Having a baby in the NICU can make the beginning of your feeding journey look very different from what you imagined.

You may be recovering from birth while learning unfamiliar medical terms, spending hours beside your baby’s incubator, all while trying to figure out pumping.

Your baby may not be ready to breastfeed yet. You may be producing only tiny drops of colostrum. You may be wondering whether what you’re doing is enough.

If this is where you are right now, there are a few things we want you to know.

Your breastmilk can be especially valuable for a premature baby

For babies born prematurely or with low birth weight, human milk provides important nutritional and immune benefits.

The World Health Organization recommends a mother’s own milk for preterm and low-birth-weight babies. When a baby isn’t yet able to breastfeed directly, expressed breastmilk can still be given when medically appropriate.

But breastfeeding in the NICU doesn’t always begin at the breast.

Sometimes, pumping is how your breastfeeding journey begins.

When your baby can’t breastfeed yet

Some premature babies aren’t developmentally ready to coordinate sucking, swallowing and breathing. Others may be too medically fragile to feed directly at the breast.

That may mean your baby initially receives your expressed breastmilk through a feeding tube. Premature babies commonly need this support while their feeding skills mature.  

It doesn’t mean breastfeeding has failed before it even started.

If you’d like to provide breast milk and your baby can’t nurse yet, talk with your NICU team or a lactation consultant about starting milk expression as soon as you’re medically able.

Your baby’s NICU team can help you create a pumping plan based on your individual circumstances.

Getting started with pumping in the NICU

If you’re able and would like to provide breastmilk, getting started early can help establish milk production.

The American Academy of Pediatrics recommends beginning milk expression within 6–8 hours after delivery for mothers providing milk for a very premature baby. It also recommends maintaining a regular pumping schedule and having access to a comfortable electric double pump.  

Your lactation consultant can help you determine what pumping schedule makes sense based on your recovery, your body and your baby’s needs.

And one thing is worth saying very clearly:

Pumping shouldn’t be painful.

If it hurts, tell someone.Pumping is annoying as is.  Do not pump in pain!  Your flange may not fit correctly, the suction may need adjusting, or there may be another issue your lactation team can help you address. I remember putting on 26mm flanges and getting very little output, but my actual size was 19mm. Sizing is very important!

When you’re only getting drops

Those first pumping sessions can be discouraging.

You may pump and look down to find only a few drops in the collection container.

Early milk, or colostrum, naturally comes in small amounts. Those tiny amounts can still be valuable for your baby. Colostrum is particularly rich in protein, antibodies and other immune factors.  

Don’t let the size of the bottle convince you that what you’re doing isn’t enough.

Milk production can take time, particularly when you’re also recovering from a premature or medically complicated birth.

If you’re concerned about your supply, ask for help early rather than trying to figure it out alone.

Storing and bringing breastmilk to the NICU

If you’re pumping away from the hospital, you’ll need a system for safely storing, labeling and transporting your milk.

The ⁠CDC’s breastmilk storage guidance recommends using breastmilk storage bags or clean, food-grade containers and clearly labeling milk with the date it was expressed.  

However, general breastmilk storage recommendations aren’t necessarily the same as the rules your NICU will use.

Premature and medically fragile babies can have different safety considerations, and hospitals may have their own requirements for containers, labels, refrigeration, freezing and transportation.

Your NICU may even provide specific bottles or labels for you.

Always follow your hospital’s specific instructions for storing, labeling and transporting breastmilk.

If you’re unsure, ask before bringing milk from home.

Skin-to-skin time can be part of feeding, too

When your baby’s medical team says it’s safe, skin-to-skin contact, often called kangaroo care, can be an important part of caring for your baby.

It is especially helpful for preterm and low-birth-weight babies.

Some babies begin with non-nutritive sucking, where they practice sucking without taking a full milk feed. This can allow your baby to become familiar with being at the breast while they’re still developing the skills needed to feed.

Breastfeeding can be something your baby learns gradually.

Moving toward breastfeeding may take time

For a premature baby, feeding is a skill.

Sucking, swallowing and breathing all have to work together, and some babies simply need more time to develop that coordination.  

Your baby may receive milk through a feeding tube before progressing to breast or bottle feeding.

Some premature babies also need breastmilk fortifier or additional nutrition to help meet their increased nutritional needs.  

Needing extra feeding support doesn’t make your breastmilk less valuable.

And it doesn’t mean you won’t eventually be able to breastfeed directly if that’s something you want to work toward.

There isn’t one correct timeline.

You don’t have to figure this out alone

NICU nurses and lactation consultants can help with pumping technique, milk supply, storing and transporting milk, and eventually transitioning to feeding at the breast if that’s your goal.

Tell them if pumping hurts.

Tell them if you’re worried about your supply.

Tell them if you’re exhausted.

Tell them if the feeding plan isn’t working for you.

Ask for help before you’re struggling.

Support isn’t an admission that you’re doing something wrong. It’s part of your care, too.

If feeding doesn’t go the way you hoped

Maybe your baby eventually breastfeeds directly.

Maybe you exclusively pump.

Maybe your baby receives your breastmilk along with donor milk, fortifier or formula.

Maybe you combination feed.

Maybe your feeding journey is much shorter than you hoped it would be.

When you have a baby in the NICU, so many parts of those first days and weeks can be outside of your control. Feeding may be one of them.

There is no amount of milk you have to produce and no number of days you have to pump before your experience counts.

You are allowed to be proud of every drop you provided while also deciding what’s sustainable for you and your family.

However your feeding journey unfolds, it’s yours.

And mamma, it matters.

Sources & Further Reading

American Academy of Pediatrics / HealthyChildren.org
⁠Mother’s Own Milk for Very Premature & Very Low Birth Weight Babies: Why It’s So Important

American Academy of Pediatrics / HealthyChildren.org
⁠Pumping & Expressing Breast Milk for Your Premature Baby

American Academy of Pediatrics
⁠Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant

World Health Organization
⁠WHO Recommendations for Care of the Preterm or Low-Birth-Weight Infant

Centers for Disease Control and Prevention
⁠Breast Milk Storage and Preparation

March of Dimes
⁠Feeding Your Baby in the NICU

This article is intended for general educational information and isn’t a substitute for medical advice. Your baby’s needs may be different, so always follow the recommendations of your NICU team, pediatrician and lactation professionals.