Breastfeeding in the NICU: What You Need to Know

I’m so excited to have Rebecca Meredith share her experience and tips for breastfeeding in the NICU. This is a must-read for all mothers!

You’re doing everything right.

You take the birth classes, watch the videos, read the books, and slowly but surely cross things off your baby to-do list.

Then you find yourself in an unexpected situation with a premature baby in the NICU, and many of the things you learned don’t apply anymore.

For me, a regular and uneventful check with my midwife was followed up at 1:30 that morning with my water breaking during my nightly bathroom break.

Fast forward 13 hours through a helicopter ride to the closest NICU, one cervical check, and twenty minutes in the delivery room and I found myself with a 33-week preemie and many questions about breastfeeding.

Here are a few tips from a first-time mom navigating the journey of breastfeeding a NICU baby.

Breastfeeding in the NICU

1. Skin-to-skin:

If your baby is premature or has some other type of health condition, he will likely have his own team in the delivery room waiting to scoop him up and provide any necessary medical interventions.

As recommended to get my milk supply started, I was hoping to do skin to skin for a couple hours following his birth.  Instead, his need for breathing assistance meant I only had a couple minutes before he had to leave for the NICU.

This part is hard as you envisioned yourself snuggling with this squishy little newborn on your chest, but both you and baby need proper post -birth care at this time.

Rest assured, there will be time for you and your partner to do skin-to-skin and kangaroo care with your little one in the future.

2. P-U-M-P:

Pump became a four letter word for me, and don’t be surprised if you develop a love/hate relationship with the breast pump.

It is unlikely your little one will be strong enough to suck and nurse directly right away.  A hospital grade breast pump is necessary to begin establishing your supply, and many places offer a rental option until you are established enough to use your home pump.

I used the hospital’s pump when at the NICU and a rented one at home (or in my case, at the Ronald McDonald House next to the hospital). Make sure to see if your insurance covers a pump – most do; you can check out your eligibility here and order one right away!

Don’t be afraid to advocate for yourself to get the pump you need.  My nurses throughout labor, delivery, and NICU stay were wonderful, but no one seemed in a hurry to get me pumping after I delivered.  I was the squeaky wheel asking for the pump as soon as possible to get my supply started.

A lactation consultant was able to meet with me once I was settled in my postpartum room, and she was vital in teaching me how to hand express and use the pump for colostrum collection.

Your baby will hopefully be able to take the colostrum you pump through a mouth swab or a feeding tube depending on her needs at the time.

My husband was also essential as the amount of colostrum produced is small, and it can be difficult to collect each drop in a medicine syringe or medical cup.

Whether or not your baby can take your breastmilk in some form yet, this is important to get your supply going and you can freeze for future use.

Similar to the schedule of feeding a newborn baby, expect to pump every three hours or more.

3. Taking care of you:

Newborn babies are exhausting and NICU babies are no different!  Your day will likely be consumed by visiting your baby during their care times and pumping.

The NICU will likely establish care times when the baby can be stimulated and all of their care is completed to allow the most rest time.

Your baby should still be in utero and resting for the majority of her day, so diaper changes, temperature checks, skin-to-skin, etc. are completed at one time about four times a day/night.

I never wanted to miss these times to be involved in his care, so my day revolved around care and pump times.  I had a hospital pump in his NICU room but I wasn’t allowed to eat there.

Plan appropriately and don’t forget to take care of yourself.  Get as much sleep as possible in between pump times and schedule times to eat. Don’t beat yourself up if you miss a care time because you needed to care for yourself.

The NICU nurses reminded me that they were the most expensive babysitters available, so your little one will be well cared for when you need time for yourself.

A healthy mama equals a healthy milk supply.

4. Nipple confusion:

“Don’t use a pacifier or bottle for at least 4 weeks or your baby won’t nurse- nipple confusion!”

This is another example of things that you learn and promptly disregard when you have a premature baby.

Pacifiers are given as soon as possible to help the baby with the sucking reflex.  The three main things my fella needed to do for discharge were to breathe on his own, to eat by mouth, and to maintain body temperature.

All of these things are tiring for your babe, and strengthening the ability to suck will help achieve the “eat by mouth” requirement, whether breast or bottle.

Once my guy was strong enough to attempt to nurse,we greatly benefited from the use of a nipple shield.  He didn’t have to exert as much energy to draw out milk and was used to sucking on his Pacifiers.

I know there are mixed reviews on nipple shields, but it worked well for us to get him nursing sooner and off the feeding tube.

After we were home and breastfeeding was well established, we didn’t have problems weaning from the nipple shield once he was ready.

Your baby may also be introduced to a bottle sooner than you expected.

She may require additional fortification to your breastmilk for the nutrition and calories due to her prematurity, and adding that to your milk in a bottle also means getting off of IVs and feeding tubes sooner.

We haven’t had trouble going between pacifier, bottle, nipple shield, and later breast. I was happy to try both the nipple shield and bottle while I had lactation consultants and nurses there to assist anytime I needed it.

Do what is right for you and your situation! I also recommend getting the slowest flow bottle nipple possible, and we use the Dr. Brown’s bottle and preemie size nipple (recommended by our nurse).

When you go home you may need to continue pumping and using bottles for the vitamins or extra fortification.

(Pumping is also recommended when using a nipple shield to make sure your breasts are completely drained.)

5. Becoming a newborn:

You will hopefully be discharged before or around your due date.  This means when you take your baby home, he may still be considered a fetus by his adjusted age.

You may be waking him to eat at the recommended time, he may spend a lot of time asleep, and for the most part you are sticking to the schedule established at the hospital.

Fast forward a few weeks and you may start to question if you are doing things right.  He is crying more, wanting to eat more, and you worry that he isn’t getting enough from thebreast.

Chances are, you are doing everything right, and your little one is now moving into more typical newborn behavior.

Throw out your expectations from your previous schedule and feed on demand, utilize soothing strategies like swaddling and baby wearing if you haven’t yet, and celebrate your baby’s growth.

(Remind yourself this is a good thing when they start waking you for feedings at night instead of the other way around!)

Expect some weight check appointments to make sure growth is on track.

A baby in the NICU and breastfeeding can each be challenging in their own way, let alone when the two are combined.

His or her early arrival is not your fault, and you CAN be successful in breastfeeding your preemie.

Don’t be afraid to utilize your resources and ask many questions of your nurses, lactation consultants, and pediatrician both at the hospital and when you are home.

Regardless of how your breastfeeding journey takes shape, you are doing what is best for you and your family.

A fed baby is a happy baby!

Make sure to join our breastfeeding mama’s support tribe on Facebook. If you are looking for additional knowledge on breastfeeding, be sure to sign up for this excellent Simply Breastfeeding course, taught by two very knowledgeable IBCLCs.

If you are coming home from the NICU, you might have gotten used to have all the monitors to show you that your baby is doing fine. The Owlet is a great product you can buy to give you a little peace of mind while baby sleeps – you can learn more and check out the Owlet Coupon Code page for all current offers – the only coupon codes will be available here. They also offer refurbished ones for $199.

Breastfeeding in the NICU is possible - here are some must-know tips for doing so, from a first-time mom who experienced it.

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  • I had my first son at 7months could only pump breast milk for 4 weeks after that was on formula. We did a lots of skin to skin doesn't mean you can breast feed. Gave him a dummy to develop his sucking
    • Absolutely - every situation is different. While skin to skin can certainly help, it doesn't guarantee anything. You did a great job!