Breastfeeding Basics in the NICU

August 1, 2023

Breastfeeding Basics in the NICU, hand to hold, breastfeeding awareness month Breastfeeding can be challenging under the best of circumstances, but when your baby is in the NICU, a whole new set of challenges presents itself.  Every family’s feeding journey looks different. Feeding your baby may not look the way you imagined it, but feeding success is still possible. With the help of your NICU team, your baby will have the opportunity to receive adequate and healthy nutrition during their stay and after going home. 

The benefits of breastfeeding and breast milk for your NICU baby

Preterm Breast Milk, breastfeeding in the NICU, hand to holdBreast milk is especially important for premature and medically-fragile infants. A baby born prematurely hasn’t yet received all the antibodies and nutrients from the mother that they would have if they’d been full-term.  Colostrum, early breast milk that is usually yellowish in color and especially rich in nutrients and antibodies, and breast milk of mothers of preterm infants can still deliver these vital nutrients. Even the smallest amount of colostrum is valuable.  Breast milk contains unique properties and is designed to meet your baby’s particular needs. Preterm milk contains significantly higher concentrations of protein, sodium, and chloride, and lower concentrations of lactose. Premature breast milk also contains different types of fat that your baby can more easily digest and absorb.1 The anti-inflammatory properties of breast milk play a big role in preventing many diseases and conditions, especially necrotizing enterocolitis (NEC), a dangerous disease in which parts of the bowel become inflamed and damaged and start to die. Breast milk also protects the gut, enhances brain development and is associated with a shorter hospital stay.

Challenges of Breastfeeding in the NICU

Breastfeeding in the NICU can present some unique challenges for NICU moms.

4 breastfeeding challenges NICU moms face:

  • Limited milk production. The stress of a high-risk pregnancy, traumatic birth, and the uncertainty of the NICU can impact a mom’s ability to produce milk
  • Lack of privacy. Many moms pump and breastfeed at the bedside, and unless you have a private room, you may not have much privacy. Screens are available to place around the bedside for more privacy.
  • Inability to nurse. Your baby has to learn to breastfeed, as opposed to a full term baby who is born with the reflex needed to suck, swallow and breathe at the same time. Breastfeeding sessions can be challenging until baby gets the hang of it.
  • Difficulty bonding with baby. Mothers may not feel like they are connecting or bonding with their baby in the NICU.

Being in the NICU is stressful, and the pressure to provide milk for your baby can be intense. Every little bit counts. Talk to your NICU staff and lactation consultant about any challenges you are facing when it comes to pumping or breastfeeding.

Feeding and Nutrition in the NICU

NICU baby with feeding tube, hand to hold

NICU baby with feeding tube

Most babies aren’t developmentally ready to nurse until they are 34-35 weeks gestation (adjusted age, if they were born early). They are unable to coordinate the suck-swallow-breathe reflex required to nurse or have problems with getting too tired to finish a feeding.  Even if your baby is not yet ready to breastfeed, you can make sure they receive the benefits of breast milk by pumping and keeping up your milk supply until your baby is ready to nurse. In the meantime, your baby will most likely be fed through a feeding tube, also called a gavage tube, that goes into their nose or mouth and leads to their stomach.  When your baby receives nutrition through their feeding tube, you can still prepare them for breastfeeding by holding them skin-to-skin, also known as kangaroo care, whenever possible. Ask your nurse if they are ready and stable enough to nuzzle at the breast.

What is non-nutritive sucking?

Non‐nutritive sucking is defined as any suckling in which no fluid is being introduced.2 Your NICU nurse or lactation consultant may encourage non-nutritive sucking during gavage feeding or in the transition from gavage to breast/bottle feeding to improve the development of sucking behavior and the digestion of feedings.3

Donor Milk in the NICU

Many NICU moms have had to rely on human donor milk for their babies in the NICU, for a variety of reasons. Receiving donor milk is not a failure on your part!  A NICU mom may face multiple barriers to breastfeeding and pumping. The stress of the NICU alone is enough to delay and even prevent milk from coming in, and not all women respond well to pumps. That’s where donor milk can come in to fill the gap.

Read more: Everything You Need to Know About Human Donor Milk in the NICU

Pumping in the NICU

Once you have delivered your baby, your care team will encourage you to start pumping as soon as possible, which may be surprising. But this is so your baby can start receiving the benefits of even the smallest amounts of your colostrum and breast milk. In the beginning you may only get a few drops, these drops are valuable.  It is important to pump regularly, every three hours or as your NICU team advises. This will help you get off to a great start, maintain your milk supply, and will be very helpful when it is time to begin feeding your baby directly from the breast. 

Read more: Pumping Tips for NICU Moms

Breastfeeding in the NICU

What is OXYTOCIN, hand to hold, When your baby is ready to breastfeed, your first sessions should be done with a lactation consultant. Ask your NICU nurse if they can schedule the lactation consultant to come by when your baby is awake, alert, and calm. 

4 Signs your baby is ready to breastfeed:4

  • Baby maintains an awake/alert state
  • Baby is looking for your breast or showing feeding cues
  • Baby demonstrates respiratory stability
  • Baby displays good muscle tone

Premature babies often tire easily, so your first breastfeeding sessions will be brief, but you can spend the remainder of the time cuddling your baby while they receive the rest of their meal via their feeding tube.  Prepare to feel tired and drowsy after your first breastfeeding session. Oxytocin, a hormone that helps you feel love towards your baby, also reduces stress and relaxes you. Additionally, prolactin, another hormone key to breastfeeding, can cause drowsiness. Make sure to schedule time for rest after your first breastfeeding sessions. Once your baby is ready, try to breastfeed as often as possible in the NICU, even when the sessions are brief. Continue pumping in the NICU and at home. Frequent nursing, pumping, and skin-to-skin contact will all help maintain your milk supply.

What supplies do I need to breastfeed in the NICU?

The good news is you really need nothing extra in order to breastfeed in the NICU. Here are a few things that may help:

  • Breastfeeding pillow
  • Comfy robe (or ask for a hospital gown and open it in the front)
  • Nipple shield – Nipple shields are helpful for premature babies who may not be quite strong enough to position themselves or create the suction necessary to breastfeed. It allows your baby to pause and breathe without having to reposition. Nipple shields also help by making the nipple easier to stay latched on to and by moderating the flow of the milk. They also may help transition a baby to the breast who has become used to the bottle.5

Bottle feeding in the NICU

Your baby may also receive bottles of your expressed breast milk in the NICU, especially for feedings in which the you are not physically present or if the mom is not able to breastfeed. This does not mean that your baby will necessarily have trouble transitioning to the breast if you choose to breastfeed. Work with your NICU team to create a plan for when your baby will attempt breastfeeding and when they will bottle feed.

Other reasons a baby may bottle feed in the NICU

  • Mom has chosen to exclusively pump and bottle feed
  • Baby is having trouble latching onto the breast
  • Baby is receiving donor breast milk due to inadequate milk supply (possibly from the stress of a high-risk pregnancy, traumatic birth, or the NICU)
  • Baby is receiving fortified breast milk for added nutrients

Breastfeeding in the NICU is challenging, but with the help and support of your NICU team and your loved ones, your feeding journey will develop into whatever is best for you and your NICU baby.

Hand to Hold Mobile appDownload the app designed specifically for NICU & bereaved parents. Get support, find community, and learn from educational resources, all in the Hand to Hold app. Available in the App Store and Google Play.