Breastfeeding a Preemie in the NICU

Did you deliver your baby early? Were you planning to breastfeed your baby after birth? Breastfeeding in the NICU can sometimes take you by surprise when you have a preemie.

If you’re a first-time mama, it can get overwhelming. Learning the ropes of breastfeeding pumping while worrying about your preemie and your health makes your early experiences as a new mom more demanding.

There are multiple ways to gather breastfeeding information a little at a time. You’ve probably researched it already before giving birth. Take those lessons in as you navigate breastfeeding your preemie baby in the NICU.

You may also be worried if your milk will be enough or have to use donor milk for the first few days.

But, Mama, again, there’s no right or wrong way to address these questions, depending on your circumstance.

My personal experience: I breastfed my 28-weeker preemie daughter in the NICU, and our journey wasn’t that easy but worth it. It was exhausting and hard. I was a working mom when I had her, so I also pumped while I worked during my breaks. Finally, we reached over two years on our breastfeeding journey that started in the NICU.

Also, for my disclaimer – I am a breastfeeding advocate. I support all moms who choose to breastfeed, use donor’s milk and use formula milk. I don’t shame anyone for their choices. Whatever you decide to do with regards to feeding your baby – I am all for baby’s fed and happy and a happy mama too.

Your breastfeeding journey isn’t the same with any NICU mama. But, knowing what to expect when breastfeeding a preemie in the NICU can help you feel secure and informed.

Reasons a Preemie needs Human Milk.

• Best suitable nutrition for your baby
• Lowers the risk for Necrotizing enterocolitis NEC (infection in the gut), Sepsis (infection in the bloodstream), and other health problems.
• They are getting the extended passive immunity your baby needs in the first few weeks/months.
• Part of your baby’s treatment plan. A study suggests it helps develop preemie babies’ brains and help a sickly preemie.
  

What can you expect when you plan to provide breastmilk to your Preemie Baby or start breastfeeding in the NICU?

• Preemie babies may have multiple health conditions when delivered or become sick preemies during their NICU stay.

• Early preemies may not have the coordination to suck, swallow and breathe yet.

• Your breast milk may come in between 3-4 days after giving birth. It’s natural to feel worried about this

• Colostrum in the first 24 hrs to 2 days is enough for your preemie baby needs. It may be a few drops of breastmilk at a time. Moms may use hand expressing at this time. You can help stimulate milk production with frequent pumping sessions.

• Per orders, the NICU staff may fortify the breastmilk you provide for your early preemie with multi-nutrient such as calcium, phosphate, and more; may need more protein, etc. It is crucial because the very low birth weight preemies consuming your breast milk may not get sufficient nutrients for better neurodevelopment and overall growth.

• Get proper nutrition for yourself. Your top priority as a breastfeeding mama is taking care of yourself. Your body will need what it can get to produce milk. Hydrating frequently keeps your body balanced to function correctly and supports a good milk supply.

• Establishing your milk supply even before your preemie can direct feeding is crucial. Slow start of milk supply: stress, worry, personal recovery from birth can affect your milk supply. Your body can sometimes limit prolactin production – which helps you make milk for your baby.

• Non-nutritive sucking for preemie practice and milk stimulation. This method is encouraged in the NICU setting to help preemies practice coordinating their breathing, sucking, and swallowing reflex; mom benefits in bonding and more milk supply.

• Weight Feeding: Before and After – Preemies are weighed before they have a breastfeeding session and weighed afterward. The difference will show how many ounces of human milk they have transferred from mom.

• You will see a lactation consultant during your NICU stay.

In my experience, I’ve seen my lactation consultant throughout my hospital admission and even the entire NICU stay of my daughter.

She provided me with information on how to get started with pumping and increasing my milk supply. During NICU visits, I also spoke with the lactation consultant about breastfeeding techniques, pumping troubleshooting, creating a proper latch, and addressing breastfeeding issues.

• A lactation staff can be a valuable resource for any NICU mom who plans or breastfeeding their babies.

• NICU nurses will help you out as well. They’ll be there to show you how they do tube feeding, explaining the TPN and when your baby will transition to oral feeding. They also showed me how to bottle-paced-feed my preemie daughter with my breast milk.

• Some NICU graduates may go home with a feeding tube; it’s best to get lessons from the assigned nurses of your baby. One-on-one teaching sessions can help boost your confidence in feeding your preemie at home. Ask questions and write them down if you need to, so you’ll be able to refer back once your baby is discharged.

Most Common Questions When Breastfeeding a Preemie in the NICU

How does the NICU feed preemies?

As mentioned above, having a baby in the NICU, you will witness different preemie feeding methods:

• Feeding tubes with your breastmilk. A nasogastric tube (NG) will be placed on your preemie and adequately secured in place. The nurses will deliver your milk through this feeding tube at scheduled times.

• Total parenteral nutrition (TPN) through an intravenous line with specialized nutrition for preemies. There’ll be constant monitoring of the TPN, blood draws, and rates adjustments.

• Breastfeeding – where you come in.

• Paced bottle feeding – this method mimics how a baby does while breastfeeding. The baby controls the milk intake, takes breaks, and gives cues when the baby is full. Some helpful tips to be successful at paced bottle feeding a preemie.

How to keep up with milk supply for your preemie?

• Hand expressing – you use your hands to massage your breast and help express the milk into a sterile container or syringe.

• You are pumping every 2-3 hours for the first two weeks, day and night. Time your pumping schedule with your preemie feeding schedule in the NICU.

• How long to pump depends for every mom. Some moms don’t feel full on their breasts between sessions. Don’t pump for more than 30 minutes. Average pump sessions from 15-20 minutes.

• Power pumping sessions: additional pumping sessions as needed

• Spend as much time with your preemie in the NICU

• Kangaroo care when possible – skin-to-skin time with your preemie. Some call it therapeutic touch, some healing hugs.

RELATED POST: Kangaroo Care for NICU Babies

Proper Latch and Positions

A gentle approach and patience are what a NICU mom needs to breastfeed a preemie.

Breastfeeding babies need to have a proper latch when feeding; however, it can be challenging for preemie babies to do that.

Oral muscles development, tongue function, and coordination are needed to do proper latching. A speech therapist will often work with your baby and the lactation consultant to assist you.

They will check for tongue-ties and other oral feeding issues involved. Keep working with the NICU staff as you learn how to breastfeed your baby.

Position your preemie as much as you and she are comfortable and undistracted during breastfeeding in the NICU. Usually, you will have a recliner next to the NICU isolette, prop up pillows behind you, and one under the side where your baby is feeding.

Preemie Feeding Issues in the NICU

• Preemies need to learn how to feed (suck, swallow and breathe)

• Feeding too fast may lead to oral feeding aversion, more spit-up incidence

• Practice paced-feeding to give preemie time to develop and adjust to the feeding. It also lessens their energy used while feeding.

• Sleepy preemie – preemie babies get tired quickly. It’s essential to consider the timing of primary care and feeding times.

• Nipple diversions – either breast or bottle, some preemies may not adjust properly to the switch. Moms can use temporary nipple shields until the preemies are reintroduced to mom’s nipples each feeding.

• Preemie feeding is challenging enough. Some NICU babies will have therapists work with them with oral exercises to help develop muscles and learn to feed.

When do you start directly feeding your preemie baby?

It will depend on how your preemie is doing medically, how your baby has adjusted to non-nutritive practice feeding, your baby’s gestational age, and readiness. Most preemie babies start to do direct breastfeeding around 34 weeks.

However, early preemies under 34 weeks can also do limited breastfeeding sessions with moms. It depends on every preemie, health condition, and other feeding factors.

What If I can’t provide Breast Milk?

Donor human milk – these breast milk are donated by moms who are thoroughly screened and health checked. The donated milk undergoes pasteurization to eliminate possible pathogens.

For the first 24 hours, we used donor’s milk donated by a mom in the NICU my daughter was admitted. I am forever grateful for her for being able to share her milk. I was sick from severe preeclampsia and couldn’t produce milk yet. My preemie daughter was able to receive that mom’s gift.

Preemie formulated milk – specialized milk for premature babies.

PAUSE: It’s okay if you want to stop for your benefit/health. No one can force you to pump or breastfeed your baby. Your decision is your own, and it can change at any time. Don’t feel pressured to produce if you aren’t able or feel you’re going insane with providing milk for your preemie.

Your health and mindset are important too to care for your NICU baby.

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What pumps should I use to help my milk supply?

The pump

Having a reliable and quality pump makes all the difference in any pumping/breastfeeding mama.
If it doesn’t fit what you need, it’ll only sabotage your efforts.

Research and ask around any pumping moms you know or lactation consultants for pump options.

Will my insurance cover the pump? Renting options? Most insurance will cover the pump or pay for part of the cost. You may also want to check the possibility of renting a hospital-grade pump and send an insurance claim to cover the cost.

Hospital-grade pumps are available in the hospital where your NICU baby stays. Check out this Medela Pump I rented.

The commercial personalized pumps are readily available in stores or online, with plenty of options to choose from portability, quality, flexibility, and cost-effectiveness.

I was able to use the hospital pump during my admission. I rented one from the hospital on the day I got discharged. You can extend rent periods or return the pump whenever you have your pump.

Honestly, the Medela hospital grade pump was a lifesaver for my early pumping days. It delivers the perfect suction and encourages milk production when I wasn’t producing enough.

I purchased the Spectra Two pump for home use and work; I got the Medela Pump in my pumping bag, and my insurance covered the cost. Also, I recommend getting a Haakaa silicone milk collector.

Pumping Accessories:

Properly sized flanges – for comfort and to prevent nipple issues.
Bottles for Pumping
Pumping storage bags
Pumping tubes and duckbills
Nipple creams

What if I take regular medications and pain medications while pumping/breastfeeding?

Most importantly, speak with your healthcare provider and your baby’s doctor about taking medications while pumping/breastfeeding.

Some medications can affect your baby. However, if you are in pain from childbirth, you most certainly don’t have to skip the prescribed medication regimen. If you had a C-section birth, you want to keep on top of the pain before it gets worse.

Learning more about breastfeeding and medications can help you feel at ease in providing breast milk for your baby and taking good care of your health while breastfeeding.

Proper Storage of Breast Milk:

Store pumped breast milk: quality breastmilk bags for freezing or extra bottles for freshly pumped milk.

How long will thawed breast milk be good for?

Check with your NICU policies for specific breastmilk storage and thawing.
You can also read on proper care and storage of breastmilk here.

Transporting pumped breast milk from home:

You can transport freshly pumped breast milk in a cooler with ice. It is suitable for 48 hours only in the NICU refrigerators.

Frozen breast milk can be in an insulated cooler. Make sure the breast milk doesn’t begin to defrost in transit.

Once thawed in the NICU, the milk is only suitable for 24 hours.

Essentials for pumping success:

Be consistent with your pumping schedule.

Pump when and wherever you can – whether at home, in the car, at work, or in the NICU. Getting extra pump parts makes your pumping efforts efficient.

Celebrating your progress – if you have enough for your baby, great! If you have a freezer full of pumped breast milk, great! You do you.

Purchasing a pumping bra – for convenience and freedom.

It was life-changing for me. I didn’t have to hold the bottles. I can do whatever I’m doing at the moment while pumping. As a working mom, I could quickly eat while pumping on the side on my breaks. Talk about multi-tasking.

Get support from your spouse, family, or other postpartum support. Please don’t do it alone. Ask when you need help and learn from every experience.

The NICU staff will continue to evaluate your preemie with their feedings, especially once the discharge is imminent. It ensures they’re correctly taking in amounts of milk, exhibiting good oral feeding practice, and ensuring that transition feeding is up to a good start before going home.

It’s a massive milestone for NICU babies. Finally, they tolerate their paced bottle feedings, breastfeeding sessions, and transitioning to transitioned feedings. You and your preemie have come this far in your NICU journey.

NICU resources and breastfeeding support:

1. La Leche League 
2. International Lactation Consultant Association
3. Office on Women’s Health
4. Milky Mama – products for breastfeeding mamas
5. Kelly Mom – breastfeeding resource

Final words of encouragement for breastfeeding a preemie in the NICU

As a NICU mom, you have a lot on your plate. Breastfeeding or pumping for your preemie requires your commitment, and it can be challenging during the NICU stay. 

There are other challenges you face as a NICU mom. You may be struggling on all sides of your NICU journey. You may also feel alone in this, but you are not. 

Not only will you have NICU worries, if you have children at home – it adds up too. If you have a job before giving birth, you may have to navigate your maternity leave differently because of a NICU baby. 

Take refuge that everyone will be rooting for you and your preemie baby. Your number one supporter is your spouse; the rest are your family, friends, NICU staff, and other encouraging people in your circle. Lean on them at this difficult time.

Prepare to ask for help more times than you want to. It’s okay to delegate other tasks to keep you free to do the pumping for your preemie. However, you may have to adjust some routines at home to accommodate NICU visits and breast milk transport. 

Remember, you are doing your best. You are enough and what you do is enough. Stressing over what you can’t control or can’t do at this moment will only affect your milk production for your baby. 

Put your effort into staying as healthy as possible. Take time for yourself as well. You can check out these tips for NICU mama. If you have children at home, read on how they can adjust with a NICU baby. 

You are an amazing mama. Facing limitations and fears of being a NICU mom is hard. Breastfeeding your preemie is a beautiful experience that comes with its challenges. You are strong; you are NICU mom strong. 

If you are a NICU mama, let me know what you are struggling with right now concerning breastfeeding. What helped you get through breastfeeding your preemie in the NICU for all our NICU mama graduates? Please share this post.

All breastfeeding information is only for general purpose use only. It doesn’t substitute a professional medical or healthcare provider’s advice. Always consult your healthcare provider and seek advice.