One of the hardest jobs as a lactation consultant is walking into the room of a new NICU mother. There’s a million things going through her mind and keeping her attention to discuss breastfeeding and pumping is challenging. Rationally, NICU moms know their breast milk is important for their babies – but the reality of pumping can be overwhelming.
As a rule, NICU moms are exhausted, often in pain from delivery, and just starting to cope with the separation from their child; getting them to use a machine on their breasts every 2-3 hours is a big ask. Even the most well-intentioned NICU mom often grows frustrated with the frequency of pumping.
So how do we support NICU moms despite these hurdles?
One of the hardest times to start pumping education is right after a NICU admission. Moms are generally in a haze and research shows retention of new information is low.
Whenever possible, try to counsel NICU moms and families prior to delivery. Setting expectations for what’s going to happen immediately after the baby is born gives moms and their families something to plan for and focus on. If delivery is imminent and mom is already on the labor floor, making sure pump equipment is ready in the recovery room is a big help to labor floor nurses.
Cover your education in phases. Trying to teach everything at once will limit mom’s retention. The most important education to stress in the first few days is how and when to pump. Reinforcing this over and over will help emphasize the importance of early and frequent pumping. Other education topics can be trickled in throughout an infant’s hospital stay.
Include Partners & Family
Partners and family members of NICU moms often confide that they feel helpless. Pumping education is a great opportunity to include the support people in mom’s life. After delivery, empower partners by teaching them to set up and clean pump parts. Encourage partners and family members to be cheerleaders for moms and remind them about a pumping schedule.
Even small tasks go a long way in helping partners and support people feel included in the NICU stay.
Assist with Ordering Pump for Home
Under the Affordable Healthcare Act, almost all insurance plans are required to provide a free professional-grade breast pump to a new mom. However, navigating the process of ordering a pump through insurance can be very difficult for a NICU family.
To help, provide families with contact information for common insurance plans in your area. You can also provide numbers for durable medical equipment (DME) companies that deliver pumps nearby.
Any bit of direction helps families order and receive their pumps for home as quickly as possible.
Making pumping easy goes a long way in increasing pumping adherence. Lilu makes a bra that assists pumping. While moms uses her breast pump, and the bra initiates the breast massage (see cover image). Combining compression and massage technology, this bra maximizes milk output. Tests show moms getting 30 percent more milk with the Lilu Massage Bra than with breast pumps alone!
There are low-tech hacks I have seen work in the hospital too. At a previous hospital, we used belly-bands to hold fetal-monitor leads in place. A labor floor nurse came up with the idea to pull the belly band up and over mom’s breasts after delivery. Using scissors, she cut out small holes over mom’s nipples. By disconnecting the flanges from the pumping equipment and sticking them through the holes, she was able to create an instant hands-free pumping bra. It’s a small intervention but it goes a long way to help compliance, especially when moms are sleepy and would drop their pump parts if holding them in place themselves.
There is strong evidence to support logging pumping sessions increases adherence and overall milk supply. Provide mom with a means to log her pumping sessions from the start. Paper logs, phone apps, or white-board schedules are all great ways to keep mom focused on her pumping schedule.
Encouraging her to continue after discharge provides a great way for mom to stick with her routine as well as for you to check in later.
Cheerleading, Not Judging
For some, breastfeeding is a planned feeding choice. Others never planned to breastfeed but decided to try after a NICU admission. In either case, success with breastfeeding is influenced by a mom’s background, support system, and beliefs. It is important to always be positive and encouraging to NICU moms.
A universal sentiment expressed by most NICU moms is profound guilt about their infant’s NICU admission. Many moms feel some part of their baby’s NICU stay is their fault. Consequently, they are vulnerable to any perceived criticism or judgment.
The challenge and joy of helping moms through this time is getting to assuage that guilt by being a constant voice of motivation, praise and encouragement. It’s also about sensing when a mom is really asking “permission” to quit. Every woman will find a pumping balance in a different way. At the end of a NICU stay, the most important thing to strive for is making a woman feel like a confident and proud mom.
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