In recent years, NICU admission rates have been steadily increasing. Having a baby in the NICU can be one of the hardest phases in the lives of parents. For mothers, the extra responsibility of establishing, maintaining, and learning how to boost breast milk supply when the baby is in the NICU can further intensify the stress and anxiety they experience. However, it requires bravery, resilience, and determination for NICU moms to choose breastfeeding during this challenging time.

The most common causes of NICU admission are premature birth, term babies with respiratory distress or cardiovascular issues, birth injuries, etc. In such cases, babies won’t initially be able to feed directly from the breast. Mothers often have to opt for hand expressing or pumping milk, which can be quite challenging and tiring. However, the benefits of breast milk make all the effort worthwhile.

Tips for Establishing Milk Supply when the baby is in NICU

• Start Early: Begin expressing or pumping milk as soon as possible, ideally within 6 hours of birth, to initiate your breast milk supply. Initially, hand expressing is usually recommended.
• Colostrum: The first milk, called colostrum, is packed with vital nutrients and antibodies essential for newborn health and immunity. It’s important to provide your baby with colostrum, no matter how small the quantity. Keep collecting, mark each with date and time and store in a fridge to preserve.
• Invest in a Good Pump: A hospital-grade breast pump is ideal if possible. Maintaining breast milk supply until the baby is ready to nurse can be significantly impacted by the quality of the pump. Manual, single, or handheld pumps might not be sufficient in the long run. Using a Double Electric Breast Pump can save time, be more effective and helps reduce the stress of manual extraction.
• Frequency Over Quantity: Focus on the frequency of pumping, not the quantity, in the initial days. Pump more often until the milk supply is established. This requires patience and effort. Don’t pump with quantity in mind; just try to match the number of times your baby feeds.
• Manage Stress: Stress can adversely affect breast milk supply. No matter how much you try, nothing can stop you from thinking about your baby in the NICU. But be strong and understand how important it is to maintain your mental strength. Just like you need your baby, your baby needs you. So try your best to stay positive, read and practice coping strategies as an NICU mom, and seek help whenever needed.
• Eat Nutritious Food: Ensure you eat nutritious food. Don’t skip meals or any supplements prescribed by your doctor. Proper nutrition is vital to establish and boost breast milk production. Make sure your diet is rich in vegetables, proteins, and calcium-rich foods.
• Get Proper Sleep: Getting proper sleep can be challenging. You might have the tendency to scroll, surf, and read everything about your baby’s condition late at night. Even though the baby is in the NICU, you still need to wake up at night for pumping milk, and your body is still recovering from the birth trauma. So, make sure to give yourself enough rest and sleep.
• Realistic Goals: Being a NICU mom, you might find yourself obsessed with your breast milk supply, thinking it’s the only thing you can do for your baby right now. Reading a lot about the benefits of breast milk and seeing the quantity other parents supply can put you under pressure. Be realistic, set achievable goals, and try your best. Don’t worry too much about the results; your milk supply will gradually increase.
• Monitor Mental Health: Be aware of the risk of postpartum depression, anxiety, PTSD, or other mental health issues. Seek professional help if needed. Read more: Emotional Health After Childbirth: Understanding and Coping with Postpartum Anhedonia
• Stay Hydrated: Drink plenty of water. Since breast milk is composed of 87-88% water, it’s important to stay hydrated.

Breast Pumping Tips

• Relaxing Environment: Set up a relaxing environment; the more relaxed you are, the more milk you will pump.
• Avoid Obsession with Quantity: Focusing solely on the outcome can add stress. Distract yourself during the process and maintain a pleasant demeanor.
• Hands-Free Pumping Bra: Invest in a hands-free pumping bra.
• Massage Before Pumping: Massaging your breasts for 5 minutes before and during pumping can improve breast milk production.
• Create a Pumping Schedule: Aim to pump 8-9 times a day or every 2-3 hours for 20 minutes each session, initially.

It might be challenging to stick to a schedule initially, especially with visits to the baby in the NICU. However, do your best to monitor timing and frequency to boost your milk supply while baby is in the NICU. Make sure to create a pumping schedule that works best for you, write it down, and stick to it consistently.

Always remember, breast milk production depends on demand and supply. Each time the breast empties, it signals the body to produce more milk. Results may take time, so stay consistent with your routine for a few days before evaluating. So keep in mind: the more you pump, the more you stimulate breast milk production.

• It’s completely normal for the amount and composition of breast milk to fluctuate throughout the day. Prolactin levels are typically higher in the early morning hours, which can result in increased milk production during that time. It’s best not to overly focus on these minor changes.
• Make sure to wake up at night for pumping sessions. If anything prevents it, aim to pump at least once during sleeping hours. This is important for establishing and maintaining milk supply.
• Be well-informed about the hospital policies regarding the transportation and storage of expressed milk.
• Avoid comparing the amount of milk with other mothers you meet. Negative comments about milk quantity can be discouraging during pumping sessions. Remember, you’re already a strong mom, especially as an NICU mom.
• Even though the baby is in the NICU, the first two weeks postpartum are crucial for establishing milk supply. Try to do your best without stressing your body and mind to build your milk supply.

Maintaining and Boosting Breast Milk Supply

Maintaining and augmenting milk supply requires a lot more effort, depending on the baby’s status—whether they’re rooming in, discharged, or if you’ve been discharged but the baby remains in the NICU, requiring daily travel to be together.

Sometimes, the baby might be ready for direct feeding now, making it essential to optimize breast milk quantity. Accept that this adjustment can take time and patience. Additionally, there is a higher likelihood of the baby developing latching problems or nipple confusion due to bottle feeding habits. Consult a lactation specialist if you find this transition challenging.

Challenges Faced by NICU Moms in Maintaining Milk Supply

• Skipping Pumping Sessions: Skipping sessions when visiting the hospital or feeling demotivated due to separation from the baby can decrease milk supply.
• Rooming-In Days: When the baby is rooming in, you may feel overwhelmed and completely forget your routine. The joy of having your baby in your arms, frequent checkups from nurses, concerns about the baby’s health, and the fear of managing the baby alone after discharge can make you lose track of your routine.
• Time Management: Managing time is vital until the baby is completely ready for exclusive breastfeeding. Balancing expressing milk, attempting direct feeding, and caring for both your baby and yourself can be complex, even with support. Proper planning and scheduling are essential to maintain consistency with pumping sessions.
• Quantity Issues: Sometimes, frequent nursing and expressing may be necessary to boost milk supply. Try creating a routine, as both feeding and expressing consume extra time and energy.

Mistakes that Affect Milk Supply

• Skipping Sessions: The most common cause of a drop in milk supply is skipping pumping sessions. When breasts are full, the collection of a protein called FIL (Feedback Inhibitor of Lactation) increases. This protein inhibits further milk production, and when this process is repeated, it can lead to a drastic drop in milk supply. Missing one or two sessions occasionally due to your busy schedule is normal and typically won’t significantly affect your milk supply, aside from causing discomfort, leakage, or engorgement. However, when this becomes a repeated pattern, it can eventually impact milk production.
• Mistaking a Sudden Increase as a Positive Sign: After skipping a session or having a long interval between two sessions, you might notice an increase in the quantity of milk. Don’t mistake this as a positive sign and assume that waiting longer for pumping results in fuller breasts. In reality, fuller breasts send the body misinformation, signaling that the baby doesn’t need as much milk.
• Top-Up Trap: Due to various circumstances, you might have already started supplementing expressed milk with formula. This can lead to a ‘top-up trap,’ causing you to rely more on formula and lose focus on your pumping sessions, potentially diverting you from your breastfeeding goals.
• Not Taking Care of Mental Health: Unexpected events that happen in your life can lead to a mix of emotions: guilt over decisions you have made, worries about your baby’s health, anxiety, and trauma from the delivery experience. These feelings might lead to an obsession over your baby’s health and care. You might find yourself completely neglecting your own self-care. However, it is important to monitor your own mental health and preserve it.
• Relying on Misinformation: You might be receiving a lot of advice and misinformation from everywhere. Make sure to follow only trusted sources, especially as this is not the time for trial and error.

Formula Feeding is Okay, No Need for Guilt

Even after trying your best, you might end up combining or exclusively using formula. That’s okay. You did what you could. Formula feeding is not a bad thing; many healthy babies are completely formula-fed. Stay optimistic.

Reflections from Mindful Portrait

Dear NICU mom, this phase can be incredibly challenging to overcome. Establishing and maintaining milk supply during this struggling period can feel exhausting , but it’s all worth it. Your breast milk provides your baby with all the nutrients, energy, and antibodies they need. Even though there are a hundred reasons to give up, you chose to fight back, embrace challenges, and do your best for your baby. This shows how strong you are and what a wonderful mother you are.

Now, accept and adapt to the results. Don’t stress yourself too much about how to increase breastmilk supply when the baby is in the NICU. Remember, there is something more nourishing and valuable for your baby than breast milk: a healthy you, a healthy mother. So, focus on your health.

Stay strong – Your strength is the key to your baby’s bright future.