Breastfeeding in the NICU: 10 Must Know Tips

Hi! I’m Amber, momma of 4, and let me tell you… baby #4 was a bit of a surprise…

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We knew we wanted a fourth, but didn’t think it would happen so soon. I was still nursing my daughter when we conceived #4, and my daughter was and still is very much not ready to wean yet. I went on with the pregnancy with no issues and continued to nurse her. I started having Braxton Hicks around 12ish weeks. I asked my midwife about it and she said it was normal and expected with the more pregnancies you have the more sensitive your body becomes. I have had 7. My miscarriages were due to a clotting disorder that I never knew I had until I had the 3 losses. My doctor was also okay with me continuing to breastfeed my daughter because my previous losses were due to the clotting disorder.

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When I hit 32 weeks this time, I went into my normal scheduled appointment at 32 weeks and 2 days. On my way there I had 3 contractions. I mentioned it to the midwife I saw that morning, and she said it was just my body gearing up and things felt more intense because of the multiple pregnancies. She told me to take it easy, start drinking more water and put me on a limited weight lifting restriction. Okay, come on now, I thought… I had an almost 2-year-old daughter… how was I not supposed to lift her to put her in her car seat or in her highchair, etc?! Later on that evening I was going out for a moms’ night out dinner celebration with a group of women I volunteer with. During dinner I continued to have random contractions with some pressure. I remember a few of the women asking me if I was okay and joking if I needed a ride to the hospital. I got home around 11 pm, went to bed, and woke up not even an hour later because I felt some leaking (we all know when you’re pregnant there’s always something weird going on down there). I stumbled to the bathroom half asleep with one eye open and the lights off. I did my business, and when I went to wipe (we all know you look at the TP when you’re preggo to examine it!) I noticed I had blood, looked in my underwear and wow more blood. Um what was going on?! My little guy was still moving around like crazy so I wasn’t trying to freak myself out to much but really I was so worried. I rushed to the living room and got out my fetal doppler and checked on my sweet boy. His heart rate was perfect. I then called my doctor’s office and left a message for the answering service to see what I should do. Within 10 minutes one of the midwives called me back and asked me a few questions and then told me to go to the ER. I woke up my husband and our 3 kids. We got ready and headed up to the hospital. We called my mother-in-law to meet us at the hospital so she could sit with the kids while we figured out what was going on.

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They put me in a triage room and hooked me up to the monitor. I was indeed having contractions and the bleeding was still pretty heavy. They did a quick ultrasound to see where the bleeding was coming from, but my little guy’s head was already on top of the cervix so they couldn’t get a clear shot. They also did a cervical check and I was 2-3 cm and 75% effaced.They decided I needed to stay and stay on hospital bed rest until my bleeding and contractions stopped. They also gave me some medicine to help try to stop my labor and a steroid shot for baby’s lungs to mature. Unfortunately, the medicine to stop my labor gave me a really bad reaction so they couldn’t give me anymore. The nurses kind of gave me a heads up about what would be happening if my labor progressed more and little man decided to come. My contractions continued throughout the day and really got intense around 11:30pm on Saturday. I remember the nurse saying just a few more hours hold out a few more hours so I could get that second steroid shot for his lungs. They even tried giving me another medicine to stop my labor but he was born within 30 minutes after taking that and just 20 minutes shy of being able to have that second steroid shot. I remember it happening so fast and having so many different doctors and nurses in my room. The NICU staff was amazing though. They told me everything they were doing and what they would be doing. I got to see him through his incubator and then off he went.

10731103_10152873505351764_3315717089749180574_n 10801807_10152873505231764_7842383657733812075_n Once I was able to leave L&D, they took me straight to the NICU before I went to the Mother/Baby Unit. The NICU nurse asked if I had planned on breastfeeding and I responded with a quick YES! They didn’t know I was still nursing my daughter so they gave me all kinds of advice and tips to help get my milk supply in. They gave me all kinds of bottles to start pumping in and some swab sticks because even if I could only get drops out they could still use my milk on the swabs and put it in his mouth. I started pumping right away every 2-3 hours. His care times were every 4 hours around the clock so I would pump and then take what I pumped straight down and they would give it right to him for his feed. My milk came in full force on the 3rd day. I was so happy because I struggled with my supply when my daughter was born. On that 3rd day I was also able to let my little man latch on for the first time, he was 33 weeks that day and he latched right on like a newborn who had been nursing for weeks. I was super weary about giving him a pacifier because I wondered if that was my problem with my daughter. So those first few days I didn’t let them give him one. But then a really awesome nurse let me in on a secret that preemie babies actually need and benefit more with a pacifier because they learn how to suck, swallow and breathe, which is crucial for them to start nursing/bottles and be able to go home. So after that talk I decided to give him a pacifier and watch him figure out how to suck, swallow and breathe.

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After that nursing session I met with the speech therapist and we came up with a plan. I was able to let him nuzzle skin to skin but not push the latching because he had to be monitored on his milk intake. So I continued to pump and pump and pump. Once he hit 34 weeks, the speech therapist and I met again and we decided he was ready to try to nurse and or have a bottle (he’d been fed from a tube until this point). I was super nervous for some reason, so I gave him his first bottle. He still had to use the feeding tube when he was too tired to finish the bottle. After a few days of getting the bottle regularly, he was tolerating his feeds and I wanted to try to nurse him. It took a few tries for him to latch and me hand expressing to show him that’s where milk comes from till he got it. Every morning I would arrive at the hospital and nurse him as soon as he started his feeding cues, he would get a fortified bottle of breastmilk if I wasn’t able to be there and during the night feedings. He was able to come home the day he hit 35 weeks.

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When he came home, I went straight to the breast to see how he would do. He nursed constantly, so I didn’t think there was anything wrong. Little did I know he had a pretty bad tounge tie. So we had that revised and then he started packing on the pounds… well ounces really. We are now 5 months in and I’m still tandem nursing with him and his older sister!

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Here are my breastfeeding in the NICU: 10 Must Know Tips

1. Surround yourself with support

Breastfeeding a NICU baby is totally different than a full term baby. You don’t get that first skin to skin contact, let alone holding your brand new baby as soon as they are born.

2. Become familiar and develop a close relationship with the lactation consultants in your NICU

If there aren’t any available, then seek one out; a lactation consultant is going to be your biggest cheer coach and support.

3. Don’t be afraid to TELL your NICU staff your plan

They can’t help you if they don’t know what you want. Write it down and plaster it in your baby’s room/area. Make a copy for your nurses’ chart.

4. Start pumping as soon as you can

You have to get the milk supply started and since your NICU baby is most likely unable to nurse straight at the breast, a breast pump is going to be mimicking your newborn until you can get your precious little one to latch.

5. Make sure you have the right size pump parts

If you don’t have the correct sized flanges, it can be crippling to your supply and extremely painful for your nipples!

6. Pump every 2-3 hours just like your newborn would be nursing

This is going to help build your supply up. I know you’re thinking “Who has time to pump that often and have time to do anything else?!” Once you develop a system, you won’t look back.
I had 3 kids at home, a toddler still nursing, lived 40 minutes away from my hospital, and still managed to pump every 3 hours around the clock. Not going to lie, it was HARD. But if you want it bad enough, you will do what you have to do.

7. Take care of YOU!

If you aren’t getting enough to eat, drink, sleep, then your output of milk is not going to be the greatest. Having a baby in the NICU is stressful enough, but you have to remember to put momma first.

8. When you FINALLY get to try that first latch…

You will feel a little stressed that babe might not get it right away, but don’t give up. Make sure you have a nurse/LC with you when you do try that first latch, so that they can help and guide you through everything for a successful latch.

9. Keep practicing at latching even after you have pumped

Letting baby practice (nuzzle) is not going to hurt your supply. The more and more you “practice getting baby to latch” the quicker you can begin nursing your babe and ditching that pump.

10. Take it one day at a time

It’s most likely going to take some time but don’t give up! Push through because you will be nursing that sweet little baby in no time!