Breastfeeding Support in the NICU

Kim Flanagan, MSN, CRNP / March 2017

It can be a time of unbearable stress to learn that your child is critically ill. The visions of holding a healthy, pink, vigorous newborn baby disappear all too quickly when an infant is born prematurely or with critical health issues.

NICU nurses are extraordinary at helping families deal with this crisis while balancing the medical management and care of theses fragile patients. When it finally comes down to it, a big part of the job is educating families and helping them to manage their expectations.  This is especially true when it comes to breastfeeding.

Breastfeeding a premature infant is different than breastfeeding a full term baby. As obvious as this may be to those in the healthcare profession, understanding the difference can be a confusing task for families.

Prior to delivery the mother may have had a certain idea of what the experience would be like to breastfeed her baby. In the NICU all of that changes. It is the job of the physician, neonatal nurse, and lactation consultant to help educate families in understanding how to successfully accomplish this daunting task.

Below are some recommendations for nurses to help mothers meet the challenges of breastfeeding their baby in the NICU:1

  • Ask the mother if she wishes to breastfeed her baby. Discuss her goals and remember to allow her to take “baby steps”. For example, use week-by-week goals. It is much easier to think about doing something for seven days than it is for one year!
  • Let her know it is critical to begin pumping milk for her baby as soon as possible. As NICU nurses, we understand the importance of this “first hour” rule, but let mom know that you can get her started right away – and why.
  • Timing: Let moms know that when initiating their milk supply, they should pump every 2 to 2-1/2 hours around the clock. After her milk supply is established, to go no more than 8 hours overnight, and then pump at least eight times throughout the day.
  • It is important to have support. Breast feeding and pumping are hard work! Help moms try to persist through the challenges of establishing and maintaining a good milk supply. Remind her that she will only get small amounts initially, and that writing it down in a journal may be helpful. Journaling is great because it documents progress but also can identify problems when issues arise that need to be addressed.
  • Remember to assist mom with kangaroo care! Kangaroo care will relax mothers and have positive physiologic benefits for the baby: stabilizing and respiratory rates, improved regulation of an infant’s body temperature, improves oxygen saturation rates, and conservation of a baby’s calories.

Additionally, in my own practice, I saw an increase in initiation rates when the physicians and nurse practitioners took the opportunity to communicate the medical benefits of human milk at prenatal consultations. It was expressed with clarity, compassion, and a lack of judgment. It would go something like this:

We at “this hospital” believe in the medical benefits of Human Milk. We believe it is critical to provide this to your baby for the following reasons:

Protection against infection, strengthen the immune system, off IV fluids more quickly, potentially offer a shorter hospital stay, provide protection against diseases like retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and sepsis.

We have nurses and lactation support in place to guide you every step of the way. If you choose to pump for your baby we will have you start today.”

When the benefits of human milk are effectively taught to mothers in a way that supports informed choice, I have seen moms leap at the chance to “do something” for their baby at a time when they feel so helpless to intervene and desperately want to! According to Diane L. Spatz, PhD, RNC, Ten Steps for Promoting and Protecting Breastfeeding for Vulnerable Infants the first step is informed decision:

Benefits of HM are even more profound for sick or preterm infants. All women should be educated about the benefits of breastfeeding; however, a woman experiencing a known high-risk pregnancy should receive special education and guidance about specific benefits of HM and how to get the best start on lactation after delivery. Families should be aware of the very specific components of HM that can help and protect their infants.1

Having a baby in the NICU is an extremely stressful and challenging time for families. We as NICU professionals can help them through this by making evidence-based, supportive recommendations and communicating in a timely manner the impact their gift of human milk can be for their baby.



About the Author

Kim Flanagan, MSN, CRNP, has worked as a NICU nurse and Neonatal Nurse Practitioner for 20 years. She currently serves as the Clinical NICU Specialist for Medela, Inc. In this role, she works with NICUs across the country to maximize their use of human milk in the neonatal population to improve patient outcomes, patient safety and best practices.