Tips for providing breastmilk for your baby in the NICU

By Kim Carmignani, MSN, RNC-NIC

Congratulations on the birth of your baby! Although a stay in the neonatal intensive care unit (NICU) was not necessarily in your plan for your newborn, your decision to provide breastmilk for your baby during this time is one of the most important things you can do!

Because many premature babies are not yet ready to feed from the breast, you may need to express your milk using a manual or electric pump. Your baby’s care team will give you all the instructions you need to express, collect, and store your milk so that it can be the first and only nutrition your baby receives (excluding early intravenous feeding).

Once your milk is expressed, the nurses will initially feed your baby through a feeding tube placed into the nose or mouth and emptying directly into the stomach. Eventually, as your baby's energy and coordination improve enough to allow your baby to feed from the breast, your care team will ensure that both you and your baby get the help you need to make this happen. Here are some ways to ensure that you have an optimal supply of breastmilk for your baby:  

• Discuss your intent to breast feed at the time your baby is admitted! If your plan includes a breast-milk-only diet (free of cow milk-based formula or a cow milk-based breast milk fortifier) discuss how the care team can help you achieve this. It’s important that you and your NICU team are on the same page so that they can provide the support you need.
• Pumping your breast milk is an added stress and maintaining your supply is difficult. Ask about lactation support. Some hospitals have dedicated lactation consultants, or personnel with extra training in assisting new mothers with the use of a breast pump, collection and storage of breastmilk and even the process of breast feeding. If lactation consultants are not available in the NICU they may be able to provide information about community or other resources to help you.
• Do not be afraid to ask questions if you don’t understand your baby’s feeding plan. It’s okay to ask the “why” questions.
• Ask about kangaroo care even if your baby is not yet able to breastfeed. Skin-to-skin contact has a number of benefits, which include regulating your baby’s body temperature, heart rate, and breathing; decreasing crying; and increasing the likelihood of successful breastfeeding.1
• Start expressing your breastmilk with the use of a manual or mechanical breastmilk pump as soon as you can. Studies show that the earlier you start pumping, the better your production will be.2  Make sure that you use the pump that works best for you. Ask your baby’s health care team for a hospital-grade pump, if available.
• It is important to express your breastmilk every 2 to 2 ½ hours (8 to 12 times a day) for the first several days. This helps to establish a good supply. Make sure that you empty your breasts every time. You will notice that once your baby is on regular feedings, they will be fed this often as well.
• Ask for your baby’s first feeding by mouth to be at the breast (although early feeding will be through a soft tube placed directly into the stomach). Delaying an oral feed until you can be there to place your baby at your breast can be very beneficial. Many NICU teams will gladly accommodate this request.
• Make sure that you take time to eat well, drink plenty of water and get the rest and relaxation you need. Incorporating a relaxing activity like listening to music, reading, or meditation before or during your pumping routine can also help increase your milk supply.3
• Continue to work with your team to increase breastfeeding as the baby will tolerate it. This will help you to prepare for going home. Your NICU team will help you to decide how often you should breastfeed at discharge.
• Lastly, remember that every bit of your breastmilk is important to your baby!

References:

1. Fugate K, Hernandez I, Ashmeade T. Improving human milk and breastfeeding practices in the NICU. J Obstet Gynecol Neonatal Nurs. 2015;44(3):426-38. doi:10.1111/1552-6909.12563
2. Collins C, Maria M, Jennifer G, et al. Avoidance of bottles during the establishment of breast feeds in preterm infants. Cochrane Database Syst Rev. 2016;(10):CD005252. doi:10.1002/14651858.CD005252.pub4
3. Becker GE, Smith HA, Cooney, F. Methods of milk expression for lactating women. Cochrane Database Syst Rev. 2016;(9):CD006170. doi:10.1002/14651858.CD006170.pub5