Before your baby was born, you may have imagined what it would be like to hold and feed her. And you may have already decided to feed your baby breastmilk or formula. But now that your baby is in the neonatal intensive care unit (NICU), you may need to adjust your plans.

Experts agree that breastmilk provides many wonderful and vital health benefits for all newborns, especially premature or sick babies. A baby needs good nutrition to grow and become stronger. But the baby may need to be fed a different way for a while, before being ready for breast or bottle.

• Intravenous feeding. Babies who are very small or sick are often fed intravenously (through a vein). A tiny needle is placed in a vein in the baby’s hand, foot, scalp or belly button. She will receive sugar (glucose) and essential nutrients through the vein. As soon as she is strong enough, the baby will be fed by gavage feeding. (See below.)

• Gavage feeding. The baby is fed breastmilk or formula through a tube placed through the nose or mouth into the stomach or intestines. The tube may be left in place or inserted at each feeding. Inserting the tube should not bother the baby too much because babies this small generally do not gag. When she can suck and swallow effectively, gavage feedings are stopped, and the baby can be breast- or bottle-fed.

Breastfeeding
Breastmilk provides many wonderful and vital health benefits for all newborns, including premature babies. But many NICU babies aren’t ready to feed from the breast at first, so the mother can learn how to pump her milk so it can be delivered by tube to the baby’s stomach. If your baby can’t suckle, tube feeding is the best way for your baby to get your breastmilk.

Here are some ideas for meeting the challenges of breastfeeding your baby in the NICU:

• Discuss your desire to breastfeed with your baby’s medical team.
• Ask for referrals to the NICU’s lactation consultant and to other NICU mothers who are successfully pumping milk or breastfeeding their babies.
• Start pumping as soon as you can, and use the pump that best works for you, such as a hospital-quality electric pump in good working order.
• Establish a relaxing ritual so that you condition your breasts to “let-down” (eject milk) when it’s time to pump or feed.
• Establish or build your milk supply by pumping every 2 to 2-1/2 hours around the clock for a couple of days and nights (or 8 to 12 times during the day, if sleeping at night is paramount). After your milk supply is established, go no more than eight hours (give or take) at night, and then pump at least eight times throughout the day.
• Empty your breasts when you pump as this extracts the hind milk, which is highest in  fat—calories your baby needs. Pump for a minute or two after milk flow stops or comes out in slow drips.
• Persist through the ups and downs of your milk supply. Expect very small amounts at first. At any time, if your breasts seem unproductive in spite of pumping, you may be tempted to give up. Try getting more rest, drinking more water and pumping more frequently (rather than for longer sessions). Your milk supply may build up naturally in response to a decrease in stress in your body.
• If your baby is able to suckle, he will be more receptive to feeding when he is alert and quiet. Ask to feed him in a quiet, darkened room so he does not become distracted. If possible, start by doing kangaroo care: hold your diapered baby between your bare breasts. Kangaroo care may relax both of you, and the skin-to-skin contact may inspire him to suck and your milk to flow. When he starts rooting around on your skin, guide him to your nipple.
• Recognize that every mother has to do a certain amount of figuring out what works best. For instance, if your baby has trouble latching onto your nipple, try using your pump’s suction to draw out your nipple before putting your baby to the breast. Or if your milk spurts out at the beginning of the feed and overwhelms your baby, pump just enough to decrease the pressure or volume. That way, your baby can keep up without swallowing air or choking. Try to find solutions that work for both of you.
• View the entire feeding relationship as meaningful for you and your baby. If you choose to supply a small amount of milk, or if you want to put your baby to the breast even if you supplement with a bottle-feeding afterwards, do so. Permit yourself room to experiment and adjust. 

If you wanted to breastfeed but then decided not to or are forced to give it up, you may feel disappointed. Remember that you also can have a close and rewarding relationship with your bottle-fed baby. You can experience the closeness of breastfeeding by cuddling your baby against your warm skin and letting your baby observe your face.

Formula Feeding
Babies thrive with formula feeding, too. There are a number of formula options, and the NICU team will recommend one for your baby.
 
You may need to wait a while before you feed your baby from the bottle. If she is very premature or ill, she may first require gavage feeding, where a thin tube is inserted through the baby’s nose or mouth to the stomach, and the formula is inserted into the tube. Your baby’s nurse can show you how to give your baby her gavage feeding, so you can take on the important role of providing nourishment.

Resources
Breastfeeding Your Premature Baby, by Gwen Gotsch (La Leche League International, 1999).

GotMom
Created by the American College of Nurse-Midwives to provide breastfeeding information and resources for mothers and families

International Board of Lactation Consultant Examiners
Provides referrals to breastfeeding consultants. (703) 560-7330.

La Leche League International
Provides referral to breastfeeding consultants. (800) LA-LECHE.

National Healthy Mothers, Healthy Babies Coalition
Has publications on breastfeeding at home or at work, in English and Spanish. State/local chapters. (703) 836-6110.

State WIC Programs
Provide breastfeeding promotion and support.

The Ultimate Breastfeeding Book of Answers, by Jack Newman and Teresa Pitman (Prima Communications, 2000).

The Womanly Art of Breastfeeding, by Gwen Gotsch and Judy Torgas (Plume, 1997).