Providing breast milk for a baby in the NICU may be one of the best things you can do for your premature or sick baby. Your baby may be too small or too sick to breastfeed at the breast so you may have to pump your milk.
Your baby may have a feeding tube and receive the milk that way. There are very few reasons why someone cannot or should not provide breast milk for their baby. Please talk with your baby’s nurse, a lactation consultant, or your baby’s doctor before you quit providing milk. If you cannot provide milk for your baby, we offer Donor Milk to the babies in the NICU at UAMS.
If you need help getting a pump, please talk to your baby’s nurse or a lactation consultant. Pumping for your baby in the NICU can come with some challenges. If you need help with your milk supply, try doing some Kangaroo Care (if your baby’s nurse says it is okay). Skin-to-skin contact may help milk supply along with some support of the lactation team, your family and friends, and all of the other staff at UAMS.
UAMS is a Baby-Friendly designated hospital. If you experience someone not supporting the breastfeeding mother, please let the unit managers know immediately!
Feeding and Nutrition of Preterm Babies
How Will My Baby Be Fed?
Feeding through an IV
Babies who are born very early (preterm/premature) cannot feed themselves yet. If your baby is very sick or very premature, he/she will likely be started on an IV right after birth.
The IV contains fluids and total parenteral nutrition (TPN). TPN has all
the nutrients that your baby needs to grow:
- Vitamins and minerals
Feeding Through a Tube Into the Stomach
A baby will stay on TPN until he/she can get enough nutrition from milk
that goes into the stomach:
- An orogastric (OG) tube is placed from the baby’s mouth to the stomach.
- Small feedings of milk go through the tube into the stomach
- The baby slowly gets more milk through the tube and less TPN.
- Finally all nutrition the baby needs comes from the milk.
Babies who are very premature and small get extra protein, calories, and vitamins in their milk.
This is so the baby’s brain and body get everything needed to grow.
Can I Breastfeed My Preterm Baby?
Breast milk greatly helps premature babies. Things to know, so your baby can get breast milk:
- You may not be able to breastfeed your baby right after delivery.
- You can still pump your milk for your baby.
Ask our nursing staff or lactation (breastfeeding) staff to help you.
If we can’t use your breast milk, talk to your doctor about milk from a donor.
The first milk you will pump is very important for your baby. It has special benefits.
- This milk is called colostrum, or early milk.
- We will help your baby get the colostrum right away. Small amounts can be absorbed through the baby’s cheek.
When Will My Baby Gain Weight?
What is normal:
- All babies lose weight in the first few days after birth. This is from changes in body fluids and loss of extra water.
- Some preterm babies take up to 2 weeks to regain their birth weight.
How the NICU helps your baby gain weight:
- Every night, NICU babies are weighed. Once a week, their head size and length are measured.
- NICU doctors and nutrition staff check to make sure your baby is growing as he/she needs to.
- They will change your baby’s feedings, if needed.
When Will My Baby Learn to Breast- or Bottle-feed?
Feeding takes a lot of energy and body coordination. Most babies need to be at least at 33-34 weeks before they can breast- or bottle-feed. Each baby is different. Some start as early as 32 weeks to begin to learn to suck on the breast. Some are not ready until much later. These things need to happen first:
- The baby’s lungs must be developed enough so they are breathing more on their own.
- The baby must be able to suck, swallow, and breathe in a way that is safe for feeding.
Our NICU has a team that can help you and your baby learn how to breast- or bottle-feed. The team includes:
- Occupational and speech therapists
- Lactation experts
- Experienced nurses
Cue-Based Feeding for a baby in the NICU
Cue-based feeding means watching for your baby to show you when he/she is hungry.
Feeding your baby only when you see these signs helps them reach full feeds sooner. For that reason, we focus on the quality of the feed not the amount. Your baby’s cues or signs may also show times in the day that the baby is more alert allowing us to plan ahead. Once your baby is ready there are things that we all need to look for when deciding if your baby is hungry and ready to eat. The nurse will score the baby based upon the cues shown and a breast or bottle feed will be offered when the baby is ready.
Some of the cues your baby may show are:
- Sucks on pacifier
- Turning head
- Seeking and rooting for food
- Fingers in mouth
- Stable vital signs
During the feeding, there may be some signs that your baby is stressed or needs to stop feeding. Some of these signs are:
- Pulling away from bottle
- Arms extended or floppy
- Frowning or looked stressed
- Poor seal on the nipple
- Holding their breath
- Breathing events
- Aspiration concerns: watery eyes, coughing/choking etc.
If your baby loses weight, cannot maintain temperature, or there are concerns of aspiration their feeding plan will be changed. If you have any questions or concerns, please let your baby’s nurse or doctor know.
If you have lactation questions please call the ANGELS Call Center at 501-526-7425. This is a hotline, answered by a nurse, 24/7.
Questions about medications and mother’s milk? Call the Infant Risk Center At Texas Tech University Health Science Center at 806-352-2519.
You may also call UAMS Lactation Services at 501-526-3558. This is a warm-line, so you can expect a returned phone call within 48 hours.
Partners in Breastfeeding
Even though you can’t breastfeed, you play an important role in ensuring the success of your baby’s breastfeeding and the success of your partners attempts to provide breast milk for her NICU baby.
How can I help after my baby is born?
While breastfeeding is natural it is also a learned skill. It usually takes at least a few weeks for mother and term baby to get used to breastfeeding. NICU babies (especially premature babes) are a totally different ball game. The first weeks are difficult it can be tempting for the mother to give up.
Your support is vital to helping your partner continue to breastfeed!
Here are a few things you can do:
- Learn about breastfeeding/providing milk for baby: It is easier to support the mother when you know the amazing benefits for the baby and mom. She will be thankful for you taking the time to be educated on the benefits of breast milk. Explain to family and friends about the importance of breastfeeding and encourage their support.
- Encourage your partner: She will need your encouragement especially when she is very tired or finding things difficult.
- Protect her: Some people’s opinions about breastfeeding may be undermining and hurt her feelings.
- Arrange for help: During this time, mothers distance themselves from others because they are trying to bring all of their focus on the baby and to pumping. To help, you can help make sure that all of the chores and errands around the house get done so that she doesn’t feel stressed and feel the need to take the time to do it. Preparing meals and doing the housework so your partner can concentrate on feeding your baby or pumping her milk to give to baby will help a lot. By doing this, postpartum depression is less likely to occur. The easier things are for mom, the better.
- Know that breastfeeding saves a lot of money: During the baby’s first year, you save about $2,000 in formula and $300-400 in healthcare costs.
- Limit visitors: What your partner needs most now is rest, help, and time with your baby. If you allow some visitors, be sure they are there to help and support her choices. If not, delay their visit or keep it short. She may get upset easier now, so surround her with supportive people. Avoid visitors she wants to cook and clean for.
- Know who to call with breastfeeding questions: You can call the UAMS lactation line at 501-526-3558. You can also go to online resources such as La Leche League.
How can I help my partner breastfeed/pump?
Here are some of the many ways:
- Help her get comfortable. Be sure she has what she needs. Help her with pillows. Bring your partner a drink or a healthy snack to eat, such as a piece of fruit or a slice of toast.
- Help her get her sleep. Remind her to nap when baby sleeps during the day.
Offer to do her chores so that she can rest. At night, give her any needed help in getting the baby latched on deeply so the feeds are successful and efficient. Offer to go get the pumping supplies and/or clean them properly when she is done. Rest will help her recover from birth.
- Run errands for her so that she can focus on baby and pumping.
- Spend time with older children to help her rest and relax.
- Cook a meal and shop to make sure she has healthy foods to eat.
- Talk and listen. Share thoughts and feelings. While your roles are changing, it is vital to talk. Be honest about good and bad feelings. Remember to always be respectful of each other’s feelings.
It’s important to remember:
- Sometimes the feeding can be the most frustrating part of the NICU stay. Remind mom that she is giving her baby the best medicine by providing breast milk!
- Maintaining a good milk supply depends on milk being removed regularly either by breastfeeding or expressing/pumping. Long periods between expressing and feeds may lower milk supply.
- Remind mom that skin-to-skin is a great way to boost milk supply!
You may find it difficult to bond with baby, Here are some things you can do to help build that bond:
- Place your baby on your bare chest for skin-to-skin contact. There are many health benefits for the baby like temperature control, but skin to skin will also promote bonding between you two.
- Spend time with your baby. Find something to do every day with your baby that is special (this may need to be something you develop once your baby is home from the hospital).
- Give your baby a bath. This can be a fun time for both of you.
- Bring your baby to your partner for feedings. Yes, even during the night!
- Cuddle and walk. This can help calm your baby when he/she is fussy.
- Change your baby’s diaper. The more practice you get, the easier it becomes. On the plus side, when your baby is only fed breast milk, the diapers don’t smell as bad.
- Talk, read and sing to your baby. This is how babies learn to talk.
- Hold your baby. Moms and dads play in their own ways. This is how babies learn, and it can be fun for both of you.
Here is a complete guide to breastfeeding
Here is a Breastfeeding 101 module you can view