NICU Baby

Babies are admitted in NICU for a variety of reasons. In most cases, there is a separation of the mother and the baby. In some cases, the mother might be able to visit the baby. And in some fortunate cases, the mother might be able to stay at the facility and can stay available to breastfeed the baby at all hours.

However, in this article, we will address the issue of mothers who cannot directly breastfeed their baby while the baby is admitted in the NICU. At the end, there are pointers to start direct breastfeeding.

Establishing and maintaining the milk supply :

1. If the baby is separated from the mother at birth, it is most recommended to start expressing colostrum within the first hour of birth. Colostrum is easier to express by hand expression.
2. It is important to mimic the timetable or routine of a healthy breastfeeding baby at the breast even when the baby is away in the NICU. so, the mother needs to express milk at least 8-10 times in the span of 24 hours. (every couple of hours during the day and every 3-4 hours during the night)
3. If the baby is going to have a longer stay at the NICU, and it is not going to be possible for the baby to latch, it might make more sense to invest in a pump. The longer the stay of the baby in the hospital, and the longer the impossibility to attempt direct breastfeeding, the better the pump should be, ideally. Many hospitals offer hospital-grade pumps for mothers whose babies are in the NICU.
4. In case of unavailability of a pump, hand expression too can be equally effective if learnt and done correctly.
5. Even if the baby is unable to receive milk due to intubation, it is important to keep expressing and storing the milk just as regularly. It can be consumed later by the baby and a stash would never hurt.

Techniques for improving Output :

1. Mother should try to get enough rest and sleep and keep herself well hydrated.
2. Gently massage the breast before expressing the milk.
3. Applying wet heat from a washcloth can help the letdown.
4. Having the partner around reduces stress levels and helps the mother feel more relaxed and less anxious.
5. Get a back massage from the partner or other helpful family member before expressing milk. It triggers oxytocin which helps in letdown.
6. Keep the baby’s photo in front while expressing milk. Smelling the baby’s clothes can have a similar effect too.
7. Some women have noticed that they can yield maximum output during early morning hours between 1 and 5 am. This is because the prolactin production is highest around that time.
8. While using a pump, it is important to choose the right pump, with the right flange size. Also, certain settings of speed and suction need to be understood well from the instructional manual.
9. Establishing a regular routine for breast milk expression and sticking to it is helpful.
10. Taking help from gravity by leaning forward a little while pumping/hand expressing works well.

Techniques to cope with the overwhelmingness of the situation:

1. Seek help and support from the partner and other family members for washing pump parts and bottles, sterilizing them etc.
2. Refrigerating the pump between uses can save a lot of cleaning effort.
3. Read inspiring stories of women who have successfully provided breast milk to their babies throughout their hospitalization.

Tips for breastfeeding once the baby is able to and/or allowed to latch:

1. Holding and putting the baby to the breast even if the baby is too weak to nurse is always a good idea. It gradually inclines the baby towards breastfeeding and it also works wonders for the mother’s supply. Many NICUs adopt the Kangaroo Mother Care (KMC) approach put forward by Dr Nils Bergman.
2. Wearing front opening clothes is useful so that maximum skin to skin contact is achieved with the baby while breastfeeding and otherwise.
3. Some babies become averse to anything touching their face due to intubation. In such cases, going slow with direct breastfeeding is recommended. Skin to skin slowly and gradually inclines the baby to take the breast.
4. Breast compression while nursing can help babies suckle actively.
5. Working on the letdown before putting the baby to the breast is a good technique to make it easier for the baby. A wet washcloth, gentle breast massage, back massage etc can help.
6. It is important not to get disheartened during the early attempts at breastfeeding. It can take time. As the baby grows stronger, things will change for the better.

References :
https://www.breastfeeding.asn.au/bf-info/premature
http://www.gentlechristianmothers.com/articles/cyndi/bfhb.php
https://www.llli.org/breastfeeding-premature-babies/
https://momlovesbest.com/feeding/breast-pumps/how-to-pump-more-milk