Pumping for a baby in the NICU

Most parents don’t expect their baby to need to go to the NICU after being born, and the unexpected surprise can be stressful, exhausting, and emotionally draining. A mother who was planning on breastfeeding her baby may not know what to do when her baby will be spending days, weeks or even months in the NICU. While pumping for your NICU baby can be time consuming and challenging, it can be an important way for you to be involved with your baby’s care, and breast milk offers significant health benefits to your baby, especially if he is premature or ill. And even if your baby needs supplementation from formula or specialized human milk fortifier, he will still be getting the benefits of your breastmilk in any amount you can provide.

It is important to begin pumping right away for your baby. It typically takes between 2 and 5 days for your milk to come in.  Before this happens, your body makes colostrum; the yellow, thick ‘first milk’. This is nutrient-dense, packed with all sorts of good things such as immune factors, and sustains your baby until your milk comes in. You may only get a few drops of colostrum – this is normal!, but every bit is beneficial.

Healthy newborns typically eat 10 to 12 times per 24 hours – that’s every 2-3 hours.  This is normal as their bellies are very small, so they need to eat more frequently.  Your goal is to mimic the frequency of normal breastfeeding and establish your milk supply with pumping. Milk supply is typically based on a supply and demand relationship, so the more the breasts are stimulated and emptied, the more the body is signaled to make milk. The best way to set up your milk supply for your baby is to pump completely and frequently, at least 8-12 times per day for at least the first 3-4 weeks. Aim to pump at the same time each day so that your body knows to make milk at that time. Even if your baby is unable to eat much or any of your breast milk at the beginning, keep pumping consistently, as the first month is very important for setting up your supply. Establishing milk supply will enable you to be prepared if and when your baby is ready and able to nurse.

After the first month, you may be able to pump eight times per day and maintain an adequate milk supply for your growing baby. If your baby is able to be held while in the NICU, holding your baby skin-to-skin helps stimulate your milk production hormones, and is recommended before pumping. If you are unable to hold your baby, you can pump close by while you’re visiting in the NICU, look at pictures or videos of your baby, or even smell an article of their used clothing for extra stimulation while you pump. While it is normal to feel stressed when your baby is ill or in the NICU, try to find support through family and friends and NICU support staff, as stress can negatively impact milk supply. Also, taking care of yourself through good nutrition and hydration can help support your milk supply.

If your baby was born prematurely, the milk that you express is a little different than what is produced when babies are born at full term. It is much higher in protein and minerals, and contains different types of fat that are easy for him to digest.  You will not be getting as much volume because your baby’s tummy is very small (likely the size of a marble!). So if you are not getting a lot, do not fear! That is normal.

The hospital-grade electric breast pump is the most effective type of breast pump, and most moms find they’re able to get more milk when using a hospital grade pump. Electric breast pumps that pump both breasts at the same time are also effective, but for the exclusive pumper – even if your goal is to eventually nurse – a hospital grade pump is recommended and can typically be rented monthly from your hospital.

It is important to practice safely handling the pumped milk when you are transporting it to the hospital. Milk storage guidelines are different for premature or hospitalized babies, as these babies are more at risk for infection. Whenever possible, take your pump to the hospital to pump fresh milk for baby’s next feeding. It is important to discuss storage and transportation guidelines for pumped milk for your premature or ill baby with the NICU medical providers.

You will be spending a lot of time pumping. Try some of these things to make the best of it:

  • A hands free pumping bra can be very useful, or you can take an old sports bra and cut two slits in it to slip the flanges through. Then you have your hands free to grab some food, relax, or just pump without needing to hold on. 
  • Have snacks and water handy wherever you pump so you can stay nourished and fueled while you are sitting down.
  • Catch up on your favorite show or podcast while pumping! Enjoying some mindless entertainment can help give your brain a break during a stressful time.
  • Reach out to other new moms, especially NICU moms, for support and guidance, whether virtually or over the phone.
  • Close your eyes. The humm of the pump isn’t exactly the sound of ocean waves, but getting some rest when you can is important when you’re likely exhausted and not sleeping adequately.

Make sure to let the medical personnel at the hospital know you’d like to provide breastmilk for your baby.  Getting their support will be key to helping make your breastfeeding goals work. Many NICU’s have a lactation consultant on staff. Ask your baby’s nurse to meet with that person to help support you in a more personalized way.

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