Initiating Milk Supply & Breastfeeding In the NICU

Having a baby in the NICU is like having someone turn off the lights, shake the whole room up, and then flick the lights back on. You are left disoriented, trying to figure out what just happened and where you are anymore!

While there are lot of unique concerns for families with premature or sick babies, one of the questions that often gets asked is: will I still be able to breastfeed? Each individual circumstance is unique, of course, and with some work, it is possible that you can still breastfeed your baby. As a Postpartum and Infant Care Doula who has a strong passion for supporting families specifically in the NICU, here are some general suggestions for you to maximize your chances of success.

Acknowledge the Emotions

Listen, having a sick or preemie baby in the NICU is unimaginably difficult physically, emotionally, and mentally. You will not do everything perfectly. There will be days that are tough, and individual circumstances, like an unstable baby or mother, may make the ideal not a possibility. In these times, remember that you are doing your best, one step at a time. Listen to your baby and your body's needs, and don't push yourself beyond what is possible.

It is normal to feel a wide range of sometimes conflicting emotions. These feelings may center around the birth itself, and the doubt it can cast on your body's ability to care for and nurture your baby anymore. When you feel overwhelmed or sad, let yourself feel those emotions. Then allow yourself to see and acknowledge all of the ways you and your body didn't fail, and all of the hard work you have already put in. It's there, and if you can't see it, ask someone else to see it for you.

Remove Milk Early & Often

Have you ever heard the phrase "early and often" referring to getting a newborn baby to the breast as soon as possible after birth? The same applies for NICU babies, only instead of breastfeeding, we are talking about pumping! Milk production is a supply and demand system, and you are laying the foundation for your future milk supply in those first hours and days after birth. It is important to stimulate your breasts, and begin moving milk, soon!

In Cincinnati and Dayton, all area hospitals will give you a hospital grade pump to use in-hospital. These pumps are also available to rent locally, so you can continue pumping, even if you are discharged before your baby. The recommendation is to pump at least every 3 hours around the clock, and ideally starting within 1-6 hours after the birth of the baby, and aiming for 8-10 pumping sessions spaced out throughout the day.

Know What to Expect

As you are starting out on your pumping journey, it is important to know what to expect. In the first days, you may not get much milk out. Do not despair! This is normal. The first milk your body produces is very thick, and it is much harder for a pump to remove than more mature milk. Simply stimulating the breast, though, is producing hormones to help your milk come in and mature over the next few weeks.

It is normal to start out only getting a few drops of milk. Over time, with patience and consistency, you will likely start to see this output gradually increasing. It is also normal for pumping to feel like a lot of WORK, because it is! If you are concerned about your output, talk to an IBCLC to make sure you are on track. Also, as a Postpartum and Infant Care Doula, I can help you navigate what is normal, and also help you to work through the emotional difficulties that can come along with pumping.

Also remember: even a little bit is enough. You may or may not ever be able to exclusively breastfeed, or feed your baby solely on breastmilk. That is ok. It doesn't have to be all or nothing, and even just giving the little bit you can, for as long as you can, is doing so much for your baby. 

Skin-to-Skin & Kangaroo Care

Once you are cleared to touch or hold your sweet little baby, be sure to maximize that skin-to-skin time! Believe it or not, just holding your little one close to your chest will help to stimulate hormones that will in turn help your milk production. Also, prolonged periods of skin-to-skin contact, or Kanagroo Care, is shown to have a whole host of healing benefits for both you and baby.

Whether or not you are able to ultimately breastfeed, this skin-to-skin time is still so helpful for bonding and nurturing your new baby, no matter what.

For times when you are apart, you can consider leaving a receiving blanket that has been on your body all day for your baby to smell your scent. You can also take home a blanket your baby has been using all day with his or her scent on it. Keep it close, especially while pumping, to remind yourself of your sweet baby.

Self-Care with a Preemie or Sick Baby

It's OK to take time out for yourself. It is sometimes difficult to feel like you have to be strong enough for your NICU baby, and that your needs or pain are not a priority. Maybe you are even feeling anger toward your body.

I want to tell you though: you are important. Take care of yourself, even if your only justification right now is that you need to heal so you can be there for your baby. That's ok. Remind yourself that your baby is being well taken care of, and your love is with him or her even when you have to be apart.

Here are a few tips for maximizing your own rest:

  • Delegate errands, chores, and any other jobs to friends and family over the first weeks and months. Your job is resting and spending time skin-to-skin with your newborn!
  • Allow yourself some "you" things while you are spending time with your baby. It's ok to pick up a book, a magazine, or listen to some enjoyable music. Make sure that you are comfortable while you are nurturing your baby.
  • Keep a big water bottle filled with water and a straw close at hand.
  • Ask friends and family to bring you easy, one-handed snacks that don't require a lot of preparation if they bring a meal, or have a Postpartum and Infant Care Doula prepare you some grab-and-go snacks and foods! We can help you brainstorm foods to have on-hand.
  • To maximize sleep, consider "cluster pumping" or pumping at a closer time interval for a stretch of time during the day, and giving yourself one or two 4 hour blocks of sleep overnight. So for example, maybe you typically pump every 3 hours. From 4-10pm, though, maybe you pump every 2 hours instead, and then let yourself sleep from 10pm-2am, and again from 2am-6am.

Have you had a preemie or sick baby in the NICU? What was your experience trying to breastfeed?