Coming home from the NICU can be a scary experience. Your baby has been cared for by so many specialists and now what? I remember thinking “Can I do this? How can I possibly be as equipped as the NICU?” You can and you are, but that doesn’t mean you don’t need support, especially with feeding. Here are some common concerns parents have:
· Is my baby getting enough? How can I tell?
NICU babies are often supplemented while in the hospital, particularly if they are preterm or slow to gain weight. Your pediatrician as well as the neonatologist who discharges your baby can advise you on how much and for how long you need to supplement breastfeeding at home. I usually advise parents to continue supplementing as they have been in the hospital until the first pedi appointment. This may mean supplementing after every breastfeeding session, but the first pediatrician visit is often within a few days and you can re-evaluate then. If your baby is going home well before their due date or was very preterm to start, they may need supplementary calories in the form of fortified breastmilk or higher calorie formula. This is usually temporary and once baby is closer to term and gaining well they can transition to exclusive breastfeeding/ breastmilk. Watch baby for signs of adequate output (6-8 wet and 3 stooled diapers – stools may decrease by 4-6 weeks) and feed at least very 3 hours, even at night. One thing that can be helpful before you leave the NICU is to do a test weight*. This involves weighing baby before a feeding and then after to see approximately how much baby is transferring at the breast. This is also something you can do post discharge at your doctor’s office or in home with a lactation consultant (more about that later). A few test weights can help you see what an adequate feeding looks like for your baby.
· My baby is so small!
Recent advances in preterm care have led babies to go home sooner than they did in the past and for most hospitals, if baby is larger than 1800 grams (about 4 pounds) and meeting all of the other criteria for discharge (usually all feeds by mouth and maintaining temperature and heart rate/breathing) they can go home. This can mean you are breastfeeding a very small newborn! I believe strongly in a good supportive pillow, such as the Brest Friend that will lift baby up to you and provide firm support. A couch pillow can also be good, as it’s usually stiff and will lift baby higher up. The football position is good for small babies, as you have lots of control and can see everything that is going on with them re: breathing, latch, etc. If your baby gets very sleepy in this position the cross cradle is also a good one. See some photos here. Overall remember that babies are heartier than you think and grow pretty fast, but it’s normal to be nervous.
· I’m using a shield – how do I stop?
It’s not unusual for babies in the NICU to breastfeed with a shield. Preterm babies often fatigue quickly at the bare breast and need the extra support of the shield to maintain an active suck. Other babies are used to the feel of the bottle nipple and find it easier to go between breast and bottle when using a shield. When I had my first NICU baby (31w), I was completely against shield use and felt my baby wasn’t truly breastfeeding if using one. After talking with the lactation consultant on the unit and reading some research, I was open to the idea and it did help my baby begin to learn breastfeeding. As he grew stronger and my milk supply increased we were able to wean off the shield. It’s important to realize that a shield is just a tool and with or without it your baby is still feeding at the breast. Once baby is consistently breastfeeding, you can try starting with the shield and then, after baby is in a good pattern (5m or so), you can take off the shield and return baby to the bare breast. Use breast compressions to keep milk flowing and some chin support can also help baby keep the latch. Rachel O’Brien, IBCLC has a great blog post about weaning off the shield and you can find that here.
· Am I doing this right??
This is where a lactation consultant can be so helpful. Hopefully you worked with one (or a few) in the NICU but did you know that many lactation consultants do home visits? The “gold standard” in lactation care is the IBCLC or International Board Certified Lactation Consultant. IBCLCs have gone through 500-1000 hrs of breastfeeding counseling as well as college courses, lactation specific classes and a fairly rigorous exam to become certified. I would definitely recommend using one. Many insurance companies will reimburse for lactation care and some IBCLCs are able to bill certain insurances directly. The best bet is to go to ILCA and search for an IBCLC in your area. Another option is Zipmilk, although this directory does not serve every state. Finally, your local NICU may have someone they recommend. A home visit can include a weight check (*including a test weight), latch assessment, pumping guidance (including flange fit), and help with a breastfeeding plan to meet your family’s needs. You may be doing just fine, but it’s good to have that confirmation and reassurance.
You and your baby have a come a long way, so don’t forget to give yourself time to make this transition. Baby showers, visitors and welcome home parties can wait while you and your family enjoy this time together and settle in. It’s always ok to say “Our baby just came home from the NICU so we are limiting visitors for now.” Settle in, hydrate, rest when you can and if you are having trouble with breastfeeding ask for help – you are worth it!
