Feeding your baby: what are your options in the NICU?

Nobody wants their baby to spend their first days, weeks, or months in the neonatal intensive care unit, but sometimes it happens – and it can be heartbreaking for so many reasons. One is that you may not be able to hold your baby or have that first golden hour nursing session.  

While we hope your baby is put right into your loving arms once born, we also know that birth doesn’t always go as planned. We also know that one of the biggest worries for moms of NICU babies is how they’ll feed their baby. 

Our goal is to provide a little bit of info around your feeding options, so if your baby does end up in the NICU, you feel empowered to make the best choices for you and your baby.

So, if your baby is born prematurely or is sick and the NICU is the best place for them, what are your options for feeding? 

Let’s talk. 

Can you breastfeed your baby if they’re in the NICU?

Nursing your baby in the first couple of hours of their life has been shown to ramp up milk supply and make breastfeeding more successful. But what happens if your baby is in the NICU and you can’t breastfeed in those first hours, days, or even weeks? Does that mean you have to give up your plans to breastfeed your baby? 

Not necessarily. 

While you might not have the golden hour time together with your baby, you can still jumpstart your milk supply by:

1. Expressing breast milk often + as soon as possible
2. Getting skin-to-skin contact with your baby as soon as you’re allowed

At first, you’ll need to hand express and you may only get a few drops. But stick with it if you can. Even if you’re only getting a few drops here and there, those precious drops of mama’s milk will help your baby. And even if the baby can’t have the colostrum you collect right away, it can be frozen and given to your little one later on. 

How often will you need to express milk to increase + maintain your supply if your baby is in the NICU?

So, how often should you be expressing if your baby is in NICU? NHS recommends 8+ times a day at first and at least once at night. You can express into a sterile cup and your breast milk can be stored in a syringe until it’s given to your baby. With time, you should see an increase in your milk supply. 

One important thing to realize is that different NICUs will have different resources available to help ensure breastfeeding success. Many NICUs encourage early and frequent pumping for moms of NICU babies, and have lactation specialists, breast pumps, and other support and resources to help. So be sure to ask about the resources available to you – you could even get meal vouchers to keep you fed as you focus on feeding your baby. 

What are the benefits of collecting breast milk for your premature baby?

Not being able to hold your baby or feed your baby the way you planned from day one can be a heartbreaking thing for any mom. But you can still be there for your baby and give them the best start by expressing and collecting your breast milk for them. What are the benefits?

• Preemies need more protein for growth and your breast milk will be specially formulated to provide that extra protein if your baby is born prematurely. Even if you can’t breastfeed in the early days, by expressing breast milk, you can give your baby exactly what they need, when they need it. 
• Preemies also need more protection against infections. Again, your breast milk will have more immune-boosting enzymes if your baby is born prematurely, and you can still give them that boost by expressing your breast milk, even if they’re not able to breastfeed yet.
• Preemies have digestive challenges to overcome, and your breast milk will be specially formulated for your baby if they’re born prematurely. Expressing your breast milk will make sure your baby gets fed what’s easiest on their tummy at this vulnerable time. 
• Giving your baby colostrum can familiarize your baby with the taste and smell or your milk, which can make breastfeeding more successful when the baby is ready.  

Are there times when breastfeeding is not the best option for NICU babies or when it’s not possible?

There are some instances when your breast milk alone may not meet the baby’s nutritive needs. If that’s the case, supplements may be added to your breast milk to help the baby grow and develop. OR the doctor may recommend that your baby be fed formula as well. 

In other instances, babies may not be able to have breast milk for various reasons – like milk protein allergies, inborn errors of metabolism, and various other diagnoses. But even if you are not able to provide breast milk for your baby, your baby will be fed and their nutritional needs will be met. 

It’s also important to keep in mind that sometimes the stress and circumstances around having a baby in NICU can lead to low milk supply. If your milk supply is not established or you’re unable to or don’t plan on breastfeeding, you can also opt to bottle feed your baby (if they’re ready to take a bottle) with donor milk or rely on formula as the sole food for your baby. There are specific formulas that are made to meet the nutritive needs of preemies. 

For the earliest and smallest premature babies in most Level IV NICUs, donor milk is the standard of care until maternal breast milk is available. But it can take days for your milk to come in and even longer for your milk supply to become established. For first-time moms, especially if your baby is delivered via c-section, it can take up to 5-7 days for your milk to come in. Donor milk can be a wonderful way to feed your baby during this waiting period. 

The most important thing is to talk to your doctor and the NICU nurses about what’s best for you and your baby + be easy on yourself. You are not a failure! Your body is doing A LOT.  

When is tube feeding necessary?

If your baby is born before 34-36 weeks, they may not have the coordination needed to bottle or breast feed. In these situations, it may be necessary to use a feeding tube to get breast milk to the baby. Other premature or sick babies may need to be fed via IV in those early days. Even full-term babies who are in the NICU because they’re sick may require feeding tubes while they learn to eat and recover.

How do you transition to direct breastfeeding when your baby starts out in NICU?

Some good news: Even if your baby started out in NICU and you weren’t able to breastfeed from day one, breastfeeding isn’t off the table. You can transition your premature baby to breastfeeding as soon as they’re strong and healthy enough to make the switch. Just know that it may take a bit for you and baby to get the hang of things.  

At first, you may be encouraged to have skin-to-skin contact and to manually express milk onto your baby’s mouth after they’ve been tube fed. That way, they’ll get familiar with your breast and milk. This is typically called ‘non-nutritive sucking.’

In many cases, a lactation aid or tube may be used early on as well. A small tube can be taped next to your nipple and expressed breast milk or formula can be fed through the tube. Again, this helps your baby get used to breastfeeding, but ensures they aren’t relying solely on their latching and sucking skills to get fed.

As your milk supply increases and your baby shows signs of efficient latching and sucking, you will be encouraged to transition to direct breastfeeding. You may need to start out using a nipple shield to help your baby, but once you’re home and they have the hang of sucking, you should be able to wean them off the nipple shield.  

Is there anything you can do to help your body + your baby during this time?

When your baby is in the NICU, you’ll understandably be thinking about their wellbeing all the time. But one way you can help your baby is by taking care of yourself. 

You may feel like you need to be at your baby’s bedside 24/7, and while being there for your baby and with your baby is important, it’s also really important that you don’t get burnt out. That you get rest and relaxation where you can. When you show up for yourself, you’ll be better able to show up for your baby. 

The more you care for yourself by eating nutritious foods, drinking hydrating drinks, and getting rest, the less stressed and more prepared your body will be to continue providing healing breast milk for your baby. 

We realize that telling a mom of a NICU baby ‘not to stress’ is a bit like telling women in IVF cycles to ‘just relax,’ but do your best to destress whenever possible – whether that’s with a good book, a guilty pleasure TV show, some relaxing music, or a phone call with your bestie. 

But most importantly, remember that you’re strong, your baby is in good hands, and things will get better. There’s no sugarcoating it, having a baby in the NICU is scary and heart-wrenching. If you struggled with anxiety during pregnancy, now that anxiety may be in overdrive. And you may be having thoughts like, “This isn’t how it was supposed to be.” 

Those are all valid feelings, so don’t force yourself to push them down. Let your feelings out, ask for help, and vocalize your frustrations and fears. Confide in your loved ones and rely on them for support. 

You’re in the midst of one of the hardest storms a mom will weather, but you and your baby will make up for lost time once they’re healthy and strong enough to go home. In the meantime, take care of yourself and get as much skin-to-skin time with your baby as possible. They’ll feel the love, even if you feel like you can’t do enough to show them.