breastfeeding in the nicu

As everyone knows, pregnancy is a beautiful journey lasting about 9 months, providing sufficient time for baby to grow and develop and for both mom and dad to prepare for the arrival of their little bundle of joy.  In some instances however, babies decide to surprise their parents and enter into the world earlier than expected.  This can be a very stressful time with an unpredicted and unplanned delivery, followed by your little baby arriving before they are ready.  Babies that are born before their due date and before 37 weeks gestation are referred to as preterm infants.  As preterm babies are born early and before they are ready, they are kept under careful eye in the neonatal intensive care unit (NICU) so that they can be closely monitored and treated.  Usually when preterm babies arrive, practically starting to breastfeed isn’t on the radar just yet and parents are usually at that stage when it is all about getting the room ready and shopping for baby essentials.  Suddenly though baby is here and it is time to start feeding the little ones.


Depending on how early your baby arrived will determine when and how your baby will be fed. Often if babies are born very early, their guts are still too immature for feeding and babies may be fed intravenously.  The aim is however to always start feeding expressed breast milk or breastfeeding at the breast at the soonest.  There is no denying that breastmilk is the gold standard for babies, whether they are born at term or earlier.  As mentioned above though, having a preterm baby in the NICU can be very stressful, with your little baby being hooked up to all sorts of machine and pipes – not the ideal situation and definitely not what any parent would imagine.  This stress can of course affect mom’s production of breastmilk but it is vital that all moms of preterm babies seek advice and assistance from nursing staff, dietician or lactation consultant to assist them with their milk supply.   It is so important that moms start expressing breast milk as soon as possible, even if baby is not able to tolerate feeding straight away.  This will help to establish a milk supply and have expressed colostrum available for the baby’s first feeds. Some guidelines recommend starting expressing 6 hours postpartum, followed by frequent expressing (every 2-3 hours day and night).

Begin with Pumping

As preterm infants usually have not developed the feeding skills required for breastfeeding, feeding your baby expressed breast milk is the next best thing.  To do this as effectively as possible, the use of a breast pump is highly recommended. It will kick start your milk supply and remember the more you pump, the more milk you will produce. As preterm infants stay in the NICU day and night, expressing your breast milk also offers the advantage that the nursing staff can feed exclusive breast milk to your baby when you are not in the NICU. Ideally each NICU should have a dedicated breastfeeding room for moms that offer a quiet and tranquil space for expressing.  There are a wide range of breast pumps available on the market and be sure to visit your local baby store to see what they have available.  Always opt for a BPA free breast pump.  Bisphenol A (BPA) is a chemical used in the production of consumer goods made out of polycarbonate. For quite some time, this chemical has been considered as being harmful to health. Experts therefore recommend using only BPA-free breastmilk bottles.


The Importance of Hygiene

As preterm babies are at risk of infections, ensuring proper hygiene is vitally important before, during and after expressing your breast milk.

Before expressing, you should always wash your hands with soap and water.  Always follow the manufacturer’s directions for cleaning the breast pump and pump set. Containers used to store your breast milk should always be cleaned and disinfected before use. Be sure to store your breast milk in a sealed container, with a label that contains the date the milk was expressed and the name of your baby.  Although a bit of a given, you should avoid sharing breast pumps with anyone as it is unhygienic and unsafe.

Helpful Tips for Breastfeeding in the NICU

  • Discuss your desire to breastfeed with your baby’s medical team.
  • Ask for a referral to a lactation consultant who has experience in the NICU.  Ask to speak to other NICU mothers who are successfully expressing milk or breastfeeding their babies.
  • Start expressing your breast milk as soon as you can. Use the breast pump that best works for you.
  • Establish a relaxing ritual so that you condition your breasts to “let-down” (eject milk) when it’s time to pump or feed. Expressing in the NICU is great, especially after spending some time with your baby. 
  • If you’re establishing your milk supply aim to express every 2 to 3 hours around the clock for a couple of days and nights. It does sound exhausting but will be worth when then the breastmilk starts pouring in.  Find a routine that works best for you and your milk supply.
  • When you express, be sure to “empty” your breasts to extract the hind milk, which is energy dense. Express for a minute or two after milk flow stops or comes out in slow drips.
  • Persist through the ups and downs of your milk supply. Expect very small amounts at first. At any time, if your breasts seem unproductive in spite of expressing, you may be tempted to give up. But try to persist in keeping your breasts primed. Try getting more rest, drinking more water and expressing more frequently (rather than for longer sessions). Your milk supply may build up naturally in response to a decrease in stress in your body.
  • If your baby is able to suckle, he will be more receptive to feeding when he is alert and quiet. Your doctor and medical team will be able to assist with this decision ad letting you know when your little one is ready. Ask to feed him in a quiet, darkened room so he does not become distracted. Start by doing kangaroo care, holding your baby against your bare chest. Kangaroo care will relax both of you, and the skin-to-skin contact may inspire him to suck and your milk to flow. When he starts rooting around on your skin, guide him to your nipple.
  • Recognize that every mother has to do a certain amount of figuring out what works best. For instance, if your baby has trouble latching onto your nipple, try using your pump’s suction to draw out your nipple before putting your baby to the breast. Or if your milk spurts out at the beginning of the feed and overwhelms your baby, pump just enough to decrease the pressure or volume. That way, your baby can keep up. Try to find solutions that work for both of you.
  • View the entire feeding relationship as meaningful for you and your baby. If you choose to supply a small amount of milk, or if you want to put your baby to the breast even if you supplement with a bottle-feeding afterwards, do so. Permit yourself room to experiment and adjust.
Reference: Breastfeeding Your Premature Baby, by Gwen Gotsch (La Leche League International, 1999).