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Breastfeeding Your Infant in the NICU

Photograph of a mother breastfeeding baby.

For a time, your baby will be cared for in the NICU (neonatal intensive care unit). This is a stressful experience for mothers, and they are often concerned that they will not be able to breastfeed. For babies in the NICU, a breastmilk is the best food for your baby. Think of your milk as an actual medicine that no one else can make. This medicine that you produce is specifically tailored to the needs of a preemie. Breastmilk contains immune factors that help your baby fight off infection. Breastmilk also protects your baby's bowels from damage. At first, you might not be able to actually nurse from the breast. As your baby is able, however, you will be able to practice breastfeeding. This experience can help you bond with your baby and be more involved in your  baby's care.

At first, you may not be able to supply all of your baby's food. Preemie infants sometimes need more calories per feeding, and your milk may be fortified or supplemented. Your baby's health care provider will discuss this with you. Just remember, any amount of milk that you provide for your baby is important. Even if your baby is too small to actually eat, pumped milk can be used for oral care and can also be saved for future use. Your baby's health care team will also want to know about any medications that you are using as you bring your milk to the NICU. 

How do I start and maintain my milk supply?

Normally, breastfeeding stimulates the breasts to produce more milk. If your baby can't nurse, it is important to stimulate your breasts to produce milk. The milk you collect will be given to your baby or stored for future use. The best time to start pumping is within a couple hours after your delivery, the sooner the better. If you delay milk expression, or do not express more frequently, you may not make enough milk to feed your baby. While expressing milk for your baby takes work and commitment, most mothers find the process of providing for their sick infant to be a rewarding experience.

Guidelines for pumping

  • Begin as soon as possible after birth.

  • Your health care team will likely teach you to express milk using just your hand during those early days. For the first couple of days after your delivery, this can be very helpful in expressing colostrum for your NICU baby.

  • Pump 8 to 10 times per each 24 -hour period.

  • Empty the breasts with each pumping.

  • Try not to go more than 4 to 6 hours without pumping.

  • Wash your hands thoroughly before handling the breast pump or collection kit.

  • Be sure to rest and get plenty of fluids. This will help maintain your milk supply.

  • If possible, use a hospital-grade electric pump. These can be rented for use at home.

  • To pump from both breasts at the same time (double pump), use a double milk-collection kit that attaches to the breast pump. Double pumping increases prolactin, the hormone that stimulates your breasts to produce milk. It also saves time.

  • Massage the breasts before pumping and again during the final minutes of pumping. This helps stimulate “let-down” of the milk.

  • Start with a low pump setting and increase it as you get used to the feel of pumping.  Some hospital-grade pumps have special settings that help you get more  milk during those early days of milk expression.

Storing breast milk

It’s best for your baby to be given fresh breast milk that has just been pumped. Since you will often not be with your baby to immediately give the breastmilk, you may have to store your milk for future use. To store breast milk:

  • Use sterile containers. An NICU nurse can provide these or tell you where to get them.

  • Label each bottle as instructed by the nurse. Unless told otherwise, you should write the baby’s name, the date and time the milk was pumped, whether the milk was fresh or frozen. Your baby's health care team will want to know which medications you are taking.

  • Don’t mix milk from different pumping sessions.

  • Keep storage times in mind. Hospitals may have their own process for storing human breast milk for hospitalized infants. In general, the following may be typical storage times recommended for NICU patients. These recommendations may differ from hospital to hospital. Longer storage times can be used for babies who are not in the NICU.

 Room temperature

 77°F  to 79°F

 25°C  to 27°C

 Use within 4 hours

 Refrigeration

 35°F  to 40°F

 1°C  to 4°C

 Use between 4 and 48 hours is ideal.

 Frozen

 0°F  to 4°F

 -18°C  to -20°C

 Use between 48 hours and 3 months, depending on the freezer type.

Getting started with breastfeeding

Before your baby is ready to breastfeed, you may start with non-nutritive (practice) breastfeeding. This means putting the baby to the breast to suckle, without expecting the baby to feed. It can also help with your baby's digestion. It can also help you bond with your baby. And it may help prevent or overcome the baby’s “oral aversion”—a dislike of having things put in the mouth. (Some babies develop an oral aversion due to having tubes in their mouths to provide food or air.) Your baby should eventually start to take in some milk at each feeding. This amount will increase as your baby grows stronger. Sometimes, the NICU staff will weigh your baby before and after a feed to ensure that the baby is taking in enough milk. 

Tips for holding your baby while breastfeeding

  • For good support, hold the baby’s head with your hand, and support the body with your wrist and arm.

  • Keep the baby’s body in a straight line with the head and neck.

  • Sit in a comfortable position, so that you’re not leaning forward over the baby. Bring the baby to the breast, not the breast to the baby.

  • Use pillows or other props to help support your back and arms while you hold your baby.

Breastfeeding positions

Preemies need to feed in positions that provide extra support for the neck and head. These are the safest positions for nursing preemies:

The “football hold.” Place a pillow at your side next to the breast you’re going to use. Lay the baby on the pillow at breast height. Place the back of the baby’s head in the palm of your hand. Use your forearm to support the shoulders and spine. Tuck the baby’s legs between your arm and body. If you’re nursing twins, you may be able to use this hold to nurse both babies at once.

The “cross-cradle hold.” Put a pillow in your lap, and lay your baby across your lap at breast height. Support the baby’s head and neck with the hand and arm opposite the breast you’re using. Hold the baby’s head just below the ears, at the nape of the neck. Use your other hand to support your breast.

 

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