Encouragement and Guidance for Breastfeeding a 37-Week Infant with Inhibited Letdown
Your relative should be reassured that early term infants (37-38 weeks) commonly experience breastfeeding challenges due to infant immaturity and delayed milk production, but with proper support and technique optimization, most mothers successfully establish breastfeeding. 1
Understanding the Challenge
Early term infants (37-38 weeks) have decreased effective milk emptying and may consume only 45% of expected volumes per feeding compared to 95% in full-term infants. 1 This physiological immaturity, combined with the fact that most mothers don't experience copious milk production (lactogenesis II) until the third to fourth day after delivery, creates a temporary mismatch that resolves with time and proper support. 2
Immediate Action Plan
Optimize Breastfeeding Frequency First
- Increase breastfeeding to 8-12 times per 24 hours (approximately every 2-3 hours) rather than focusing on pumping initially. 3, 1
- Frequent direct breastfeeding (9-10 times per day) is associated with lower bilirubin concentrations and better milk supply establishment. 1
- Avoid breast milk supplements unless breastfeeding technique and frequency have been optimized first. 1
Techniques to Facilitate Letdown
- Maximize skin-to-skin contact throughout the day, not just during feeding. 4, 5 This stabilizes blood glucose, reduces infant and maternal stress, and helps mothers recognize feeding cues. 4
- Create a calm, relaxed environment by being emotionally present "in the here and now" and temporarily forgetting about external pressures. 5, 6
- Continue using heat and breast massage before feeding sessions. 7
- Trust the body's capacity and understand that initiating breastfeeding takes time and can be difficult initially. 5
When to Consider Pumping
Pumping should be a secondary strategy, not the primary approach. If direct breastfeeding remains challenging after optimizing technique and frequency:
- Pump for 15-20 minutes maximum every 3 hours to stimulate milk production. 3
- Use expressed breast milk as the first choice for supplementation if needed. 3, 1
Critical Monitoring Points
Schedule an urgent follow-up within 24-48 hours if the infant has >12% weight loss to assess hydration status, feeding adequacy, and bilirubin levels. 3 Watch for:
- Signs of dehydration: lethargy, poor skin turgor, sunken fontanelle, dry mucous membranes. 3
- Adequate urine output and stool frequency (indicators of adequate intake). 3
- Weight checks every 24-48 hours until birth weight is regained. 3
Common Pitfalls to Avoid
Do not assume all jaundice in breastfed infants is benign - measure bilirubin levels and exclude pathologic causes while optimizing breastfeeding. 3
Avoid introducing pacifiers or formula bottles prematurely, as these are associated with breastfeeding rejection and decreased success rates. 7 If supplementation becomes medically necessary, use expressed breast milk first, delivered by cup or syringe if possible. 3, 1
Do not let well-meaning advice about "low milk supply" undermine confidence - this is commonly a perceived rather than actual problem in the first few days. 7 The infant's stomach capacity on day 1 is less than 100 mL total, increasing to 500-600 mL by days 4-5. 1
Realistic Expectations and Encouragement
Being calm and accepting that initiating breastfeeding takes time is one of the most important strategies mothers identify for creating positive breastfeeding experiences. 5 The combination of early term infant immaturity and normal delayed milk production typically resolves by days 3-4 when lactogenesis II occurs. 2
Successful breastfeeding is an empowering experience, and with proper support, most mothers of early term infants achieve their breastfeeding goals. 8 The key is accessing skilled lactation support, maintaining frequent feeding, maximizing skin-to-skin contact, and staying emotionally present rather than anxious. 4, 5, 6