What you can do in the NICU
What you can do in the NICU
Our mission is to support and educate Canadian families of premature babies every step of the way – before, during and after their NICU stays.
Our vision is to create a brighter future for all premature babies and those who care for them.
Feeding your baby
When your baby is born early there are lots of things happening, so you may not have even have thought about how you will feed your baby.
You will likely be asked the question by many people and may even feel pressure to choose breastfeeding. It is important to be able to make a truly informed decision. It is a long journey, and you will need positive motivation to keep going. Having the right information will help you to feel good about your decision.
The good news is that you don’t have to make long term decisions right away. If you aren’t sure, then get started and learn as you go along. Talk with your baby’s nurses and doctors about it. Take it one day at a time.
There are several videos on our website about breastfeeding premature infants.
And a podcast series to keep you company while pumping.
Click here to listen to the Podcast, "With You in The NICU."
Learn more about breastmilk and feeding
Questions & Answers
Why is breastmilk so important for my premature baby?
Breastmilk is the best nutrition for all babies. When a baby is born premature, mothers make “Premature breastmilk” for their baby. This milk is specifically designed for a baby born prematurely. Even if a mother had not planned to breastfeed, her breasts begin making breast milk after birth, no matter how early the baby is born. All mothers of premature babies should consider providing this special milk to their baby for the first 30 days and beyond, even if they are not planning long term breastfeeding.
Research shows that premature babies fed their mother’s milk:
Have fewer infections
Have better digestion
Have better vision
Have stronger bones
Become smarter kids
Go home sooner
Breastfeeding can also benefit the mother of a premature baby:
hormones that can help mothers cope during this stressful time
increased connection (bonding) to the baby
healthy breastfeeding advantages for the mother including better weight loss and less risk of breast cancer and weak bones
- benefits of exclusive breastfeeding
- providing milk of their own mother to infant at risk
- what makes breastmilk so amazing
Some of the resources were written by Dr. Paula Meier, director for clinical research and lactation in the neonatal intensive care unit and professor of paediatrics at Rush University Medical Centre in Chicago. There might be some differences from your centre in the resources available.
How do I get my milk supply started after baby is born?
The first step is to start to stimulate the breast to produce milk. To get your milk supply started and keep it up, you want to pump your breasts as often as your baby would feed, at least 8 times a day. This doesn’t have to be exactly every 3 hours. It may help to plan your pumping times around your daily routine. There may be times when you have to pump after only 2 hours, and others when you go longer. In the morning, your hormone levels are higher, and you will make more milk. Pump more frequently early in the day. Hospitals usually have higher quality breast pumps. Plan to pump more often when you are at the hospital. Take advantage of time with your baby. Any time you have contact with your baby, your body will make more milk. Pump both before and after spending time with your baby, especially skin to skin time.
Both mom and dad and any other people who support you can be involved in this journey. The role of support people is very important. They can encourage and praise mom for her efforts, help mom to find the time and space to pump, and help with milk storage and transport to the hospital.
Initiating milk production (PDF)
Track your breastfeeding and pumping progress with MyMedela app (Apple) or MyMedela app (Google). It’s free for families.The app helps you to monitor your breastfeeding and pumping sessions – plus, keep tabs on your baby’s height, weight, sleep, and diaper changes.
Why does my baby need a feeding tube?
Most babies born more than a month early don’t yet have the energy and coordination with breathing and swallowing to suck steady and safely on a breast or bottle to get milk. The stomach and gut needs to have milk in order for it to continue to grow and develop. For this reason, milk must be provided through a tube. It is put into the stomach through the mouth or nose. It is referred to as a feeding tube, “gavage” tube, or a orogastric (through mouth) or nasogastric (through nose) tube.
At first, most of your baby’s nutrition is given through the intravenous with Total Parenteral Nutrition (TPN). It contains many essential elements of nutrition, such as protein, fat, sugars, vitamins and minerals, but it is not as healthy as mother’s milk.
By giving milk to the baby early, the doctors and nurses can decrease the amount of TPN as soon as possible and get the IV out to decrease the risk of infection.
Many mothers need medicine for their own health. It is important to talk to your own healthcare provider about what you are taking. You can read an info sheet from the International Breastfeeding Centre about medication and breastfeeding here: https://ibconline.ca/information-sheets/breastfeeding-and-medications/
You can also consult the website “MotherToBaby” (https://mothertobaby.org/) for more information.
What if I am taking medicine?
What do I do to keep my milk supply or if my milk supply starts to drop?
It is very common for a mother’s milk supply to decrease when they have been pumping for many weeks. It is important to not get upset about it. There are a few key elements to keeping up your supply. The first is a good pump. Generally a full sized electric breast pump is going to be the most reliable. The more often you pump, the more milk you will produce at each pumping session. Pump until the milk flow stops, and then just a bit longer. If you massage your breasts before pumping and express by hand for 5 minutes after pumping, you can also boost your supply.
Review your milk volumes every day, and keep track of how often and how long you are pumping. If you are finding that the milk stops flowing sooner, keep the pump on for a longer time. Find ways to fit extra pumping times into your day and night. As you recover from the birth, it may get easier to get up at night to pump.
You can try “power pumping” once a day. It takes one hour. Pump for 20 minutes, rest for 10 minutes, pump for 10 minutes, rest for 10 minutes and finally pump for 10 minutes.
There are some herbal and prescription medicines that can help increase milk supply. They are not magic. If you had a full supply and then it dropped off, you are more likely to respond to them. These other methods may bring back your supply without any other medicine. Talk to your nurse, doctor, nurse practitioner, midwife or lactation consultant about them before you start them.
How does my baby learn to feed?
Your baby starts the journey to breastfeeding when you do. Babies each have their own rate of progress and development and it is important to work with your team to help them reach their goals. You can expect your baby to follow a pattern similar to the one outlined below:
Tube feeding with mom’s milk. Having positive contact with mom whenever possible. Small tastes of mom’s milk are often given during this stage.
Learning to suck. This starts with a soother given during tube feedings so that baby associated sucking with a full stomach. Have regular skin to skin time with mom and introduce baby to the breast to lick and gently suck. This is called a “non-nutritive suck” because baby is often too small or weak to get much milk out of the breast. It is important to make this a positive experience for both you and your baby.
Short breastfeeding practice sessions. These are often only 5-10 minutes long to make sure that baby doesn’t get too tired. There are optimal ways to support your baby at the breast that your baby’s nurse, a lactation consultant or an occupational therapist can teach you. The focus is on the quality of sucking not on the milk volume that baby takes.
Building up breastfeeding stamina and mom’s confidence. Follow baby’s cues for what they can handle and don’t push them too hard. It is very important to keep the sessions positive for both yourself and your baby. If your baby shows any signs of stress, stop the breastfeeding session and consider just holding your baby in skin to skin until they are calm. You can try again next time. Hospitals have different protocols for helping a premature baby transition to full breastfeeding. Talk with your baby’s nurse about theirs.
Full breastfeeding. Some premature babies achieve this before going home, while others continue to work towards this at home. Your team will help you determine the best way for you and your baby. Talk to them about the people who will support you in your community. It is more difficult to do this on your own, so don’t be afraid to call for help and advice. If you and your baby never achieve full breastfeeding remember, you are still a winner! The important thing is that you are doing the best you can for your baby.
Many of the doctors and Nurses who work in the NICU have extra education to help you with breastfeeding. There are also health professionals called Lactation Consultants who can help you specifically with breastfeeding in many cities and hospitals. If you don’t have those resources in your community, there are online resources to help you. Below are some links you may want to try:
Breastfeeding Online: http://www.breastfeedingonline.com/
International Breastfeeding Centre (based in Toronto ON): https://ibconline.ca/
About Kids Health Breastfeeding Learning Hub https://www.aboutkidshealth.ca/breastfeeding
Why do they add fortifiers to breastmilk for my baby?
Many premature infants need extra nutrients added to their mother’s milk to achieve the best growth and development. Premature babies often need extra protein, calcium, phosphorus, and even salt, to build strong bones and healthy organs. The doctors, nurses and dietitians keep track of your baby’s growth and blood test results, in order to see what your baby specifically needs. These extra nutrients are added to the milk before it is fed to your baby. There are two types of human milk fortifiers available. One is made from cow’s milk and the other is made from human milk.
Doctor’s don’t add more volume, just more calories and protein for the tiny babies to get the added nutrition they need.
If only extra calories are needed, sometimes using more hindmilk (which is breastmilk obtained at the end of the feeding or pumping, which has a higher fat content) can improve growth.
Since many commonly used fortifiers are made from cow’s milk proteins (like regular formulas), some babies may have difficulty initially when the fortifier is added. They may have delayed emptying from the stomach, abdominal distention or even gas. The stools may change somewhat in color. If that happens, the doctor may remove the fortifier and try again at a later time.
It is important to remember that your baby needs these extra nutrients because of the prematurity or illness – not because there is a problem with your milk. As most premature babies are discharged home a few weeks before they were due to be born, some infants may require fortification for a time after being discharged home.
What is “donor” human milk?
If you are unable to pump enough milk to meet your baby’s needs, then it will be supplemented by either special formula that is designed for premature babies, or by donor milk, if your hospital has a donor milk program. Donor milk comes from mothers who have donated their milk to a milk bank. The mothers are screened and tested, and the milk is tested and pasteurized. It is also pooled, so that the batches come from multiple donors. This helps to standardize the nutritional content of the milk.
Donor milk is easier for premature babies to digest than formula. Although the heating process of pasteurization decreases some of the nutrition in the milk, most of it is still present. Many of the immunity properties of the milk, which are not present in formula, are present in donor milk. It is considered safe and for very premature babies it is considered an essential option.
Donor human milk information (PDF)
Human Milk Banks in Canada:
Rogers Hixon Ontario Human Milk Bank https://www.milkbankontario.ca
BC Women's Provincial Milk Bank http://www.bcwomens.ca/our-services/labour-birth-post-birth-care/milk-bank
Northern Star Milk Bank http://northernstarmilkbank.ca
Hema Quebec Public Mothers' Milk Bank https://www.hema-quebec.qc.ca/lait-maternel/donneuses-lait/banque-publique-lait-maternel.en.html
Breastfeeding during COVID: Safety and breastfeeding during the pandemic.
FAQ on COVID-19: Breastfeeding safety for mothers. https://www.medela.com/breastfeeding/mums-journey/covid-19-information-concerning-breastfeeding
Safely Fed Canada resources http://safelyfed.ca/covid19-resources/
Academy of Breastfeeding Medicine https://www.bfmed.org/abm-statement-coronavirus
World Health Organization (WHO) Coronavirus disease (COVID-19): Pregnancy and childbirth. https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-pregnancy-childbirth-and-breastfeeding
Proper Storage and Preparation of Breast Milk
Skip to Dr. Paula Meier series
Katie James Video Series
This video series is presented by Katie James, a midwife, and lactation consultant, who answers the most frequently asked questions around breastfeeding in the first hours, days, and weeks after delivery.
How do I know my baby is getting enough milk?
What to do if my baby is not latching on at the breast
I have sore nipples, what should I do?
Feeding cues, how do I know when to feed my baby?
What to expect in the first few hours after birth
Can I introduce an expressed milk bottle feed?
If the milk is not coming in what should I do?
The lactation film to watch before birth!
Track your breastfeeding and pumping progress with MyMedela app (Apple) or MyMedela app (Google). It’s free for families.
The app helps you to monitor your breastfeeding and pumping sessions – plus, keep tabs on your baby’s height, weight, sleep, and diaper changes.
Thank you to Doris Sawatzky-Dickson - Certified Neonatal Nurse and Lactation Consultant - for reviewing this material.
What to expect when you get home with your baby
What is normal breast fullness and what is engorgement?
My baby has lost too much weight, what should I do?
What if my baby is unable to breastfeed in the first hours or days after birth?
Let's Talk About Breastfeeding - Dr. Paula Meier
A six-part video series with Paula Meier, PHD, RN, who explains the impact that the first two weeks after birth on the breastfeeding experience. She reviews findings from her own and others' research and practice showing the correlation between milk supply building in the first two weeks and the ability to breastfeed for the weeks and months to come. These chats include key tips for getting breastfeeding off to a good start, discuss mother and baby conditions that can cause breastfeeding problems during this time, and provide helpful solutions for lactation professionals and parents to explore.
Dr. Paula Meier's Breastfeeding Chats: Introduction
Dr. Paula Meier's Breastfeeding Chats: The importance of the first two weeks
Dr. Paula Meier's Breastfeeding Chats: Setting expectations for delivery and hospital stay
Dr. Paula Meier's Breastfeeding Chats: Setting expectations for the first week at home
Dr. Paula Meier's Breastfeeding Chats: Preparing for potential breastfeeding problems
Dr. Paula Meier's Breastfeeding Chats: Managing challenges nursing at the breast
Dr. Paula Meier's Breastfeeding Chats: Managing post-delivery separation of mom and baby
World Breastfeeding Week (WBW)
World Breastfeeding Week (WBW) is a campaign organized by the World Alliance for Breastfeeding Action (WABA). It is considered one of the largest international joint campaigns, which includes the World Health Organization, UNICEF and many parent organizations, promoting the benefits of breastfeeding.
World Breastfeeding Week has been celebrated annually in about 120 countries since 1991 during the first week of August. There is a yearly theme, supporting the awareness of the importance of breastmilk.
CPBF supports breastfeeding/ human milk as a vital component of healthcare for all babies born preterm.
Learn more about the benefits of human milk for premature babies here.