Meeting the Challenges of Breast-Feeding in the NICU

by Deborah L. Davis, Ph.D. & Mara Tesler Stein, Psy.D

I breast-fed my older [term] son with no problems. I know what it takes -- and believe me, trying to breast-fed a baby who isn't there is pretty difficult. Add to that the fact that your two daughters are still in the hospital and you don't know when or if they will be coming home soon. Now that's a task. ~~Rosa

The NICU is not the place to get a great start, but...like everything else about the preemie experience, you don't have a lot of choices, do you? Preemies have weaker, sometimes less coordinated sucks; they tire easily; they distract easily (which I thought was more difficult that the tiring); and it's so hard with the tension, hormones, and milk-engorged breasts. ~~Sheila

I really wanted to breast-feed her right away. I did keep up the pumping and did eventually get to breast-feed, but they convinced me that bottles were better to start. I really feel bad to this day for letting them take charge because I know now this is not so. Still, who was I to know? They were the professionals. ~~Linda

Lenore & AdamUnfortunately, while your preemie is hospitalized, you may not always receive effective guidance and support in your attempts to breast-feed. Sometimes, despite the health care team's encouraging you to supply breast milk, your baby is given formula. Or the staff's decision to bottle-feed your breast milk to your baby may make you feel that they are more interested in your breast milk than in helping you master breast-feeding. Your desire to breast-feed or the pace that you had imagined for feeding your baby might not match the staff's routines.

When you're trying to assert some control as a parent, it can be frustrating to have to negotiate all of this with your baby's medical team. And sometimes, you and your baby simply will not be able to breast-feed. This can be a tremendous blow if you had had your heart set on breast-feeding exclusively.

The next day I was desperate to pump some more milk for my son, but the nurse on duty wouldn't help me. She said okay and then never showed up, so I kept calling her to help. Finally she told me that she was waiting for the lactation specialist to come in at 10 am. I was mad and shot her a dirty look. I don't think she realized how important it was to me to get some more milk to my son. I am still mad about it four months later. I was also mad at the NICU people who fed my son formula because they didn't have any of my milk. Didn't they realize that I had plenty of it but that I just couldn't get it to them? Why didn't they come get my milk -- I was only a few corridors away? If my milk is so much better than formula, then why???? The more I think about it, the madder I get!! ~~Ruby

Trying to breast-feed her turned out to be quite traumatic for both of us. She would latch on but, after thirty seconds or so, would become exhausted and fall asleep. The nurses would weigh her before and after our breast-feeding sessions and more often than not, she would have lost weight. I was very disheartened. I reasoned that breast-feeding her would be an opportunity to make up for our lost bonding experience, but it only proved to be very distressing for both of us. I tried to get her to breast-feed for six weeks once she was home, but I finally had to give up. At that point she was "hooked" on the bottle, and I couldn't get her to change her mind. I do wish the NICU nurses had told me that once she took the bottle it might be hard for me to switch to the breast. ~~Rebekah

Even if you end up succeeding in breast-feeding, the process can be quite trying and drawn out. Because preemies often take a long time to learn to coordinate sucking, swallowing, and breathing, breast-feeding can require a lot of patience. Your baby may take two steps forward and then one step back. Do keep in mind that most term babies don't learn to nurse until they are around forty weeks' gestation. Try to give your preemie credit for accomplishing as much as he or she does. Comfort yourself by imagining a future in which you and your baby have mastered nursing. Envision it. Allow yourself to hope for it. Then do what you can to try to make it happen.