Breastfeeding and Supplementing Breastfeeding In the hospital Pumping Tools and Tricks

Breastfeeding your NICU baby: Everything you need to know!

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Of course we all want a “healthy baby,” but sometimes babies end up in the Special Care Nursery or Neonatal Intensive Care Unit (NICU). This can be terrifying. I know this feeling well. My fourth kid was having a very rough start and was whisked away to the nursery immediately after birth. He ended up being transferred to two different hospitals before he was stable. Because he was having breathing issues, he was not being fed (called NPO/ nothing by mouth). I had to rally after my c/s and do the only thing that I could do for him: start pumping.

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There are many reasons why this could happen. Here are a few:

  • Birth is hard and sometimes babies have a rough transition to the outside (exhibited as breathing difficulties)
  • Some mothers have gestational high blood pressure and these babies might be born a little early
  • Some babies are born early for no known reason
  • Some babies have difficulty regulating their blood sugar initially
  • Some babies have difficulty regulating their temperature initially


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So what do you do? You’re planning to breastfeed, but now things aren’t going as planned.

  • As soon as you feel up to it, go see your baby. This will deliver a huge oxytocin surge, which will help when you begin expressing milk. (In most hospitals, you can even get in to see your baby on the gurney just after your c-section; however, they may reserve this for extremely critical babies. If this won’t work, you should be able to get into a wheelchair fairly soon after delivery if you’re doing well.)(At the very least, have someone take a picture of the baby and bring it to you.)
  • You’ll want to begin expressing milk as soon as you feel up to it after delivery–the sooner the better. The research states that hand expression is more effective at removing the milk in the first days, so if you’re comfortable with it, you should start with that. You can read more about hand expression here.
  • Either right away, or sometime on day two you can start using the hospital-grade breast pump.
  • Whether you are hand expressing or pumping, frequency and consistency are key. You’ll want to shoot for stimulating your breasts at least every 3 hours around the clock, as if you were feeding the baby.
  • General milk expression guidelines:
    • 5 minutes per side/ 10 total of hand expressing every 2-3 hours if hand expressing only.
    • If pumping, hand express or do breast massage for about 5 minutes before double pumping for 15 minutes every 2-3 hours.
    • Most moms are super exhausted the first couple of days after delivery. If they are separated from their baby and hand expressing or pumping only, I recommend pumping every 3 hours around the clock, but taking some longer stretches at night the first one or two nights if needed. Once the milk starts coming in, moms won’t be able to take those longer stretches without risking engorgement.
  • As soon as your baby is able to have anything by mouth, you can start providing your colostrum. Sometimes baby can even have drops of colostrum in their mouth just for a taste, not a feeding, before they are able to feed.
  • There are lots of ways baby can be fed your expressed milk. Read here for more information about the different ways.

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The moral of the story:

It’s really hard when things don’t go as planned and you’re separated from your baby; I know this first hand. But, it’s helpful to have a plan if things do go awry. If you’re separated from your baby, your main job is to rest, recover, and work on your milk supply with hand expression and/ or pumping. Send the visitors home and just focus on your new little family and establishing a milk supply for your sweet baby. (Read more about visitors here.)

Your frequent and consistent hand expression or pumping will be rewarded with an awesome milk supply in 3-5 days. Don’t freak if you don’t collect anything, even drops, for the first day or so of pumping. (I totally did!) This is normal. The pump doesn’t work like the baby at getting the colostrum/ milk out. Doing hand expression along with pumping might help, but either way, frequent stimulation is key in the early days. Think of it this way: You’re putting in your order now for how much milk you want, and when your milk comes in (somewhere between days 3-5), your waiter (breasts) will deliver what you requested!

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Was your baby in the NICU? I’d love to hear your story!

Share below in the comments.


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