Dear NICU Warrior Parents…
First I wanted to say how much love and respect I have for you NICU Warrior Parents. I see your resiliency, bravery and fierce devoted love. And I honor you in all you do…
Steps Towards Nursing In The Nicu
Recently, my friend Shelbi shared her breastfeeding journey in the NICU and delivering her boy 5 weeks early. Check out my facebook page for these “Good Conversations” with real parents and their challenges. Shelbi successfully nursed him for 5 1/2 months and had a very supportive NICU team. And I wanted to share what nursing may look like in the NICU with a supportive team
Keep in mind, guidelines for initiating breastfeeding should be based on medical stability not age/weight.
And remember, YOU are your baby's advocate, never forget that. The nurses and doctors are experts with the medical side of things but your role of being your child's voice is very important as well. Ask questions, be involved with decisions being made and speak up when something doesn't seem right or you need a deeper explanation of things...
Lastly, give yourself lots of grace during this time warrior NICU parent.
If possible, you will want to hand express within that first hour of delivering. Your first milk colostrum will be thicker than transitional and mature milk so you may find that hand expression is best. Once your milk begins to transition, using a hospital grade pump every 2-3 hours, 8-10x/day will help to maintain your supply. If you're able too, pumping next to your little a few times a day will help get that oxytocin flowing
TIP: Getting at least 4 hours of uninterrupted sleep each day will be beneficial for your mind, body and supply.
TIP: Using warmth before and during hand expression. "Hands On Pumping" is a great technique to be familiar with as well!
TIP: For pumping, having the appropriate flange size will be important so have your nipples measured will be key to see which flange size would be best. Searching "MAYMOM" on Amazon is a good place for flange sizes!
Depending on your littles gestational age and if her GI tract is mature enough for milk feedings, she may be able to receive your milk through NG/OG/G-tube or bottle.
Once your little is stable enough to tolerate position changes and with the help of your NICU team, Kangaroo Care (aka skin to skin time!) will be the first step towards nursing. *This may be delayed if your baby has a silo bag or is on cooling therapy. If your little is in the first 72 hours of IVH prevention then you can discuss skin to skin time with your NICU team.*
*Kangaroo Care time is very beneficial and meant to be calming for your little and you Babys arms, legs and back should be covered with a blanket. This length of time will be dependent on your babes tolerance. There should be little to no disruptions happening around you during this precious family time.*
Next will be skin to skin time near the breast. Baby will be able to smell and taste drops of your milk expressed on your nipple. You may think nothing is happening during this time. This is a time to just focus on the experience. Getting your little familiar with your touch and you comfortable with holding your sweet babe.
Some signs that your little will be ready for this step: she is not on a ventilator (it's ok if she's on CPAP) this has been done for babes with a TRACH but there should be a conversation with the team and pediatric otolaryngologist about feeding directly 27 weeks + she's showing feeding cues such as rooting and has had oral exposure to your milk For some parents, this may feel like longest stage of learning to nurse.
Practice with Latch: support your breast with the opposite hand, with your nipple pointed towards the babes nose. This practice time will be on a mostly drained breast. There should be a comfortable chair for you, slightly reclined with a foot stool. If possible, practice latching once a day. And if there isn't an IBCLC, ask for one. Baby is showing feeding cues and has the ability to maintain alertness 30 weeks+ tolerating bolus feedings
**(Keep in mind, the suck swallow and breathe coordination begins around 32 weeks and is fully developed around 36 weeks gestational age) **
Finally when the baby is reducing dependence on tube feeding and showing signs of readiness for oral feeding, you can practice with full feedings by nursing good coordination of suck, swallow, breathe sucking rhythms are maintained with appropriate rests in between
*During this time you may or may not use a nipple shield. Some parents will prefill the nippleshield to encourage latching. This is good tool to try if your little has smaller cheek pads, a weak suction and/or your nipples are slightly flat/inverted.
*An SNS (Supplemental Nursing System) may also be used during this time if your supply is low.
Watch your little for signs of distress and listen for swallowing.
You may need to pump beforehand if you have a fast letdown.
Checking for Milk Transfer: listen for swallowing, keep a record of wet/dirty diapers, keep close watch on baby's behaviors while feeding, frequent weight checks and follow ups with the baby's doctors.
No steps should feel rushed and always taken at your babys pace. I encourage you to celebrate each small/big effort made by your little. And I hope you have a supportive NICU team who listens to your lactation goals
All my love to you warrior parents,
Cat Xx