes your baby discomfort, and many babies are not noticeably happier or more contented for having been burped. Swallowing air is more common in bottlefed babies, but you can prevent it to some extent by tilting the bottle more as your baby empties it so that the nipple is full of milk and not air. Disposable bottles cut down on the air the baby swallows, because air cannot enter the bottle as the baby sucks the milk.

The good thing about burping, whether you breast or bottlefeed, is that it makes you pause, relax, slow down, hold your baby gently, and stroke or pat him, and this is good for both of you.

It was a shock for both Petrina and Mike to have their baby a full three months before they’d expected him; Petrina, who likes to be in control of everything, was particularly disturbed. It was difficult for her to sit by her new baby so impersonally enclosed in an incubator, unable to hold and, most of all, to breastfeed him, something she longed to do.

Maintaining a supply

I explained to Petrina that although no feeding is straightforward for premature babies, breast milk is especially beneficial for them, as it provides protection against infections in the first few risky weeks of life. Benjamin had to be fed intravenously for several days and then gradually through a stomach tube because he had not had time to develop rooting and sucking reflexes. Petrina expressed her milk from day one and stored it so that it could be used to feed Benjamin when the stomach tube was in place. She remained adamant that she wanted to breastfeed Benjamin when she could eventually take him home, and as soon as he could be released from the incubator for short periods, the nurses encouraged Petrina to put him on the breast. I reminded her that breast milk is produced in response to demand. If it’s not removed by a nursing infant, it must be expressed; otherwise production stops. This mean Petrina had to express milk to keep up production until Benjamin was able to breastfeed regularly.

Learning to express

Expressing milk for a premature baby is difficult because all the natural cues for milk let-down are missing: hearing the baby’s hungry cry, lifting him up, putting his mouth to the breast. To master the technique of expressing milk, Petrina needed great persistence and support from Mike; often she felt like giving up. Her breasts become engorged on day three and she could hardly bear to massage them. She explained her problems to the head pediatric nurse in the hospital nursery, who arranged for nurses to help and encourage her to take off milk every two hours (as a very small baby would) and to store it hygienically. Petrina continued to express milk during the night, every four to six hours. By the second week, she’d become quite expert and was asked to teach other mothers how to express. Now she was feeling useful and competent, her fears about her baby started to wane.

Bonding with a premature baby

One of Petrina’s main concerns was that Benjamin wouldn’t bond to her and Mike because he couldn’t hear their voices and couldn’t smell their skin or enjoy their hugs. The hospital staff, however, showed them how they could put their clean hands into the incubator to stroke and caress Benjamin gently. Within a week Benjamin was showing signs of loving this contact and responded by wriggling when they touched him. Quite naturally they would talk to him as they did this, and during the second week they saw his eyes flicker in recognition at the sound of their voices. They thought of this as their first conversation and continued to babble to him happily during their time together. The hospital staff encouraged both parents to spend as much time as possible with Benjamin, and to help feed and change him as their confidence grew.

Coping with the demands

Two and a half weeks after Benjamin’s birth, Petrina experienced a crisis. The shock of the premature birth, the anxiety of the first few days, and the loss of sleep because of expressing at night were all having their effect, and she felt that she had no emotional resources left. When one of the nurses found her sobbing, she realized immediately that Petrina herself needed some tender loving care. She suggested that Petrina talk to Mike about her feelings. Mike had thought that Petrina was totally absorbed with Benjamin, but was only too willing for them to have some time alone together each day for hugging and sharing. Petrina also started to talk some time for herself – to have her hair done, for instance – and to spoil herself now and then with nutritious treats like strawberries out of season or a salad with fresh baby greens. She drank lots of mineral water to keep herself healthy for breastfeeding.

Preparing to go home

Before Benjamin was ready to leave the hospital, the staff established him on breast milk from a bottle so that he learned to suck well before ha was put on to the breast. In the last week before he was due to go home, was taking five feedings out of eight from Petrina’s breast so she got Benjamin used to the breast in the reassuring environment of the unit. When Benjamin was 38 weeks old, and weighed 5 pounds 8 ounces (2.5 kilograms) – ten weeks after he was born – Petrina and Mike took him home and felt like a real family for the first time. At home, Petrina had to continue expressing so that she always had enough milk if Benjamin even showed signs of being hungry after a feeding. A week later, Benjamin weighted in at 5 pounds 12 ounces (2.6 kilograms) and was thriving. However, I explained to Petrina that she must think of him as if he were still in her womb; he wasn’t two months old, but 39 weeks, and she shouldn’t expect him to catch up completely with full-term babies of his age till hw was two years old.

• Always make sure that your baby has the nipple and areola well into her mouth
• Always take your baby off the breast gently
• Keep your nipples as dry as possible between feedings
• Make sure your nipples are dry before putting your bra back on after a feeding

In one of your nipples does become sore, give that breast a rest from feeding for 24 hours, or until the soreness has gone. Express milk from the affected breast and feed your baby from the other one. To prevent the nipple from becoming cracked, apply a protective cream two or three times a day

Nipple shield This is made for soft silicone and fits over your nipple; the baby sucks through a small rubber nipple on the front. Sterilize before us.

An untreated blocked duct or mastitis can result in a breast abscess. You may feel feverish, and you may have a shiny red patch on your breast that is exquisitely tender. Your doctor should prescribe antibiotics; if this fails, the abscess will have to be drained surgically, but you may be able to continue breastfeeding even if you need this minor operation – ask your doctor’s advice.

If a blocked duct is not treated, it can lead to an acute infection, known as mastitis. The breast will be inflamed and a red patch will appear on the outside, as with a blocked duct. If you can, you should continue to breastfeed because you need to empty the breast. However, you may find nursing too painful. In any case, consult your doctor, who may prescribe antibiotics.

Tight clothing or engorgement can cause a blocked milk duct, resulting in a hard red patch on the outside of the breast. You can prevent this by encouraging your baby to feed often and empty your breasts, and by making sure your bra fits properly. If you do get a blocked duct, offer the affected breast first.

Toward the end of the first week, before breastfeeding has become fully established, your breasts may become overfull and painful and quite hard to the touch. If this happens, your baby won’t be able to latch on successfully. Make sure you wear a good bra to minimize discomfort, and gently express some milk before feeding to relieve the fullness. Having warm baths will also help relieve the discomfort by promoting milk flow.

If sore nipples are not looked after properly, they may become cracked. If this happens, you will feel a shooting pain as your baby suckles. You should keep the nipples dry with breast pads or clean tissues, and stop feeding from the affected breast until it has healed. Express the milk by hand instead; it can be fed to your baby by bottle or from a cup with a spout.