Having a baby in the NICU is unexpected, but it’s not uncommon. Between 10-15% of all newborns every year end up spending some time in the NICU. It’s the best place for babies who need extra care and support to be as they recover. 

Having a NICU baby can change for plans, though. For moms wanting to breastfeed, it means making some adjustments. 

But don’t worry — breastfeeding can still happen for you and your baby. In fact, giving your baby breast milk is more important than ever when you have a little one in the NICU. And thanks to pumping, it’s entirely doable even if your baby isn’t able to nurse yet. 

Here’s what you should know about getting your baby breastmilk while they’re in the NICU.

Pumping for your NICU baby: Why it’s important

Babies end up in the NICU for a number of reasons. Some babies arrive just a tiny bit early and a little observation and support before being allowed to go home. Other babies have more serious medical needs. The common factor? The NICU provides a safe space for babies to get the care they need and recover. And providing breast milk can be a big part of that care.

Breastfeeding has huge benefits for all babies, but especially for babies in the NICU with compromised health. Breast milk contains important antibodies that boost your baby’s immune system along with the nutrients they need to grow and develop. 

Breast milk is important for the optimal growth and development of full-term infants, and it’s even more important for premature babies. But...why?

Premature babies miss the opportunity to receive important developmental factors like DHA and immunoglobulin G. Moreover, premature babies’ digestive systems are immature. This can make digesting and absorbing nutrients more difficult. However, breast milk can help bridge these gaps; it contains higher quantities of DHA and immunoglobulins than breast milk for full-term babies. Moreover, early colostrum contains enzymes that help with digestion and epidermal growth factor, supporting the continued development of their digestive system. 

(Remember, babies need only a tiny amount of colostrum, so even if it seems like you’re producing a small quantity, you should still try to provide it to your baby.)

How to successfully start pumping for your NICU baby

Establishing your supply 

For all breastfeeding moms, it’s important to initiate breastfeeding right after birth. Within 3-4 days of giving birth, though, you’ll begin to produce breast milk, but you need to pump to make that happen.   

After your baby is born, get situated with a pump as quickly as your recovery allows. Ideally, you want to pump within the first few hours after your baby is born. Following that, moms of newborns should plan to pump at least every three hours to establish their supply. This equals about eight times a day — and includes nighttime hours — for approximately 15-20 minutes per session.

Note that because it takes a few days for your breast milk to come in, you may only pump a few drops at first. Keep going! The stimulation provided by pumping will support your supply, plus it will help you collect colostrum. (Some moms do find that hand expression is more effective than pumping when it comes to colostrum.)

For mamas with babies in the NICU, all of this can be more challenging. Things can happen quickly and the focus is frequently on getting the baby the immediate care that they need. To make sure your breastfeeding plan doesn’t get put to the side, be ready to advocate for your baby. 

Skin to skin

If allowed by your baby’s doctor, kangaroo care and skin-to-skin contact is another way to support your milk supply. These practices are wonderful ways to bond with your baby, but they’re also associated with higher volumes of expressed milk and longer durations of breastfeeding. Kangaroo care and skin-to-skin are also associated with major health benefits for your baby: it can calm and regulate breathing and heart rate.

Staying organized 

Once your supply has come in, what do you do with the milk? It’s an important question to answer because the average NICU stay for newborns born after 32 weeks of pregnancy is 13.2 days. 

Your hospital will let you keep milk that you’ve pumped while there, but you’ll need to follow labeling, sterilization, and storage protocol there. If you plan on pumping some at home, check with them if they’ll let you bring this in and how you should transport it. 

Additionally, find out whether you should bring in milk that you pump at home, and if they have any guidelines about how you should transport it (particularly if it is a longer drive).

If this all seems a little overwhelming, it can help to use a pumping tracker app to help you. These apps let you record when you pump, how much, visualize your stash, and more. 

Dealing with NICU stress

Having a baby in the NICU is hard for lots of reasons. You may feel like it’s impossible, but try to rest and keep your stress levels low. Make sleep a priority. Drink lots of water. Try to find a few minutes to relax with a favorite pastime.

Many parents choose to stay at the NICU during the entirety of their baby’s stay there while others choose to go between home and the NICU. There’s no right or wrong answer — it will all depend on your other obligations and your baby’s health conditions. If you do stay at the NICU, make sure to find ways to make yourself comfortable during this time. 

Support groups and other mothers in the NICU

When it comes to getting through difficult situations, there’s nothing like the support of those who are going through something similar. For parents of babies in the NICU, support groups provide solace. Check with your hospital or pediatrician's office for local support groups. Online groups are another good option. And don't forget to seek out relationships with other NICU parents. After all, you've faced similar obstacles and concerns. 

Feeding your NICU baby

Pumping is one thing, but feeding your baby is another. Feeding a NICU baby can feel stressful with the medical apparati surrounding them, but there are lots of options. It all depends on their medical condition and whether they can suck or swallow. Here’s an overview of options:

• If your baby has developed their sucking reflex, it may be possible to nurse 
• If your baby hasn’t developed their sucking reflex, you can still deliver breastmilk:
• From a bottle. It can be helpful to use a preemie nipple or a low flow nipple if you plan on nursing your baby later on; this can reduce nipple preference
• From a syringe: This can be an easier option if you are providing just a few drops of colostrum early on or if your baby is an very early premie
• From a supplemental nursing system (SNS). This feeding tube device is worn at the breast to help support nursing.  
• If your baby needs additional help feeding, a feeding tube may be used to provide breast milk. 

Donated Milk

If you aren’t able to produce sufficient breast milk, you may have the option of using donor milk. Donor milk, which is donated to a milk bank and tested to make sure that it’s safe for babies, has all the benefits of your breastmilk. While it does need to be prescribed by your baby’s provider, it’s a great alternative to formula, especially for the sensitive digestive systems of preemies.