Breastfeeding, pumping breast milk and bottle feeding in the NICU

Breastfeeding, pumping breast milk and bottle feeding in the NICU

Breastfeeding in the NICU

Breast milk has every vitamin, mineral and other nutritional elements that your baby needs. There is no formula that completely mimics the milk your body creates. Breast milk has many immunological properties that are your baby’s first protection against the germs he or she may be exposed to.

Breastfeeding is a wonderful process that you and your baby will learn together. When you are ready to start breastfeeding, it will be a learning process for both of you and it may take a while to get the hang of it. Your nurses and our lactation consultants are here to help with your breastfeeding questions. Please check with your nurse regarding the schedule.

Both bottle feeding and breastfeeding require coordination of your baby’s suck, swallow and breathing. This may depend on your baby’s prematurity and corrected gestation. Premature babies tend to develop effective coordination for this by 32 weeks but it is more developed by 34 to 35 weeks.

If you are breastfeeding, it is important that you stay hydrated. Be sure to drink frequently, preferably before you feel thirsty. Have a glass of water nearby when you breastfeed or pump breast milk for your baby. Aim to drink at least eight glasses of water or other liquids a day.

You might need to eat a little more than normal — about an additional 400 to 500 calories a day — to keep up your energy. There is no need to go on a special diet while breastfeeding your baby. Instead, focus on making healthy choices to help fuel your milk production. Opt for a variety of whole grains as well as fruits and vegetables.

Although many medications and herbal products are safe while breastfeeding, some are not. It is always best to ensure that any prescription medication, over-the-counter drug or herbal remedy (including tea) you are taking is compatible with breastfeeding.

Daily weight gain is a good indicator as to whether your baby has an effective feeding pattern/plan. Your baby’s feeding plan is constantly revised in daily rounds and is based on his or her status.

If your baby is in the NICU, he or she may require acute medical treatment that could delay breastfeeding. There are a number of alternative feeding methods in the NICU, including bottle feeding with expressed breast milk before breastfeeding is established. Other methods include nasogastric/orogastric feeding and total parenteral nutrition, which are discussed on our ‘Alternative forms of feeding in the NICU’ page.

Pumping and storing expressed breast milk in the NICU

If your baby is in the NICU, he or she may not always be able to breastfeed. For this reason, we encourage you to pump every three hours. In the NICU, we provide a temperature-controlled (2° – 5°C) breast milk refrigerator at your baby’s bedside to store your expressed breast milk. We can accommodate up to 24 hours of milk supply. We also have a freezer available if needed.

Breast pumps available in the NICU

A breast milk pump is free to use while in the hospital, and Medela multiuse breast milk pump kits are available for purchase and rental:

Double breast pump kit $55
Freestyle double pump $495
Single swing pump $249
15% off coupon available with the purchase of an MSH Blue Book

Rental prices:
4 weeks $85

For rentals, additional weeks are $30 per week or you can opt for an additional two-week rental at $55. Prices do not include HST.

Pumping tips and tricks

Do not worry if it takes a few days of pumping before you see much milk. Once you move from hand expression to using the pump, you may see your milk production stall. That is normal. It can take five or six days for your milk to come in. Keep pumping regularly, record how much you are getting, and if you have concerns, contact the lactation consultant.

If you would like to bump up your milk production, try pumping more frequently. For example, pump every two hours during the day rather than every three. It is better to pump more frequently rather than for longer sessions.

Encourage milk flow by massaging before you pump, which can stimulate the "let down" of the milk. Warm compresses can help ease blockages and get milk moving. Hot water in a diaper can be effective; some moms use a sock filled with rice that they heat in a microwave.

Avoid wearing underwire bras; the pressure can lead to blockages. It might help if you make a hands-free pumping bra by cutting holes in an old sports bra.

You can pump either at your baby’s bedside or in the Care by Parent Room if you are staying there. The most important tip is if you have any questions or concerns, talk to your nurse or lactation consultant. And remember... pumping can be challenging, but the rewards are great.


The NICU has infant formula available if mother’s breast milk supply is not quite ready. The nurses, physicians and midwives will provide you with support and guidance to safely feed your baby.