Lactation Support for NICU Mothers

• Lactation support refers to the encouragement and empowerment by labor and delivery staff. Usually lactation support includes cooperation from baby, but if the baby is whisked away to the NICU, lactation support looks a little different. 
• Be mindful that this may be an emotional time for the mother. She may have pictured recovery differently with baby snuggled in her bosom. Exercise caution when navigating her care. 
• Lactation support to the NICU mother includes answering her questions, facilitating NICU visits, and helping her pump to retrieve colostrum and stimulate milk production. 

Lactation Support

In this article, we will discuss lactation support for mothers in the postpartum period when mom and baby are separated, and baby is admitted to neonatal intensive care unit (NICU). 

When a baby is born, it is recommended that moms hold their newborn with uninterrupted skin to skin contact until baby’s first feeding.  

It will usually happen within baby’s first hour of life, or the Golden Hour. Skin to skin can help babies regulate their vital signs, temperature and promotes breast milk production. 

When a baby is born and needs to be transferred to the NICU, both mom and baby miss this beautiful moment. Mom might have been looking forward to it and missing out on holding and snuggling her newborn baby can be hard, so we want to keep in mind what the patient is going through when caring for them.  

Answer Questions

If the baby had to go to the NICU, take a moment to ask mom if she has any questions. You may not know the answers, but try to find the person that can answer them. Provide the number for the NICU so she can call for updates or questions as needed. And once appropriate, try to facilitate a visit to the NICU.

Establish the Importance of Milk

At the same time we can explain to mom how valuable her milk is for her baby. Collecting and providing milk is something nurses can encourage mom to start right away.  

If mom’s feeding preference is breastfeeding and/or feeding her pumped milk, pumping should be encouraged and supported as soon as possible after birth.  

Explain that her first (early) milk is called colostrum; it may be a small amount but any colostrum is beneficial for her baby. Even a few drops can be saved and the NICU nurses will swab it in the baby’s mouth once the baby can start feeding by mouth. 

Newborn babies that are healthy and breastfeeding will usually feed on demand at a minimum between 8 and 10 times in 24 hours, therefore we want to mom to pump the same.  

Encourage Pumping

In some cases, mom might find that no milk is coming out. Show her how to hand express a few minutes before or after pumping. Encourage her to pump for 15-20 minutes with a comfortable level of suction with a double electric pump. 

Milk removal from the breast via a baby feeding usually helps mom’s body make more milk. If baby is unable to breastfeed, the pump will help mom’s body make more milk until breastfeeding can be started. Here is another video from Stanford University that can help moms who are pumping. 

Most US hospitals have a pump that mom’s can use while in the hospital. If that is not the case, ask her to bring a pump from home. 

 If she is bringing her pump from home (or the pump parts in the hospital are not sterile) encourage her to clean her pump parts prior to using according to her manufacturer instructions or according to CDC guidelines. A copy is also available in Spanish. 

Facilitate NICU Visits

When mom is able to visit her baby, calling the NICU ahead of time and checjing in with the baby’s nurse can help ensure the staff is ready for the parents to visit and avoid unnecessary waiting. It would be great if nurses and staff can make mom feel welcomed when visiting baby.

Which Pump to Choose?

A double electric breast pump is recommended. A hospital grade pump is even better when available.  

According to Womens Health.gov “The Affordable Care Act (2010) requires most health insurance plans to cover the cost of a breast pump as part of women’s preventive health services. These rules apply to Health Insurance Marketplace plans and all other private health insurance plans, except for grandfathered plans”. 

There are a few websites that work with insurance and can assist mother’s in obtaining a breast pump they can use. Encourage them to contact their insurance so their insurance can direct them to the right website for them to order a breast pump.  

Lactation Consultant for Lactation Support

For a mom who is pumping and/or breastfeeding lots of questions might come up, it is highly recommended they schedule some time with a lactation consultant, an (International Board Certified Lactation Consultant (IBCLC) would be the first choice if available. Many insurance companies will cover the cost of the visit if one is not available at the hospital.  

While an in person visit would be ideal if mom lives in an area where there is no IBCLC’s, she can find one online that can support her. 

Additional Lactation Support

One more thing to review with mom is how to safely store her breastmilk. Some NICUs have specific guidelines, so encourage her to follow the hospital’s protocol.  

Here are the CDC Proper Storage and Preparation of Breast Milk guidelines.

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