Expressions
transition to nursing at the breast in the NICU

Many babies are sleepy and difficult to arouse for feedings. Some suggestions include: undressing and placing skin-to-skin, sitting them up leaning forward and scratch or tickle the back, or holding them up and spinning yourself around (to make the baby dizzy).  Some feedings may go well, and others may not - this is to be expected.  Try to not get too frustrated, as anxiety will inhibit let-down and good milk flow.

Ann, (mother of 27 weeker, from USA) writes: "Be patient, don't let others discourage you, and be persistent. Even though your efforts seem for naught, the offering to breastfeed and the skin to skin contact are as important as the baby actually latching on."

Monitoring Intake and Supplementation
Methods for monitoring intake varied at different hospitals.  Some relied on a combination of: time at the breast, verbal reports from the mother, and volume of milk expressed after nursing (to estimate volume taken). Many mothers report feeling very anxious about milk intake and weight gain, and felt pressure to bottlefeed, since amounts can be measured. The best method for successful nursing appears to be weighing (on a sensitive scale) before and after breastfeedings, followed by supplementation by gavage if necessary. 

Inkan (mother of 30 weeker, from Sweden) writes "We started to weigh him before a meal - let him try to breastfeed - then weighed him again. The first 'meal' he got was 5 grams by the breast."
JoAnne (mother of 33 weeker, from USA) writes "At first he took on 5 cc's, then 10, then 15, then finally the whole feeding.  I really got to see how much he took that way and was able to see our progress".

Remember that pumping after every nursing will serve two purposes: increase your milk production (empty breasts make more milk) and provide a large stockpile for later use.

Feedings while you are away
A number of mothers who breastfed their babies reported that their NICUs used gavage or even tiny cups to avoid nipple confusion while trying to establish breastfeeding. 

Inkan writes "Bottle feeding was only for those who gave up breastfeeding, as the baby would often refuse the breast if he got used to a bottle. It uses totally different sucking techniques."
Kirsten (mother of 31 weeker, from Australia) writes: "Michael was not given a bottle until he was confidently breastfeeding (~1 week before discharge) and I was told that if I noticed any problems to let them know that they would stop the bottle feeds."

Other NICUs (especially in the USA), may routinely use bottle feeding to supplement. If you want to limit bottle feeding, you can speak to the attending neonatologist, and have your wishes written in the chart.   If your baby is fed primarily by bottle, you may have to struggle at home to get them to switch over to breastfeeding. However, a number of mothers were able to successfully transition from bottle to breast at home by always offering the breast first (and frequently).  Continued page 23