Giving birth elicits many emotions from moms, but having a baby who goes straight to the NICU is a unique challenge. Not only do moms have to care for themselves, but they also have their work cut out for them when it comes to getting a handle on breastfeeding.
From postpartum recovery to pumping to trekking back and forth to and from the hospital, NICU mamas are some of the toughest and busiest parents out there. And after you’ve had one NICU stay, you’ll never forget it. The experience is both nerve-wracking and life-changing, and you develop a new appreciation for how difficult parenting is when you’re barely able to hold your baby, let alone take him or her home.
But even though your baby might be staying in intensive care for an undetermined amount of time, that doesn’t mean you can’t breastfeed. Whether it’s through nursing directly or bringing milk to the hospital, you can successfully breastfeed your NICU baby and give him or her every opportunity that full-term and healthy babies have.
Of course, there’s a lot to learn about breastfeeding if it’s your first go-around. But there’s also a lot to learn about breastfeeding in the NICU and the unique challenges (and a few helps) that come with it—starting with these 25 things.
25 You Might Have To Start Small
Since some NICU babies are tiny little preemies, you might not be able to breastfeed directly at first. But don’t worry—as your baby grows, odds are, you’ll be able to nurse easily. In the beginning, though, you might want to consider cup feeding or using a tube so your baby can latch onto your finger.
Finger feeding is a common step in getting babies ready for bottle and breastfeeding, and in the meantime, you’ll need to express milk manually or with a pump.
Of course, plenty of NICU babies are big enough to latch on without help, so this only applies to smaller babies or those with latch struggles.
24 Timing It Right Can Help
Since many NICU babies are dealing with health problems and other challenges unrelated to breastfeeding, eating can wear them out! And since breastfeeding can take a lot of energy for such small babies, you might need to take a different approach to feeding than you would with an older baby.
For example, some NICUs recommend having babies attempt to nurse after they’ve already had some expressed milk or formula through a bottle or other feeding method. This way, they’re getting the calories they need but are still practicing breastfeeding for when they’re big enough to handle it 24/7.
23 It Might Take Time—But Never Say Never
Consistency can pay off, even when it comes to NICU babies who are dealing with overwhelming health issues. After all, babies are naturally programmed to want their mamas and their milk—the instincts are all there!
However, NICU babies—and preemies in particular—often have a long road toward being able to eat on their own. And during that time, breastfeeding may be difficult and even seem impossible—but you should never say never! One day, your baby may just surprise you with a great latch and a passion for nursing.
22 Need A Shield? Get One
If you’ve breastfed before, or just done a lot of research, you might have read conflicting information about nipple shields. A breastfeeding shield creates a barrier between your baby and her food source, reducing pain for mom and making it easier for the baby to latch.
There are tons of reasons why moms choose to use nursing shields, but some lactation consultants, and other healthcare professionals, caution against them.
The thing is, if it comes down to choosing to nurse with a shield or not breastfeeding at all, most mamas will choose the shield—and there’s nothing wrong with that! If you need it, just use it—you can worry about weaning off it later.
21 Pumping Is The First Priority
It can be stressful and emotional to give birth only to have your baby whisked off to the NICU. But apart from spending as much time as possible with your new bundle, the next most important thing for moms to do is start working on making milk! If you want to breastfeed, you should start pumping as soon as possible after delivery.
Keeping consistent will help your milk to come in sooner and will help encourage a full milk supply.
This way, whether you’re nursing directly or not, your baby will have milk stockpiled for when he’s ready to chow down. Then, you can transition to breastfeeding directly when possible.
20 Supplements Might Not Help
There are scores of lists of natural galactagogues online, but not all of them are ideal for moms of NICU babies. A galactagogue is something (food, herb, or other consumable item!) that helps moms produce more milk. But many have side effects, and some are more difficult for NICU babies to deal with.
For example, fenugreek, a common herb used to promote milk production, has the pleasant side effect of making mom and potentially her baby smell like maple syrup. However, fenugreek can also cause tummy troubles in both mom and baby—and NICU babies’ sensitive tummies are often more susceptible than term and older babies.
19 There’s Help Available Practically 24/7
One helpful thing about having a baby in the NICU is that there’s no shortage of professionals to answer questions and help you out. From the nurses to the doctors and lactation specialists to social workers, there’s always someone who’s willing to lend a hand and share their expertise.
Hopefully you’re able to maintain relationships with all these connections, so that you have the best chances possible of having both you and your baby’s needs met. Especially when it comes to breastfeeding, the more advice and assistance you can get, the better. And, hospitals are literally open 24/7, so someone knowledgeable is always around.
18 You Might Have To Fight For Your Rights
Unfortunately, some mamas struggle to breastfeed their NICU babies because the staff there discourage it. And it’s hard to continue to try nursing your baby when the staff continually ignores your requests to have her breastfeed before having a bottle, or to give her expressed milk instead of formula.
After all, it’s often easier for NICU staff to feed your baby a bottle of whatever’s on hand per a schedule rather than waiting for you to bring in milk or stop in to nurse your baby.
That said, the more you speak up, the more respect you command—so make sure you’re voicing your wants and needs and not backing down.
17 Prepare To Pack In Milk
As much as all parents wish they could stay in the NICU all the time with their babies, we do have to go home to sleep, eat, and even go to work. That said, mamas who are fully committed to breastfeeding have some extra work to do even when they’re away from their babies.
Moms who are breastfeeding have to keep expressing milk while they’re at home (or work or anywhere else) and package it properly for the NICU. Some NICUs have special rules about bringing in milk, whether it’s the size of the container or the need for names, dates, and other info on the bottles.
16 Supplementation Is Sometimes Needed
If you’re a mama who hoped to breastfeed from day one, it can be a devastating blow to be told that your baby needs supplementation. But know this: some babies legitimately need more than just mom’s milk at first. Whether it’s a calorie related issue or volume related (most mamas don’t produce a whole lot of milk the first few days postpartum), many NICU infants will need a bottle of formula or even donor milk.
However, this doesn’t mean they’ll always need supplementation—plenty of babies go on to drop supplementary feeds and then breastfeed exclusively—no long-term issues caused!
15 Size Doesn’t Mean A Thing
Even if you have the tiniest baby in the entire NICU, you might be surprised how little size actually matters. The tiniest tots are sometimes the most eager with breastfeeding, and just because your chest dwarfs his tiny head, that doesn’t mean your baby won’t be able to latch.
Of course, not every 24-week preemie will be able to handle directly breastfeeding.
After all, some babies have health issues that make latching on hard. But don’t let your baby’s size alone deter you from trying to nurse, and make sure you give her a shot at nursing if it’s something you really want to do.
14 Twins Aren’t A Deal-Breaker
Many times, when moms find out they’re expecting twins, everything becomes much more intense. Doctors tend to want automatic C-sections, people tend to assume you’ll just bottle feed, and if you don’t do those things, you’re the exception rather than the rule. But there’s no reason mamas with twins (or even triplets or higher multiples!) can’t breastfeed (or have a natural birth, too).
While some mamas won’t be able to produce enough milk for two babies, many can! Therefore, twins aren’t a deal breaker no matter your choices about birth and baby feeding.
13 It’s Always Possible To Learn Something New
With all the worries about confusing babies with different bottles and forms of feeding, it’s common for mamas to think they’ll never be able to nurse if they don’t start right away. But even babies who are physically unable to nurse at birth can learn to do so later.
Some babies spend months in the NICU and go home to successfully nurse for months or even years, so it can be done! Of course, it may not be easy, but many babies can learn new things pretty easily—and as your NICU baby grows, he’ll learn all kinds of new skills—including how to eat.
12 Milk May Be More Important Than The Latch
Many NICU babies won’t be able to eat by mouth, especially if they have health issues apart from arriving earlier than expected. But in the end, most studies about the benefits of breastfeeding are related to the milk itself rather than the physical aspects.
Of course, holding our babies to feed them results in optimal bonding. But giving tube-fed babies breastmilk is almost always preferable to formula whenever possible, even if they never breastfeed directly. Tube-fed babies can still get all the nutrients and immune benefits of mom’s milk, no nursing needed.
11 Your Stress Shows In The Milk
Having a baby in the NICU is a super stressful experience—ask any parent even decades later, and they can retell the story with every detail intact. But the thing is, your milk production depends on remaining calm, getting enough to eat, enough sleep, and just generally taking care of yourself.
After all, milk production depends on adequate nutrition and a relaxed mama. Studies have shown that moms who are apprehensive about their milk tend to produce less when pumping—a clear sign that your mindset is the most important part of your breastfeeding approach.
10 Know What To Ask For On Site
If it’s your first time in the NICU with your baby, you may not realize just how much the hospital can help you out! For example, with my first baby, our NICU had a separate pumping room for moms on another floor. If the staff hadn’t told me about it (and given me the access code!), I wouldn’t have seen it or ever known it was there! Of course, you need to know what to ask for when it’s your first (and hopefully last) experience there.
So make sure to inquire about an on-site nursing room—many have hospital-grade pumps that are safe for moms to share—you just bring your own tubing and pump kit.
9 Make Sure You Have Your Pump Parts
Another helpful part of the NICU experience is the fact that most will give new moms a pumping kit. The kit includes parts that connect to each hospital’s trademark pump. In most cases, it will likely be a Medela pump kit, since multiple moms can use the closed-system pumps just by bringing their own tubing, flanges, and collection containers.
And, if there’s no pumping room available, most hospitals can either lend or rent you a pump to use during your baby’s stay. You can even request a pump be brought in so you can sit by your baby while you express milk.
8 You May Not Get Any Privacy
Depending on the setup and layout of your baby’s NICU accommodations, there might not be much privacy to be had. This goes for moms who are trying to nurse and parents who are trying to have private or serious conversations with medical staff.
However, if you’re shy about nursing next to your baby’s bed, you can ask if the hospital has any curtains. My NICU had portable room dividers to give moms a bit of privacy while nursing. They also had rocking chairs they dragged over so the moms could be comfy.
7 Maximum Output Isn’t Necessary!
If you’ve just begun pumping and your baby is a new resident in the NICU, you might not be getting much milk yet. After all, in the first few days postpartum, most moms are only producing colostrum. And while you won’t have more than an ounce at most of this milk, every drop is precious for your new baby.
Even if you never have a full milk supply—more than 20 or so ounces per day—you’re still giving your baby a great nutritional boost and tons of love. So don’t feel bad if your output doesn’t match your expectations—any amount helps your NICU baby get healthier and stronger.
6 Your Milk Is Making A Difference
The reason why quantity isn’t such a big deal is because no matter how much the baby gets, your milk is making a difference! Each mom’s milk contains custom-made nutrients for her baby.
At birth, you’re still operating off your pregnancy hormones, and postpartum, you and baby work together to get the milk started. Therefore, your milk contains immune protection, antibodies, and custom nutrition for your little one. And, the more you nurse, the more your baby (and his saliva) tells your body what it needs to make, and how much.
5 You Can Ask For Donor Milk
Even if you haven’t produced a drop of milk yet, you can still ask for breastmilk for your baby. Many hospitals have policies in place to offer donor breastmilk to NICU babies. Donor milk is screened, tested, and, typically, processed to reduce the risk of contamination or other issues.
In my experience, I had to sign a waiver for my baby to receive donor milk. I also had to sign each time we fed him a bottle of the milk, confirming that he used it. Don’t hesitate to ask for donor milk if it’s something you prefer over formula supplementation!
4 Hospital Regulations Are The Rule
In some cases, your hospital NICU may have specific guidelines for which babies are “allowed” to nurse. After all, if your baby is significantly premature or has other health problems, such as respiratory distress, it may not be safe to directly breastfeed.
Many hospitals limit visiting hours in the NICU to ensure that babies get their rest—and that nurses can take care of their patients (and their paperwork). Keep in mind that the staff wants what’s best for your baby—just like you do—so try to roll with the punches if their policies limit you.
3 Making Friends With Your Nurses Helps
While your baby is in the NICU, his nurses will be the people who see him most. And while it’s sad for moms and dads to leave their tots, you know that they’re in good hands while you’re away.
What’s even better is when you can develop a relationship with your nurse(s) and have their support in your efforts to breastfeed. No matter whether your baby is in the NICU for one night or five months, talking to his nurses and letting them know what you want and need can do wonders for your working relationship.
2 Only Check-Ins Can Help You Know For Sure
From personal experience, I know that a lot of doctors are reluctant to let NICU babies breastfeed and call their feedings good. After all, progress in the NICU is often marked by gain in pounds and developmental milestones. So if your team can’t document how many ounces your baby just ate, they might resist you breastfeeding regularly.
But you can ask for check-ins pre- and post-feeding to prove how much your baby is getting—and to give yourself peace of mind.
1 Bilirubin Isn’t Enough Reason To Ban Breastfeeding
Many babies, both NICU tots and full-term and healthy infants, are born with jaundice or develop it within a few days after birth. Jaundice is a condition caused by bilirubin buildup in babies’ blood. The way to get rid of bilirubin is usually through feeding; the more babies eat, the more bilirubin gets flushed out.
Therefore, babies who are formula or otherwise bottle fed tend to get rid of the bilirubin (and the yellow tint of their skin) faster than breastfed babies. However, a jaundice diagnosis doesn’t automatically mean you have to bottle feed—especially if your baby doesn’t have any other health problems.