We sat down with Barbara Carr, M.D., neonatologist and medical director for Pediatrix® Neonatology of Missouri who practices at Saint Luke’s Hospital of Kansas City, to discuss common questions new moms with babies in the neonatal intensive care unit (NICU) may have about breastfeeding.
Q. Should you wait to try breastfeeding until after your baby is out of the NICU?
A. Definitely not. Premature babies, as well as term babies who need care in the NICU, may have difficulties learning how to eat by mouth. Beginning breastfeeding with the support of a lactation consultant in the NICU can be critical to long-term breastfeeding success. Even babies who don’t have significant difficulties can benefit from this support. The NICU staff can help a nursing mother understand and recognize what is normal and what isn’t for a baby’s gestational age, preventing frustration. Studies show that if a baby’s first oral feeding is at the breast, there is a greater likelihood that the baby will be breastfeeding at discharge. Attempting to breastfeed as soon as your baby is able will also help stimulate your milk supply. Delaying breastfeeding until after discharge increases the likelihood that your baby will not breastfeed.
Q. Will I need to pump my milk out if my baby isn’t strong enough to latch?A. If your baby is initially unable to feed by mouth, you will be asked to hand-express or pump milk to provide nutrition to your baby. We recommend that most new moms begin pumping within the first two hours after delivery and continue pumping every three hours, day and night, as though they have an infant nursing. This will help your body begin producing adequate milk more quickly. In fact, research has shown that women with preterm babies (born at less than 31 weeks gestation and weighing less than 1,500 grams) who practiced hand expression five to six times a day for the first three days in addition to pumping had as much as a 50% increase in their milk supply at eight to nine weeks.
As neonatologists, we advocate that moms of babies in the NICU start pumping or hand expression as soon as possible. While you may feel helpless while your baby is in the NICU, this is something that only you can do for your baby. We recommend using a hospital-grade pump, which you may be able to rent or purchase at your hospital.
Q. Is early milk different than full-term milk?A. Colostrum is the first milk a woman produces after giving birth and the first food a breastfed baby receives. In some women, colostrum may be yellow and thick. For others, it may be clear and watery. Colostrum is similar to amniotic fluid, but it is full of infection-fighting components.
Your body will produce colostrum for about five days after your baby is born. Then, transitional milk will come in. Mothers of premature babies produce breast milk that’s a bit different from term milk, at least for the first few weeks. Premature breast milk is higher in protein and minerals, and has higher concentrations of antioxidants and protective antibodies, like immunoglobulin A (IgA). These differences are designed to meet your baby’s specific needs as he or she adapts to being fed outside the womb.
Q. Can I pump and store milk at the hospital while the baby is in the NICU?
A. If you’ve been discharged from the hospital but your baby needs to stay, the hospital will provide you with a supply of bottles or bags to store milk for your baby. You’ll need to work with your hospital’s lactation and baby care team to coordinate storing milk. According to the Centers for Disease Control and Prevention (CDC), freshly expressed or pumped milk can be stored at room temperature for up to four hours and in the refrigerator for up to four days. A breastfeeding app can help you keep track of your milk stock and when each batch expires.
Q. What if a mother isn’t able to produce enough milk? Is donor milk safe?A. If you’re having trouble producing enough milk, try to increase your skin-to-skin contact (kangaroo care) with your baby and pump at his or her bedside. Power pumping is another option to increase milk supply. This technique involves pumping more frequently within a set time frame each day. Contact the lactation consultant if you have a sharp decrease in milk supply in a 24-hour period or if you are seeing a more gradual decline over a few days.
Donated human milk through a reputable milk bank is another option. The American Academy of Pediatrics recommends donor milk as the next best option to your own milk, especially if your baby is at high risk of developing medical complications. Using a milk bank is a safe way to supplement a new mom’s supply, as a bridge until your milk supply comes in or to provide nutrition if you’re taking medication that affects your milk. Always let your baby’s care team know if you start a new medication to be sure it’s safe for your baby.
There are for-profit and non-profit banks, and most follow the guidelines set by the Human Milk Banking Association of North America. Milk donors must complete a rigorous application and approval process that includes collecting an extensive health history, screening donors for medications that may be harmful to infants and completing bloodwork to identify any infections or other medical conditions. After the milk is collected, it is pasteurized and tested for bacteria. If approved, it’s frozen and then shipped to health care facilities. However, while using donated milk is very safe, the pasteurization process depletes breast milk of some of its positive properties, making mothers’ own milk the healthiest, best choice when available.
Q. Are there reasons that my baby may need formula in the NICU?A. Some medical conditions, such as certain metabolic disorders, require specialized nutrition that can only be given with a formula. Sometimes a baby may be intolerant of cow milk protein, so he or she may require specialized formula while the new mom eliminates dairy from her diet. Additionally, babies may require thickener to help them eat orally. These thickeners often can’t be added to breast milk during the time the baby is in the NICU.
Breastfeeding is a learning process for both mother and baby. It can take time and there will likely be bumps in the road. Ask for help if you need it, and be patient with yourself and your little one. The benefits you and your baby will have from long-term breastfeeding are worth it but always remember that being a mom involves a whole lot more!