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Breastfeeding in the NICU: How to Solve a Unique Challenge

Aug 10, 2023
Two bottles of breastmilk and a pacifier

Note: We use the term “breastfeeding” to encompass all forms of lactation, including direct breastfeeding, chestfeeding, and providing expressed human milk in a bottle.

Soon-to-be parents often imagine what their baby will be like, what they will name him or her, what will happen during the delivery and how their lives will change. No prospective parent wants to imagine their child will end up in the NICU, an intensive care unit especially for babies, but it’s a situation many families face. This separation is never easy, especially for the mother and baby when it comes to breastfeeding. As a neonatologist, I am familiar with many of the situations unique to the NICU environment that can affect breastfeeding, as well as some ways to overcome theses challenges.

Some babies have to go to the NICU immediately after being born. Many of the hormones involved in making milk are stimulated by the baby’s presence, especially baby’s presence at the breast. As soon as Mom is able, she should be encouraged to visit her baby in the NICU. Many NICUs have open visiting hours, meaning Mom and Dad are welcome to visit any time of day or night.

Most babies are able to be placed skin-to-skin with Mom in the NICU, even shortly after birth or surgery. This is called kangaroo care and it is very important for breastfeeding, baby’s development, and strengthening the maternal-infant bond. Moms should ask the medical team in the NICU when she will be able to do kangaroo care.

One of the most common reasons for a baby to go to the NICU is because the baby was born early, or premature. Babies who are born prematurely need breast milk even more than term babies. Studies show that premature babies are at higher risk of infection than babies born on their due date and breast milk has been shown to help prevent infections in these babies. That is why breast milk is really important for premature babies in the NICU; it’s a medicine that only Mom can give.

When Mom delivers a baby early, she is at higher risk for not making enough milk. Women are exposed to hormones when they are pregnant that cause glands in the breasts to increase in number so there will be lots of them to make milk when baby is born. Women who deliver a baby early are not exposed to these hormones for the same amount of time as women who deliver on their due date. They may not have as many glands to make milk, so it is very common for these women to have trouble keeping a full milk supply.

The best way to make as much milk as possible, is to pump as early after delivery as possible (preferably in the first hour) to stimulate the release of hormones to make milk and to obtain the colostrum that Mom’s body is making in those first few days. Colostrum is the very best kind of breast milk, loaded with antibodies and factors to help baby’s immune system, which is why it is often referred to as “liquid gold.”

Colostrum is a small amount of thick, dark yellow liquid that doesn’t look like regular milk because it is concentrated with so many good things. Sometimes it is easier to get this milk by using hand expression after you pump. Every drop of colostrum that Mom can get is very important! It is normal for Mom to get very little milk in the first 3-5 days after delivery, but it is important to keep pumping during this time to increase her supply.

Some hospitals have donated breast milk available to use until Mom’s milk comes in. Donor breast milk is screened and pasteurized. It has many of the same benefits, but Mom’s own milk is even better! A Mom who delivers early will make milk specifically designed for her premature baby. This special milk has more protein and electrolytes to help her premature baby grow.

It is also important to make sure you continue to pump 8-10 times every 24 hours with a hospital grade electric breast pump and hand express afterwards to get any milk remaining in your breasts. If you have trouble with your supply, remember you have lactation specialists and nurses that can help! It is a lot of work but ANY amount of breast milk you can give your baby is very important!

Click here for more information on the Nationwide Children's Hospital Neonatal Intensive Care Unit.

Featured Expert

Nationwide Children's Hospital Medical Professional
Vanessa Shanks, MD, FAAP
Clinical Nutrition and Lactation

Vanessa Shanks, MD is a neonatologist at Nationwide Children’s Hospital and Wexner Medical Center at The Ohio State University. She is also assistant professor of pediatrics for The Ohio State University College of Medicine.

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700 Children’s® features the most current pediatric health care information and research from our pediatric experts – physicians and specialists who have seen it all. Many of them are parents and bring a special understanding to what our patients and families experience. If you have a child – or care for a child – 700 Children’s was created especially for you.