UNC Health Care

Breastfeeding Month: Breastfeeding difficulties related to having a special care/NICU baby

Jennifer Majors, IBCLC, RN, is a Lactation Consultant at Rex HealthcareJennifer Majors, IBCLC, RN, is a Lactation Consultant at Rex Healthcare. Prior to being an IBCLC, she was a Pediatric RN. Jennifer and her husband have three boys.


When things don’t go as planned: Breastfeeding difficulties related to having a special care/NICU baby

Breastfeeding can be challenging for moms who have perfectly normal and healthy babies, but having a NICU baby has all kinds of challenges. Whether it’s prematurity, blood sugar issues or something entirely different, there are many things you can do to try and ensure that your baby gets the breastmilk and breastfeeding experience they deserve.

Baby Noah meets his brothers Reed and Logan for the first time
Baby Noah meets his brothers Reed and Logan for the first time

My first two sons were healthy and of normal size. We had our breastfeeding issues, but overall things went as expected. Noah, my third son, was found to have severe growth restriction at my 35 week prenatal visit. It was decided that he would be delivered at 36 weeks and 6 days because he would likely grow better outside than inside. He was born via c-section weighing 4lbs 2oz.

Shortly after he was born he began having difficulty breathing and keeping up his oxygen level. He spent 3 days on a ventilator, then some time on cpap, and needed oxygen for a few more days. Once his breathing stabilized, I was able to hold and even nurse him.

Nursing a NICU baby came with many challenges and I’m grateful for the knowledge base and training I’ve had. I often asked colleagues of mine for advice and support through our journey, so I couldn’t have done it without their help. Noah is a happy, busy, and healthy 15-month-old now.

I would like to share some of the things I learned through this process that may help any moms who may go through this or anything similar. There may be some tips to encourage moms who have perfectly healthy babies too!

Jennifer's oldest son Logan 'nursing his baby'
Jennifer’s oldest son Logan ‘nursing his baby’
  • The pump is your new best friend if you are separated from your baby!
  • Try to start pumping ASAP, and definitely within 6 hours of delivery when physically possible
  • You should be pumping 8-12 times in 24 hours. If you accidentally have a longer stretch than intended, pump a couple of times more frequently to make up for it
  • When possible, use a hospital grade pump. They are more reliable for establishing and maintaining a good milk supply. Renting one until nursing is well established is a great way to go if it is within your budget. If it isn’t, contact a lactation consult to discuss all options. I used to be skeptical about this one, but I ended up renting a hospital grade pump for a year because it did make a difference. It came with a price, but was certainly worth it!
  • pump at baby’s bedside when possible, often you will find that helps increase the amount you are able to pump. If not, look at pictures while listening to relaxing music or even a tape of some recorded sounds of your baby
  • Try not to ‘watch’ the pump. I would often cover up w/a receiving blanket once the pump was in place. It made it easier to relax and would easily get better output
  • use the highest level of suction that is COMFORTABLE. It doesn’t do anyone any good if it hurts. I found I would start on a low setting but gradually increase to a higher setting as my body got used to the suction
  • Don’t forget to squeeze/massage/compress. You often get better output by doing these. If you find this difficult while double pumping, either invest in a hands free pumping bra or do a search on the internet about how to make your own. The hands free bra was a game changer for me(for the better!)
  • Learn how to hand express. Often in the beginning, moms don’t pump a lot of colostrum out, but can easily hand express. Hand expressing after a pumping session has been proven to also boost milk supply and it is rewarding to see the colostrum and have something to give baby. Here is a great tutorial : http://newborns.stanford.edu/Breastfeeding/HandExpression.html
Jennifer holds Noah for the first time at three days old
Jennifer holds Noah for the first time at three days old
  • Skin-to-skin contact; I can’t say it enough. There is so much research that shows this benefits babies in so many ways. If the baby is medically stable and the doctors and nurses are okay with it, then do this all the time. Dad can do it too. Don’t sit at their bedside and hang out. Hold them skin to skin as much as possible. It helps that baby regulate their body systems, vital signs, breathing, temperature and metabolism, and has so many psychological and social benefits. It also encourages breastfeeding when ready.
  • try to wear buttoned shirts, zip hoodies, or cardigans that allow for easy access, but the ability to stay modest if you haven’t already lost all modesty through the childbirthing process

All in all, be patient. Breastfeeding can rock your world and throw your confidence in a way nothing else can. Remember that babies aren’t born with instructions and they have no idea what they are doing yet. If you are dealing with a preemie especially, then expecting them to breastfeed with ease is like expecting a 3-year-old to read a book cover to cover. Celebrate the tiny baby steps and DO NOT EVER let yourself feel like a failure. Show that baby that you are a fighter just like they are and that you can handle difficulties under pressure. Breastfeeding success no matter what depends on patience.

4 month old baby smiling
Noah at 4 months

Finally, follow up and get support. I encourage you to ask lots of questions, accept help daily if needed from nurses and lactation consultants. When baby goes home, it doesn’t have to end there. Many pediatricians have lactation consultants on staff who can help you with feeding plans and adjust them as baby grows and gets older. Le Leche League and Nursing Mothers of Raleigh have meetings and telephone support as well. There are also local lactation consultants that can come to your home if needed as well. Check out www.zipmilk.org if you are looking for local breastfeeding resources.

There are many, many more tips and advice for breastfeeding and pumping in addition to this. Here are some of my favorite breastfeeding websites:

Best wishes on your journey into parenthood! Having a special care or NICU baby can be challenging and emotional in so many ways but is also so rewarding to watch your baby overcome and thrive. I have such a great amount of admiration and respect for my youngest son, and a bond with him that is so strong. Spending those 13 days, many for hours on end with him snuggled on my chest is something I consider a blessing that I may not have had otherwise.

Jennifer and her 3 boys
Jennifer and her boys