Tips to Successful Breastfeeding in the NICU

NICU (Neonatal Care Unit) moms are warriors!  

Whether your baby lands in the NICU as a preemie or is full-term but has a problem which requires a NICU stay, the NICU can be a very scary place. The postpartum period is hard! As a mom, worrying about a sick infant and having to travel back and forth to the hospital is draining. Mother’s actually can experience a lot of trauma related to having a baby in the NICU – but that’s for another post! As a Physician Assistant in the NICU for the past 38 years and an IBCLC (International Board Certified Lactation Consultant) I will share some tips for successful breastfeeding in the NICU.

Perhaps you planned to breastfeed but now feel you are on an emotional rollercoaster. Your baby is not in your room with you at the hospital as you had expected. Now you feel breastfeeding is going to be lost as well. It can feel like one devastating loss after another. BUT – NOT TRUE – this does not have to be your reality! Here are some tips for successful breastfeeding in the NICU.

What if I never even intended to breastfeed?

First, let’s consider the alternative. Perhaps you never planned to breastfeed at all. The NICU staff is educating you about how important human milk can be to your little one’s survival. Now you have agreed to pump to provide breast milk. Either way this article is for YOU. You may not have the first idea about how to initiate your milk supply (since this wasn’t your plan). But you can successfully initiate your milk supply and maybe you will decide to breastfeed your NICU baby. But, even if you stick with your original plan of NOT breastfeeding you can help your baby. Your baby will benefit from your breast milk while in the NICU by getting discharged home faster, growing better, and decreasing the chances of life-threatening illnesses that preemies are more susceptible to. All these benefits for your baby you can provide – just by pumping to provide your breast milk for awhile.

For now – let’s assume you have delivered – your baby is in the NICU and it’s time to start making milk! Here are some of our best tips to successful breastfeeding in the NICU.

Tips for initiating your milk supply when baby can’t go to breast yet.

• Spend as much time as the staff will allow skin to skin with your little one.
• Begin pumping/hand expressing as soon as possible following delivery. Studies show that beginning to pump/hand express within the first 6 hours helps milk supply a lot.
• Make sure to use the hospital grade breast pump that the NICU/hospital provides.
• Make sure you are educated by the staff or an IBCLC regarding how the pump works. The massage and expression settings for the pump are there for a reason. Also, have a flange fitting done by the IBCLC in the NICU. Many mothers need smaller flanges than the ones supplied by pump manufacturers.
• Your goal is to get to 900 milliliters (30 ounces) of breastmilk per day in the first few weeks.
• As tempting as it may be to skip overnight pumping – DON’T DO IT! Your prolactin (the hormone that makes milk) levels are highest at night and you will be missing a wonderful opportunity to ensure a good milk supply.
• Remember this key point: It is the frequent (typically 8-12 times/24 hours) and good removal of milk that increases supply.
• Supply will start slow (drops only) but steadily increase with advancing days.

Tips for starting out feeding at the breast in the NICU.

• There is no hard and fast rule about when a baby can begin to go to breast. NICU’s have varying policies regarding this but preemie babies can breastfeed at very early ages. However, it takes extra care in the early days to make sure they are doing well/getting what they need when they are premature.
• In the early days when baby is perhaps having gavage feeds (feeds where the food goes through a tube directly into the baby’s stomach) hold your baby skin to skin or at breast during the feeding so your baby begins to make an association of feeding and time at breast.
• When baby starts going to breast – use the IBCLC (International Board Certified Lactation Consultant) staff in the NICU to help you as needed with positioning and latch. Often they can help and offer suggestions to make this easier and comfortable for you.
• Baby may start out with some minimal suckling/swallowing and tire out easily. This is very typical for a preemie baby or a baby who has been sick. This does not mean that your baby won’t be able to do better with time- HANG IN THERE! Patience is hard but necessary in the NICU.

Tips for continuing to breastfeed as your baby improves.

• Most NICU’s should have the ability to do weighted feeds for you so that you and the staff will not need to guess about how much the baby is getting when breastfeeding. While this is not needed as much with a full term healthy baby it can be really important in the NICU with preemies or late-term preemie babies. The staff can gauge how much additional breastmilk if any the baby needs to have after breast-feeding.
• Better yet as time goes by baby can receive all the feeding at breast using a supplemental nurser system (if needed). Baby will learn that all feedings happen at the breast.
• One of the things that is most frustrating in the NICU is that feedings are often “scheduled” instead of “responsive“. This means that sometimes feeding cues or feeding readiness has already passed for the baby and the “scheduled feeding time” isn’t necessarily when the baby is hungry or ready to feed. As your baby improves here is where advocating for “feeding on demand” or feeding responsively is really helpful to your success.
• Make sure that you and the NICU staff are practicing paced bottle feeding when/if bottles are used.

Tips if your baby is struggling to breastfeed in the NICU- what could be wrong?

• Some NICU’s will experiment with a nipple shield if baby is having difficulty latching, staying latched or transferring milk. Some studies show that premature infants do better in the early days with milk transfer using a nipple shield.
• Remember babies in the NICU can have tongue ties as well and if feedings/latching/milk transfer are a big problem continually this is something to consider. Many MD’s, even IBCLC’s are not skilled in evaluating for this so you may need to seek out someone you know who has this skill.
• The more you are present in the NICU the easier it will be to spend more time breastfeeding.
• Some NICU families figure out that just being able to take feeds by bottle is the NICU staff’s goal for discharge. This often makes families not want to spend time breastfeeding – YOU JUST WANT TO TAKE YOUR BABY HOME!

Tips as you prepare to go home from the NICU.

• Remember even if you go home bottle-feeding – you can still figure this breastfeeding thing out- you just may need some help.
• Arranging to rent a scale to do weighted feeds at discharge can be helpful in the transition home from the NICU.
• If you are leaving the NICU not yet making 30 oz/24 hours of breast milk then continuing to use a hospital grade breast pump can be helpful.

Tips for continuing to breastfeed once you are home.

Now you are home. Whether you have left the NICU as a fully breastfeeding mom OR you have a long way to go to reach your goals – there is a lot of help available for you. Now that you are more in control of things you can spend more time breastfeeding. Most mothers transitioning home need the help of an IBCLC. Figuring out how to move from breastfeeding occasionally to more full time feels scary. Having an IBCLC to help you to build your confidence is really important. By being able to monitor how you and your baby are doing as breastfeeding improves, you will begin to feel more confident and successful.

Leaving the NICU is a milestone – but it can be both scary and exciting. It is easy to become overwhelmed with anxiety and fear regarding many aspects of this transition. Having an IBCLC along for the ride makes it so much easier.

We believe in you! You can do this…….

Patrice

Check out this amazing story of how one midwife and mom successfully navigated breastfeeding in the NICU

Interested in learning more about the emotional toll of being a parent of a premature infant?