In the NICU

• In the NICU, your baby receives special medical care.
• It's natural for you to feel frightened and confused.
• Become your baby's advocate and get involved in his care.

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Before your baby was born, you probably dreamed about what it would be like to hold and feed her. And you may have already decided to feed your baby breast milk or formula. But now that your baby is in the neonatal intensive care unit (NICU), you may need to adjust your plans. Because feeding is so central to nurturing your baby, your plans and decisions are likely to be loaded with emotion for you.

Use the combination of breast milk and formula, bottle-feeding and nursing that works best for you and your baby.

Breastfeeding
Breast milk provides many wonderful and vital health benefits for all newborns, especially premature or sick babies. But many NICU babies aren't ready to feed from the breast at first. The mother can learn how to pump her milk so it can be delivered by tube to the baby's stomach. If your baby can't suckle, tube feeding is the best way for him to get your breast milk.

If you must pump, you may feel sad and disappointed to substitute an electric pump for a warm, hungry baby. This is not how you planned it. And yet, providing breast milk for your baby can soothe your sorrow over his hospitalization. Breast milk is something truly special and beneficial that you can give your baby. And when your baby is ready to suckle, you can start putting him to the breast.

Here are some ideas for meeting the challenges of breastfeeding your baby in the NICU:

• Discuss your desire to breastfeed with your baby's medical team. Ask for referrals to the NICU's lactation consultant and to other NICU mothers who are successfully pumping milk or breastfeeding their babies.
• Start pumping as soon as you can. Use the pump that best works for you, such as a hospital-quality electric pump in good working order.
• Establish a relaxing ritual so that you condition your breasts to “let-down” (eject milk) when it's time to pump or feed.
• If you're establishing your milk supply, or want to build it up, pump every 2 to 2-1/2 hours around the clock for a couple of days and nights (or 8 to 12 times during the day, if sleeping at night is paramount). After your milk supply is established, go no more than 8 hours (give or take) at night, and then pump at least eight times throughout the day.
• When you pump, be sure to "empty" your breasts to extract the hind milk, which is highest in the fat calories your baby needs. Pump 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 pumping, you may be tempted to give up. But try to persist in keeping your breasts primed. Try getting more rest, drinking more water and pumping 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. Ask to feed him in a quiet, darkened room so he does not become distracted. Start by doing kangaroo care, holding your diapered 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 without swallowing air or choking. 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.

If you wanted to breastfeed but then decided not to, or are forced to give it up, you may feel disappointed. Remember that you can have a close and rewarding relationship with your bottle-fed baby. You can experience the closeness of breastfeeding by cuddling your baby against your warm skin and letting your baby observe your face. You can also continue to do kangaroo care for many months.

Formula feeding
Babies thrive with formula feeding, too. There are a number of formula options, and the NICU team will recommend one for your baby.

You may need to wait a while before you feed your baby from the bottle. If she is very premature or ill, she may first require gavage feeding, where a thin tube is inserted through the baby's nose or mouth to the stomach, and the formula is inserted into the tube. Your baby's nurse can show you how to give your baby her gavage feeding, so you can take on the important role of providing nourishment.

Resources
Breastfeeding Your Premature Baby, by Gwen Gotsch (La Leche League International, 1999).

GotMom
Created by the American College of Nurse-Midwives to provide breastfeeding information and resources for mothers and families

International Board of Lactation Consultant Examiners
Provides referrals to breastfeeding consultants. (703) 560-7330. 

La Leche League International
Provides referral to breastfeeding consultants. (800) LA-LECHE. 

National Healthy Mothers, Healthy Babies Coalition
Has publications on breastfeeding at home or at work, in English and Spanish. State/local chapters. (703) 836-6110. 

State WIC Programs
Provide breastfeeding promotion and support.

The Ultimate Breastfeeding Book of Answers, by Jack Newman and Teresa Pitman (Prima Communications, 2000).

The Womanly Art of Breastfeeding, by Gwen Gotsch and Judy Torgas (Plume, 1997).

See also: Share your story

August 2009

Excerpted from the March of Dimes booklet, "Parent: You & Your Baby in the NICU", written in collaboration with Deborah L. Davis, Ph.D., and Mara Tesler Stein, Psy.D., authors of "Parenting Your Premature Baby and Child: The Emotional Journey".