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Breastfeeding In The NICU Is Not Impossible, But A *Real* Challenge

Having a baby in the neonatal intensive care unit (NICU) is obviously super stressful. No mother imagines that her baby is going to be whisked away from her just after being born, and it can be a truly heartbreaking situation. It can also throw a wrench into your plans for breastfeeding, because you can’t nurse a baby on demand when they’re not by your side 24/7. But that doesn’t mean you have to totally give up your breastfeeding intention. If you’ve ever wondered, “Can I breastfeed in the NICU?”, the answer is yes — but it’s going to take even more effort than normal.

I spoke with Dr. Marianne Garland, Medical Director of the NICU Lactation Program and Donor Human Milk Program at New York-Presbyterian Morgan Stanley Children's Hospital, about the challenges NICU moms and babies face regarding breastfeeding. She says while making it work can be challenging, the littlest NICU babies can really benefit from it. ”Preemies are much more at risk of infections, one in particular that we call NEC, which stands for necrotizing enterocolitis. The disease is about as bad as the name suggests, and the only thing shown to prevent or reduce the risk of it is mother’s milk.” Kids Health describes NEC as "the most common and serious intestinal disease among premature babies. It happens when tissue in the small or large intestine is injured or inflamed... In NEC, the intestine can no longer hold waste. So bacteria may pass into the bloodstream and cause a life-threatening infection."

But as much as breastmilk can benefit them, some NICU babies just won’t be able to nurse right away. “Infants less than 32 to 33 weeks gestation are usually not placed to breast for their feedings because they are not developmentally ready to feed by mouth,” explains Ashley Harper, a Registered Nurse (RN) in the NICU at Forrest General Hospital in Hattiesburg, MS. “With these infants we will place a feeding tube and feed the infant their mothers’ breast milk through the feeding tube.”

Even babies who are born full-term can struggle with figuring out the suck-swallow-breath mechanics of breastfeeding. And of course, those moms whose NICU babies take to nursing right away will still need a back-up feeding plan, because not many NICU facilities allow to you stay with your baby 24 hours a day. In these situations, moms end up spending lots of time hooked up to a breast pump, unfortunately.


You’ll need to pump pretty much around the clock to make sure you get off to a good start, according to Dr. Garland. “Normally a baby is feeding from the breast maybe 12 times a day. So when we ask [moms] to pump 8 times a day, it’s certainly not as many times a day as a baby is feeding, but most of them pump 3 to 5 times a day, and that’s not enough for them to really establish a good milk supply.” Harper agrees that the more you can pump, the better: “If you only pump twice a day then your body is going to think it does not need to produce as much milk.”

The good news about pumping, however, is that you can usually still practice breastfeeding from the breast (as long as your medical team is OK with it), and get in lots of snuggle time with your newborn. “We try and have the moms do a lot of skin to skin holding, so they get comfortable holding their babies. Then they can begin to recognize feeding cues from the baby. That way they can do some what we call non-nutritive latching where the baby can practice trying to latch on and explore, latch on for a few seconds and take a few sucks,” says Garland.

Most NICUs have plenty of support staff on hand to help you make the transition from pumping to nursing full-time, so don’t hesitate to ask for assistance. Garland says moms shouldn’t be too hard on themselves if they’re struggling. “Realize that this is going to take time. The baby’s learning, she’s learning. As the baby matures, they’re going to get stronger and be able to do better… Being prepared and having confidence in yourself are really the keys to being successful.”

Breastfeeding a NICU baby is totally doable, but it’s also super hard work. Harper reminds moms not to neglect themselves in the process. “Our breastfeeding mothers need to sleep, eat, hydrate, and destress.” If you can do all those things, and still manage to pump and/or nurse whenever your baby needs, your odds of achieving the breastfeeding relationship you want are strong.

After a very frustrating first birth experience, this Deaf mother wanted a change. Will the help of two Deaf doulas give the quality communication and birth experience this mom wants and deserves? Watch Episode Four of Romper's Doula Diaries, Season Two, below, and visit Bustle Digital Group's YouTube page for more episodes.