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Question: I have just had a 29 week infant who is in the NICU. He didn't eat anything for a week and now is eating only tiny amounts. Why should I be pumping so much and storing milk if he is not using it?
Answer: The single most important factor in establishing successful breastfeeding during and after the NICU stay is the volume of milk produced in the first 1-2 weeks postpartum. Because of the physiology of human milk production, a full milk supply (i.e. enough for a full-term healthy baby) must be established early on by regular nursing/pumping, or the alveolar tissue and receptors developed during pregnancy will rapidly involute. Initiating early pumping (within the first 24 hrs) is associated with higher levels of milk production and longer exclusive and any breastfeeding post-discharge.
Family members and health care professionals sometimes discourage mothers of premature infants from initiating lactation as they feel that providing milk will be an added stress. Several studies indicate that providing milk for their infants helps mothers cope with the emotional stresses surrounding the NICU experience and gives them a tangible claim to their infants.
For the mother, the decision to provide breastmilk for an NICU infant is quite different from the decision to breastfeed a full-time infant. First, the decision is usually made based on health-related issues (the special benefits of human milk for preterm infants). Second, mothers who did not intend
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to breastfeed often decide to pump, for at least a short time. Third, mothers are highly influenced by the advice of professionals who care for the infant, feeling thankful for (not coerced by) their guidance, and even resentful if misinformed about formula being equally acceptable.
Health care providers, especially physicians and nurses who care for post-partum women and their NICU infants, must take responsibility for educating mothers about the need for, and methods of, establishing their milk supply. Ideally, these discussions should take place before delivery as well. Every drop of human milk pumped for preterm or ill infants should be considered "liquid gold".
 Nancy E. Wight MD, FAAP, IBCLC -- an attending Neonatologist at Children's Hospital and Sharp Mary Birch Hospital for Women, San Diego, and Medical Director, Sharp HealthCare Lactation Services. She can be reached at www.breastfeeding.org.
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