Breastfeeding a premature baby in NICU – 11 tips to help you get started

NICU (neonatal intensive care unit) is a place alot of people don’t know a great deal about until it affects themselves or someone close to them. I was one of those people until my daughter Freya was born at 30+3 weighing a tiny 2lb 10oz.

Freya was delivered via C-section as I developed severe preeclampsia and another condition called hyponatremia which lead to me becoming very unwell within a matter of days. I never had a birth plan other than wanting skin-to-skin and to breastfeed. However, when Freya was born so premature and with me being in ICU I didn’t expect to be able to breastfeed. I was wrong. 5.5 weeks after Freya’s birth she was discharged exclusively breastfeeding with no nasogastric tube.

I’m going to share a few tips that I picked up along the way on how you can establish breastfeeding a premature baby in the NICU.

#1 Tell the NICU you want to breastfeed

They normally ask how you want to feed your baby. In NICU they are very pro breast milk due to the amazing benefits of breastmilk for premature babies; however, make sure you let them know you want to breastfeed. My husband was an advocate for me as I was in ICU and unable to be in NICU. When he told them I wanted to breastfeed they did a little dance because they know how beneficial it is to a baby’s development.

#2 Hand express colostrum

When I was in ICU, NICU arranged for a lactation specialist to visit me and showed me how to hand express colostrum. This is the first part of the milk also known as ‘liquid gold’ and is so important for premature babies due to all the immunity and antibodies it contains.

You can start expressing colostrum straight away and if you ask the hospital for some colostrum syringes they will provide you with some. You may not feel like you are getting alot but the stomach of a premature baby is tiny so they only require very small amounts. 

I’d suck up those tiny droplets of liquid gold and my husband Warren became the milkman making deliveries to NICU.

I’d suck up those tiny droplets of liquid gold and my husband Warren became the milkman making deliveries to NICU.

#3 Pump,pump,pump.

Just because you may not be able to breastfeed your baby directly yet, it doesn’t mean you can’t give them breast milk. Most premature babies are initially given milk via an OG (orogastric) or NG (nasogastric) tube. To ensure Freya had enough milk for her feeds I would express multiple times of the day and night to ensure I kept up my milk supply.

I found expressing at night particularly hard as I wanted to be waking up to feed my baby not hooked up to a machine, but I knew I’d be taking another few bottles of the milky goodness to her the next day. I would express every few hours to make my body think it was feeding a newborn.

#4 Think about your baby or have them near when you express

Look at photos when you express, do plenty of skin to skin or express whilst next to them. In our NICU they gave me and Freya a small knitted square each. One would be with Freya and I would keep mine in my bra. We would swap every few days so she could smell me and I could smell her.

#5 Don’t be afraid to ask for help

I was a first-time mum and had watched no end of videos of breastfeeding classes prior to Freya’s arrival; however, I had no idea whether I was doing it right when it came down to it. I had to push a few times to get someone to help me but we got there eventually.

I also asked another mum who was in the same room as she had breastfed all three of her babies. Don’t sit and struggle. I shed many tears thinking Freya wasn’t going to breastfeed but we got there with the help of a very patient nurse who sat with us for an hour watching and helping us.

We got there with the help of a very patient nurse who sat with us for an hour watching and helping us.

#6 Don’t compare your baby to others

I made this mistake. There was a baby of the same gestation in the same room as us and he started breastfeeding at around 33 weeks gestation. I found this frustrating and couldn’t understand why Freya wasn’t yet. However, now I understand that his mum had breastfed her two children before and knew exactly what to do. Not only was Freya learning but so was I. I wish I’d not put so much pressure on myself. Remember premature babies are still developing as they would in the womb but in the outside world instead so they still need to develop their suck, breathe, swallow coordination before they will be able to breastfeed. Just like everything else, they all develop this in their own time.

#7 Join breastfeeding support groups

These helped me no end during our NICU stay and still do 14 months later. You will often find other preemie mums but also general advice. I even sent in a video of Freya when she first latched asking if she was doing it ok. When I look at it now it was so obvious she was but at the time I needed some reassurance and they were there for me.

#8 Get comfy, relax and try different holds

I never even realised how tense I was sitting in a chair trying to breastfeed Freya until a nurse pointed it out. My shoulders were nearly at my ears and I wasn’t comfortable. How can I expect my daughter to breastfeed if I’m full of tension and uncomfortable.

From that moment I would always sit on the chair comfortably and make a point of relaxing my shoulders and taking a few deep breaths. From there I would try the two classic holds to get her to breastfeed. The rugby ball and the cross-cradle. Do what’s best for you.

I never even realised how tense I was sitting in a chair trying to breastfeed Freya until a nurse pointed it out. My shoulders were nearly at my ears and I wasn’t comfortable.

#9 Express a bit of milk before-hand to help baby latch

I made the mistake of trying to get Freya to latch whilst my boobs were rock solid and then wondered why she wasn’t latching. Expressing some milk beforehand can ease engorgement and allow baby to latch on more easily.

#10 Speak up! 

Ask to try and breastfeed before they’re tube feed. I started doing this because I found it frustrating that Freya was having her 2/3 hourly tube feeds and then not wanting to breastfeed. This is understandable. Why would a tiny baby weighing only a few pounds want to work for their food? They want to conserve their energy. In the morning I would call and ask what time Freya’ss next feed would be and tell them I will be there before to try and get her to latch. I’d then sit with her all day and do the same before every feed. Some nurses were more relaxed with feeds and happy to let me try for a while but others were very strict with timings.

#11 Persistence is key

If you want to breastfeed your premature baby you can. Your baby may be small but they will still be able to breastfeed once they have developed enough. No one ever said breastfeeding was easy, and trying to breastfeed a premature baby is no different.

My once 2lb 10oz baby is now 14months old and still loves her booby milk. I’m so glad we kept at it. I would do it all 10 times over to feel the love and connection I have with Freya when feeding.

I’m so glad we kept at it. I would do it all 10 times over to feel the love and connection I have with Freya when feeding.

September is NICU Awareness Month – designed to honor families experiencing a stay in the neonatal intensive care unit and the health professionals who care for them. You can find out more here.