Expressions
transition to nursing at the breast in the NICU

Preparing to nurse.
Kangaroo Care  (skin to skin contact) should be encouraged as soon as possible. In addition to the many benefits for baby, kangaroo care can help increase a mother's milk supply.  The first feedings will be expressed breastmilk given by gavage (tube) until the baby is ready to nurse.

Shelley (mother of 24 weeker, from New Zealand) writes "we held him in the
feeding position when he was tube fed, and if possible with my breast
exposed as it normally would.  I used my clean little finger or a tiny
pacifier in Brogan's mouth when he I was present while he was being tube
fed so that he got the idea that a feed was associated with the mouth, and
not only unpleasant things like intubation, etc."

When can my baby start nursing at the breast?
Research done by Meier and others indicate that preterm infants weighing as little as 1300 grams and as early as 30 weeks gestation had the sucking reflex.  There is little evidence to suggest that bottles should be
introduced first, in fact, studies show that preterm infants were more successful at suckling at the breast (better oxygen levels, able to maintain temperature) and learned how to breastfeed sooner than it took to learn how to bottle feed. 

Barbara (mother of 28 weeker, from USA) writes "I pumped for about 2.5 weeks before they let me put him to the breast.  He was 30 weeks at this time, 1373 grams." 
Sherilyn writes "Kangaroo care was very much encouraged and I began nursing Conal at 32 weeks, 1220 g."

However, some NICU staff still adhere to outdated policies of only allowing nursing at 34 weeks or even later.

Renee writes "I decided to approach the doctors because I was getting nowhere with the nurse. I convinced the attending that the longer I waited the harder it would be and besides I felt that she would be no more likely to aspirate nursing than if she was to drink the bottle (since bottles just drip)."

The first nursings.
Although you are probably excited, and a bit nervous, try to be relaxed and get comfortable.  Elevating your feet will take strain off your back and a pillow behind your back will provide support.  Place pillow(s) on your lap to bring the baby up to breast level.  The temperature of the room should be warm, and it's beneficial have the baby clad only in a diaper to allow for maximum skin-to-skin contact, with a light blanket on top. Brief massage or pumping to achieve letdown before starting to nurse. Have a lactation consultant or nurse who is knowledgeable about breastfeeding help you with getting started.  The cross-cradle, or cross-over and football holds work well in providing good head support while allowing you to easily visualize latching on.  With the cross-over hold, you hold the baby's head with your right hand, with their body along your forearm, leaving your left hand free to hold your left breast. It is often very handy to have an extra pair of hands to assist with latching on, a process that may be needed many times during a feeding.  Your husband or a nurse can press down firmly on the baby's jaw to open their mouth, allowing a good latch. Proper position with a good latch is very important for extracting the milk.