Covered in this class:
– Preterm Considerations
– NICU Stays
– Genetic Variances
– Cleft Lip/Cleft Palate
– Ways to protect milk supply
Blog: Motherly Love – Blog (motherlylovelactation.com)
Website: Motherly Love – Home (motherlylovelactation.com)
Contact: sabrina@motherlylovelactation.com
When your baby arrives earlier than expected or requires specialized medical care, breastfeeding goals may feel uncertain. This comprehensive overview, presented by lactation consultant Sabrina Barber IBCLC, provides evidence-based guidance for families navigating feeding decisions during NICU stays.
Understanding NICU Feeding Realities
Preterm babies face unique feeding challenges that vary significantly by gestational age. Babies born before 36 weeks are considered preterm, but a 36-week baby has vastly different needs than a 28-week micropreemie. These challenges include underdeveloped sucking pads, reduced stamina, temperature instability, and potential blood sugar regulation issues.
Micro preemies (under 28 weeks) may initially be unable to feed by mouth, receiving nutrition through feeding tubes or IV solutions. However, this doesn’t preclude breastfeeding success later—it simply means the journey looks different than originally planned.
The Critical Importance of Early Milk Expression
Your milk supply will establish regardless of your baby’s feeding ability. Once the placenta is delivered, hormonal changes trigger milk production whether your baby is 28 weeks or 40 weeks. However, the key difference is that you’ll need to mechanically remove milk to maintain and build supply.
Hand expression in the first hours is crucial, even if you only collect drops. NICU staff highly value these early drops of colostrum—they contain billions of infection-fighting cells and can be applied to your baby’s gums even if they cannot yet feed orally. This provides critical immune protection when your baby needs it most.
Realistic Expectations for NICU Feeding Goals
Many families don’t achieve direct breastfeeding before NICU discharge, and this is developmentally normal, not a failure. NICU priorities focus appropriately on medical stability and adequate nutrition rather than exclusive breastfeeding. This institutional approach, while medically sound, can feel disappointing to parents with breastfeeding goals.
Factors affecting NICU breastfeeding success include:
- Limited supervised skin-to-skin time due to medical equipment
- Strict feeding volume requirements that may exceed what babies can transfer at breast
- Variable staffing and lactation support availability
- Baby’s developmental readiness, which may not align with discharge timeline
Equipment and Supply Protection Strategies
Hospital-grade pumps are essential during NICU stays. These “power rangers” of pumps are specifically designed for establishing milk supply when babies cannot effectively nurse. Your personal pump can wait until after discharge when supply is better established.
Realistic pumping expectations: In the first days, you may see only drops despite frequent pumping sessions. By day 3, small amounts may be visible, with gradual increases over the following weeks. Full feeding volumes (2.5-5 ounces) typically aren’t reached until around one month.
Special Considerations for Genetic Conditions
Babies with conditions like Down syndrome, cleft lip/palate, or other genetic differences can often breastfeed successfully with appropriate support and positioning modifications. For example, the “koala hold” helps babies with low muscle tone achieve better latch depth, while some cleft lip presentations may still allow for direct nursing.
Post-surgical breastfeeding is possible for many babies with cleft palate repairs, though this typically occurs after 12 months of age and focuses more on comfort nursing than nutritional needs.
Supplementation in the NICU
Supplementation decisions often prioritize medical stability over exclusive breastfeeding. Donor milk is typically the first choice for micro preemies, while older preterm babies may receive formula supplementation based on institutional resources and protocols.
This doesn’t preclude future breastfeeding success. Many babies who receive significant supplementation in the NICU go on to breastfeed successfully at home with appropriate support.
Planning for Post-NICU Success
Discharge doesn’t end the breastfeeding journey—it often marks the beginning of phase two. Many families benefit from continued lactation support at home, where there’s more time and flexibility to work on direct breastfeeding skills without the constraints of medical monitoring.
Consider assembling a feeding support team that may include lactation consultants experienced with preterm babies, occupational therapists, and speech therapists for babies who need additional oral motor support.
Supporting Your Mental Health
NICU experiences are inherently traumatic, involving separation from your baby and disruption of expected bonding experiences. Recognize that pumping around the clock while your baby is hospitalized requires enormous emotional and physical energy.
Your feeding goals may evolve, and that’s completely normal. Some parents find that combo feeding or exclusive pumping better serves their family’s needs after a NICU experience, and these approaches still provide significant benefits to babies.
Key Takeaways
- Milk production will occur regardless of baby’s feeding ability—focus on establishing and maintaining supply through regular expression
- NICU discharge without successful latching is common and doesn’t predict long-term breastfeeding outcomes
- Post-discharge support is often crucial for achieving direct breastfeeding goals
- Every drop of colostrum and breast milk provides valuable immune protection
- Feeding success looks different for every family, and your mental health and wellbeing matter in these decisions
The NICU journey rarely follows the feeding path parents initially envisioned, but with appropriate support and realistic expectations, many families do achieve their adapted breastfeeding goals. Remember that providing breast milk in any form—whether through direct nursing, pumping, or combination feeding—offers significant benefits to your baby and represents a meaningful contribution to their health and development.