NICU Advice: What I Wish I’d Been Told on the First Day in the NICU

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From day one – literally, almost from conception – my son Ned was an active baby who liked to make his mama worry. So maybe I shouldn’t have been surprised when, at 33 weeks pregnant, I woke up in the middle of the night barreling into active labor. We made it to the hospital just in time, and after two intense hours with some med students who insisted it couldn’t be happening like this, Neddy was born. I got to hold him for just a few seconds before he was whisked off to the NICU in a warming contraption.

“Unprepared” doesn’t even begin to describe how we felt. Breastfeeding class wasn’t for a few weeks! On the first day we got some woefully inaccurate information – that Neddy would need just a few extra days in the hospital and then we’d be home. But that was far from the truth. Our NICU stay was 40 days – we had to wait as he grew and learned how to coordinate sucking, swallowing, and breathing.

We were lucky that he had few complications and was generally healthy. But he had a floppy airway, a tongue tie, a lip tie, a high palate and a set-back jaw, and I had a low supply and a slow flow, all of which made breastfeeding one of the biggest challenges of my life.

When the lactation consultant showed up in my room just a few hours after birth with a hospital-grade breast pump, I didn’t have the slightest idea what she was talking about. I didn’t know how hard pumping would be, or how scary a desat (baby’s low blood oxygen concentration) during feeding would feel, or how quickly pumping around the clock and worrying about my baby’s well-being in a scary hospital setting would lead me into the wilderness of postpartum anxiety. And I certainly didn’t know we wouldn’t be able to establish breastfeeding, and I’d still be pumping 7 months later.

The NICU while we were there was full of other families just like ours, facing the same fears and obstacles. It was a world that was totally new, but quickly became all-consuming. Since we’ve been home from the hospital, I’ve thought a lot about what would have made those first days pumping milk in the NICU a little easier. Here’s a few things I learned that might help other NICU moms who are pumping while struggling with feeding issues, low supply, and postpartum depression or anxiety. Hope it helps!

1. Get a lactation consultant, and stick with the same one over time if possible. (This article assumes you’ll get the basics of lactation from them and the hospital nursing staff.) You will HATE them at first because they’re telling you to do things that seem impossible. But, honestly, they have the knowledge. And everyone has different advice, so maintaining just a few sources can help keep you sane.
2. Take advantage of the hospital’s resources. Rent the hospital-grade pump. Buy supplies from the store. Take anything free that the lactation department will give you. Talk to every single nurse or doctor you can. Hoard supplies from your baby’s room. And, use the social workers and psychiatrists and the cheap food at the cafeteria to take care of YOU. You (and hopefully your insurance) are paying a gajillion dollars to be there – don’t be shy.
3. It’s okay if it takes a while for your milk to come in. I didn’t pump anywhere near the target amount after the first week, and I thought I’d lost my chance at breastfeeding. But I kept pumping around the clock and didn’t give up, and eventually my supply was fine. It was never too much, and wasn’t enough when he was older, but it was just right when my baby needed it most. Many other women will be in this same boat. It’s frustrating to hear about other moms building up their freezer supply just a few weeks after giving birth, but that’s not always the case, or even typical.
4. Pumping all day and all night is awful, but, like I said, YOU CAN DO IT. It’s important to keep up about eight pumping sessions a day until your supply starts to regulate at about one month. You will be more exhausted than you have ever been, and if you’re anxious like I am, the relentless schedule will start to take a toll on your brain. Making milk is HARD on your body in the best of circumstances, and being in a hospital setting worrying about your baby is hard on your mind. Know this going in and cut yourself some slack. It doesn’t have to be pretty and you don’t have to handle it with grace. Just doing it is what matters.
5. Give yourself longer stretches between pumping sessions at night to make sure you can get some sleep. BUT, don’t miss pumping during the crucial 2 am – 5 am window. It’ll decrease your supply, for real. Do try to figure out how to get five hours of sleep a night in one chunk IF it’s possible for you – that’s what the brain needs to process traumatic events (like, you know, a scary birth and a baby in the NICU).
6. Use your hands when you pump – breast compression is one of the BEST and easiest ways to get more out of each pumping session.
7. Buy or make a hands free pumping bra, and shop online for some clothes that make pumping easy. Don’t hold off thinking that “maybe I won’t have to pump for very long,” because it will make your life easier right away. The best pumping clothes for me turned out to be nursing tank tops worn under zip-up hoodies, which allowed for fast access to both boobs at once (not all nursing clothes are designed for that). Shopping sucks when all you want is to be in the NICU with your baby. (Sometimes hospital gift shops will sell this stuff.)
8. Get a set of pump parts for the hospital and another set for home, maybe more. The more sets you have the less frequently you have to wash (and you will quickly start to hate washing) or carry back and forth. Same with bottles for feeding baby, although the hospital will take care of this until you go home. Try putting pump parts in a clean bag in the fridge in between pumping sessions (for no more than 12 hour stretches) to save washing as well!
9. Sometimes pumping less is pumping more. When my supply was stagnant at the beginning, I begged a lactation consultant to tell me what else I could do. She said to add more pumping sessions. I broke down in front of her because I didn’t feel like that was physically possible. A friendly nurse saw, and, once the lactation consultant was gone, let me in on a secret – a well-rested and relaxed mama produces more milk. If you don’t rest, she said, you’ll never increase your supply. So, I decided to drop a pumping session rather than add one (from 8 to 7 per day). I felt less anxious, and my milk supply went UP instead of down. Moral of the story – do what YOU have to do to feel better and the milk will follow. After that first month, use the magic number approach to figure out how much you, personally, REALLY have to pump to avoid a decrease in supply. Then do the minimum that it takes, and don’t sweat it.
10. Hydrate hydrate hydrate – this is more important than any supplement. Your body needs liquid to make liquid gold. But also consider supplements if you have to – the lactation consultants can help you with this (supplements should be a last resort after you’ve tried everything). Oatmeal is actually super helpful and super easy.
11. Try, try, try not to worry about how much you are pumping. The more you worry the less you pump. Make it fun!!
12. Power pumping really works (I did 10 minutes/10 off for an hour at least once a day for the first month). Do it while you’re in the hospital because there are tons of nurses around to help you take care of your baby. It’s really hard to fit in once you’re home.
13. If breastfeeding doesn’t work out eventually, exclusive pumping is an option. Many LCs and nurses don’t really know this and will act like it’s all or nothing, breastfeeding or formula. It’s not. People pump for a year, or longer. I’m not one of them (I’m weaning off the pump at 7 months). But if you decide you want to, you can.
14. Formula is okay. Really. It’s okay. Neddy started eating more than I could pump at around 4 months. I felt like I was failing him, and hated myself for not being able to do more. But any amount of breastmilk is an awesome amount. Seriously, celebrate it because every bit you give your baby is worth it. And, at the same time, deciding to pump less so that you can feel better, or get more sleep, or whatever you need to be a more present, less anxious mom, is okay. Formula is a useful tool our modern society has developed to help moms in your position. Channel your strong baby-nourishing energy into researching the best formula for your baby’s special needs (reflux? check).
15. I found this page (and this website in general) to be a great source for reliable information about establishing and maintaining milk supply. Do not read the mom forums. REPEAT. Do not read the mom forums.

I’m curious what other NICU moms out there have experienced. What other NICU advice do you have? Share in the comments!