Babies are admitted to the NICU for a variety of reasons, such as preterm birth or a need for additional medical management. You will receive ongoing support from several specialists throughout your baby’s time in the NICU. Lactation consultants are specialists who will guide you in establishing your milk supply and support breastfeeding as your baby heals and grows.
During your time in the postpartum unit, we recommend you:
- Establish with a lactation consultant
- All babies who are admitted to the NICU automatically have a lactation consult ordered. If you have not seen a lactation consultant by 24 hours postpartum, please follow up with your nurse
- Learn how to hand express
- Learn how to pump
- Ensure proper pump flange size with a lactation consultant
- Receive a NICU pumping diary
- Develop a pumping plan. Typically, when baby is not yet latching, the recommendation is to pump every 3 hours for no more than 15-20 minutes per session.
- It is very important to ensure proper breast pump usage, pumping frequency, and flange size with a lactation consultant. Incorrect use of the breast pump can cause nipple damage, breast pain, and a decreased milk supply.
- Know how to schedule an appointment with a NICU lactation consultant after you are discharged from postpartum. Latch support at your baby’s bedside can occur gradually (over days to weeks).
Depending on where your baby is developmentally or medically, your baby may or may not be taking oral feedings. Some babies start by only receiving nutrition through an IV, an NG tube, or a means other than breast or bottle feeding. Initiating oral feeding is very individualized to your baby’s progress, and the first step is clearance from the medical team. Your NICU nurse is the best person to update you on your baby’s feeding plan and arrange different specialty consultations based on your needs.
The production of breastmilk is a dynamic process that works as a “supply and demand” system. The breasts should be stimulated to release milk at least 8 times per day. If your baby is not yet latching, breast stimulation and milk collection will come from a combination of hand expressing and pumping. Women who hand express 3-5x/day, especially in the first few days postpartum, produce more milk than women who pump alone.
Overview of initiating and maintaining a milk supply during periods of separation:
- When baby is not yet latching or breastfeeding, pump every 3 hours for 15-20 minutes per pumping session. Ensure proper breast pump usage, pumping frequency, and pump flange size with a lactation consultant.
- It is most effective to time pumping during or shortly after times you can hold or visit baby. During separation, we recommend viewing photos or videos of your baby, or alternatively smelling blankets or clothing that has your baby’s scent.
- Hand expressing 3-5 times per day before or between pumping sessions for ~5- 10 minutes per breast produces more milk than pumping alone.
- Depending on your baby’s circumstances, you may be latching and attempting breastfeeding. Work closely with a lactation consultant in the hospital to assess feeding. For preterm babies especially, initial breastfeeding attempts may be recreational feedings rather than full feedings with milk transfer. Pumping is adjusted on an ongoing basis based on where your baby is with breastfeeding.
- The importance of rest, nutritionally dense foods, and adequate hydration for parents cannot be overemphasized. Utilize friends and family as needed to support you during this time. Caring for yourself is as important as caring for your baby, especially in circumstances such as having a baby in the NICU.
Frequent or incorrect use of the breast pump can increase your risk of challenges such as overstimulation of the breasts, clogged ducts, and mastitis. Mastitis is a spectrum of breast inflammation/ infection that is often related to clogged ducts and oversupply.
Overview and management of clogged ducts:
- Work closely with a lactation consultant to manage your pumping plan. While the standard is to pump every 3 hours for 15-20 minutes, this may change based on your milk supply or as your baby starts latching.
- Take 600mg of Motrin every 6 hours with food to decrease inflammation and discomfort. You can also concurrently take 1000mg of Tylenol every 6 hours with Motrin. Discontinue these medications when your symptoms improve.
- Apply cold compresses for 15-20 minutes between breastfeeding. Do not apply ice directly on the skin, we recommend a barrier such as a thin cloth.
- Wear a supportive bra without underwire.
- We do not recommend applying heat or aggressively massaging the breasts, as this can worsen inflammation and cause tissue damage.
- If you have recurrent clogged ducts, ask your provider about a supplement called Sunflower Lecithin.
If you are experiencing clogged ducts and your symptoms do not improve in 2-3 days of management, or you develop a fever >100.4F or flu-like symptoms, please contact our nurse triage line at (415) 666-1250. You may have a breast infection.
