Having a baby in the NICU is a stressful situation,  whether your baby is a micro preemie, late preterm or has a congenital birth defect, the NICU environment can be draining, scary and overwhelming.

Keeping up your milk supply can be difficult to manage under the stress and lack of sleep, but it is extremely important to empty the breast frequently as you would in any other situation, perhaps even MORE important because your baby’s health and well being depend on getting human breastmilk to avoid debilitating life threatening issues such as NEC. 
There are some fundamental basics that a mother needs in order to maintain supply in such a stressful situation and I will touch on each and give some helpful tips and tricks to not only maximise milk supply, but also rest.
Support


Support is huge in any breastfeeding relationship or new parent situation, without support, your chances of succeeding diminish greatly.

Not only is the support from your partner important, but family, friends and hospital staff can all have either positive or negative effects on your ability to succeed.

Support comes in many shapes and forms, making sure you are hydrated by bringing you something to drink, making sure you have eaten, wiping your sweaty brow while pumping under the heaters of your baby’s bassinet, encouraging you through reminding you of the facts and benefits of providing breastmilk and letting you rest between feeds.

Making sure you have a supportive network is important, so remind those closest to you to not phone between feeding sessions when you should be eating and sleeping, have dad take on the role of information hub and turn off your phone between feeds.

Arrange for snacks and meals to be brought immediately after feeds, that way you are able to eat and drink quickly and lay down and rest.

Make sure that the nursing staff understands how breastmilk production works so they do not tempt you into sleeping through the most important pumping sessions, although they may mean well, this kind hearted suggestion could be potentially harmful your supply.


Frequency


Making sure you empty the breasts frequently is extremely important, although in the first few weeks of breastfeeding your supply is predominantly hormone driven, it is setting the foundation for the supply /demand stage, so it is vital that you aim to empty the breasts between 10 to 12 times in a 24 hour period, majority of women will pump every 2 hours during the day and 3 at night.

While rest is important, understanding which sessions you could potentially skip if you are becoming exhausted can help you to get the best of both worlds. Between the hours of midnight and 5am, your body naturally increases the production of prolactin, a hormone that helps in the production of breastmilk, so avoid skipping your midnight and 3 am feeds, instead, every once in a while take a longer nap around your 6am feed, avoid skipping any session on a regular basis as this leads to an increase in the whey protein FiL which can lead to your supply dropping.

Remember that 5 minutes sessions every hour are far more beneficial than an hour session every 3 hours as stimulation is key, mastering the art of hand expressing can be far more convenient and give you a lot more freedom to express wherever you are.

Sustenance 


Making sure you always have food and water available will help you maximise time between sessions, ask the catering staff to keep your food warm until after your session so you can quickly eat and climb back into bed.

If you are unfortunately not able to board at the hospital and need to travel back and forth, arrange for a family member or friend to bring you meals. 

Rest


Sleep is a hot topic, even more so in a stressful environment like a NICU with a sick or premature baby, so pacing yourself is important.

Hospital schedules generally run on a 3 hourly routine, 3, 6, 9 and 12 over a 24 hour period, so plan with family and friends to help get you the most rest.

Hospitals are very clinical and it helps greatly to put pumping into that clinical mindset, after all, it is the best medicine for your baby, so don’t be shy hand expressing next to baby’s bassinet, medical staff have been through a vast majority of training and have probably seen far worse than a lactating breast, if you do feel shy, ask for a screen to be put up or allow time before visiting the NICU to pump in your room. This will allow you to maximise your time so after your visit so you are able to just rest.
If you are unable to board at the hospital, ask the hospital if you can make use of their comfort room and take a nap between sessions.
You are not obligated to keep everyone informed, appointing a family member or friend to update everyone can be helpful and give you the time to rest, ask family and friends to check in with you first before coming to visiting hours, turn off your phone between sessions or have a designated time where family and friends can contact you.
Rest doesn’t always necessarily mean sleep, sometimes due to baby’s condition or just the stress of the situation in general can make sleep hard to achieve, so put your feet up and relax as often as you can, if you find rest in prayer, or meditation or you find rest in reading or watching TV,  then take that time to get what you need in order to provide what your baby needs.

Knowledge is power


Understanding how breastmilk production works and how to best optimise pumping sessions can be hugely advantageous.

Breastmilk production works on the basis of supply and demand,  so the more often you remove milk from the breast, the more milk your body will make. Breasts are not passive containers so they do not need time to fill up, they are more like factories, so when milk is taken out, more is produced, if milk is not removed frequently then production slows down.


Hand expressing can be very convenient and efficient, but if you choose to use a pump make sure that it’s the right pump for you. Some moms respond better to electric pumps and others to manual, some hospitals provide a hospital grade pump and others require you to bring your own, either way, make sure that your flange size is correct and that your spares are new and changed often.


Using techniques such as hands on pumping can also help get the most out of your sessions.

Having a great support system, access to a certified lactation consultant  (always check certification), or access to La Leche League South Africa and a leader and a good understanding of breastfeeding,  you can reach your personal goals.
I have personally had both my children in NICU,  my first born at 34 weeks was in NICU for almost 2 weeks for breathing, temperature control and feeding,  she never latched and I exclusively pumped for 4,5 years giving her only my breastmilk until just after her 5th birthday and my second born, also born at 34 weeks with a congenital birth defect, was in NICU for just over a month and had 3 major surgeries, so I am familiar with the stress that comes with a NICU stay, if breastfeeding is important to you, then you will always find a way.

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