The majority of my daughter's stay in the NICU has been concerned with feeding. Can she feed orally? Does she need a feeding tube? Premature babies do not yet have the jaw and muscle development to handle the suck/swallow combination. They also have probably had difficulty breathing. So combine breathe, suck, swallow and get enough food and by the way we're really little and tire easily...and you get a difficult time eating (breast or bottle fed alike).
So we started out pumping, a lot of pumping. Because she wasn't breastfeeding yet, I had to let my body know that yes, indeed I wanted this milk and I had to build up a supply for her needs. When she was ready to be tube fed, she tube fed my breastmilk. So I pumped, and I pumped, and I pumped. My milk came in. I stored it, she 'ate' it. And we started to breastfeed.
She needed help here. We used a lactation tool called a nursing shield that helped her nurse. Preemies often can't quite latch onto the breast without slipping off. A nipple shield is make of sillicone and fits right over your own nipple, allowing the baby to have an easier time of it. We also used a lot of breast compressions, helping her get to the milk that she needed.
We started off slowly. 2 ccs, 4 ccs, and then the jump to 10ccs, 14ccs. We enlisted the help of a lactation consultant - an absolute fountain of breastfeeding knowledge. She reminded me that 40-42 weeks gestation babies can have difficulty with breastfeeding initially, never mind these 35 week gestation babies, they shouldn't even be born yet, never mind learning all of this. She helped me get a better position for the latch and how to do a better breast compression. And just encouraged me. She'll get it, it just takes time. You can't rush development. Did she get it? All of a sudden she started to take 16-24 ccs per feed (she needed over 50 at this point - over 60 by the end) and then one day she took 51. 51! I was so excited. It was the first time I didn't have to end a feed by gavoging her (tube feeding). Then the full feeds started to take over until finally she went from being 7% oral to 65% and finally 100%. She needed to be 100% for over 48 hours to come home. Because I couldn't be there for every feed, I okayed the nurses to bottle feed her breastmilk on the feeds I was at home (you have to balance, and I have 3 children to care for). I stayed over nights in the parent courtesy room, sneaking off in the wee hours of the morning to get my kindergartener off to school.
Getting a preemie to eat orally is a lot of work, but neccessary work. You wonder if they will ever get it, but they do, all in their own time.