Pumping for Your PreemieThe shock and stress of having a baby born prematurely is difficult in and of itself to deal with. The frequent trips to the hospital are exhausting. And the worry you feel about the health of your son or daughter can be overwhelming. If you had hoped to breastfeed your baby, you will no doubt want to use a breast pump to initiate and maintain your supply until your baby is strong enough and developed enough to start short attempts at breastfeeding and hopefully eventually transition to exclusive breastfeeding, but until this point, a breast pump will be a necessity. The requirements of expressing breast milk in the early days and weeks post-partum can add additional stress to what is already a difficult time, but having good information on how to best establish your milk supply will assist you to build a strong milk supply and provide the best nutrition possible for a pre-term baby: mother’s milk. The benefits of breast milk for preemies have been well researched. Not only can breast milk decrease the risk of necrotizing enterocolitis (a serious intestinal infection which is a very serious complication for any baby), but the breast milk from mothers of preemies is uniquely suited to the needs of these tiny infants. Breast milk contains an high level of antibodies which can decrease serious infections and illness in preemies. Breast milk also has growth factors which are very important for premature babies who are often very small and may have difficulty gaining weight. Mothers of premature babies also produce milk that is higher in nitrogen, protein, lipids, fatty acids, vitamins, calcium, and other vital elements important to the development of preemies. It is important to begin using a breast pump to provide stimulation as soon as possible after the birth of your baby. It is best to use a hospital-grade double electric breast pump at least until your supply is well established. Your baby’s neo-natal intensive care unit (NICU) should be able to help you locate a place you can rent a hospital-grade breast pump. When starting to use a breast pump following delivery you will want to follow, as closely as possible, the feeding patterns of a full-term baby in order to establish a strong milk supply. This means that it is important to use a breast pump 8 to 10 times within a 24 hour period for at least the first couple of weeks. Frequent stimulation is crucial to establishing a good supply; just as a full-term newborn would nurse on demand frequently, but likely for short periods, you must provide frequent stimulation to your nipples, breasts, and areolas. It is important to pump around the clock: both day and night. Although at night you can go for slightly longer periods between sessions. When beginning to pump soon after delivery, you do not need to pump for lengthy sessions. Ten to twelve minutes per pumping session is enough. Initially, you many not express too much in the way of colostrum or milk, but it will increase over the next several days with dedicated pumping. At first, the milk you express is colostrum: a thick, yellow milk that has a very high concentration of antibodies and fat. While there is not a large volume of colostrum, it is worth its weight in gold! It can sometimes be difficult to express colostrum with a breast pump because it is thick and somewhat sticky. If you are finding it difficult, try hand expressing to see if you can express more. Use a syringe to collect as much of the colostrum as you can. Your baby’s NICU will give you instructions on storing and transporting your breast milk. Since preemies are more susceptible to bacteria, viruses, and other illness, it is important to carefully follow the guidelines the NICU gives you. Always use sterile collection bottles and sterilize your pump kit regularly. Fresh breast milk is almost always best, so try to deliver your expressed breast milk to the hospital as often as possible. Usually within the first week or two, you should see your milk supply start to increase. You may find that you become engorged frequently. Frequent pumping is the best way to combat this. It will subside as your body starts to regulate its milk production. When your daily volumes start to increase, you will need to increase the length of your pumping sessions to ensure you are emptying your breasts as fully as possible. A general guideline is to pump for 120 minutes per day divided by the number of sessions you are pumping. Therefore, if you are pumping 8 times a day, you would pump for approximately 15 minutes per session. This is just a general guideline though and you may need to pump longer. The breast pump you are using can also vary the length of time you need to pump since not all pumps are as efficient in removing milk. Initially, lactation is hormonally controlled, but this endrocrine control switches to an autocrine control- supply and demand- over the first several weeks post-partum. Prolactin, the primary hormone involved in lactation, dramatically decreases within the first couple days post-partum (one reason why frequent pumping is vital starting as soon as possible after delivery) and then slowly continues to decrease over the next 6 to 12 weeks. Many women who have not pumped frequently during the first few weeks after the birth of their baby find that their supply starts to decrease around the time that their prolactin levels would naturally be decreasing. It is best to make use of the prolactin you have in your system in order to establish a strong supply early on and then maintain that supply by maintaining the demand through efficiently and completely removing the milk in your breasts on a regular basis. Generally, it is important to continue pumping frequently- at least 6 to 8 times per day- for the first couple of months post-partum or until you are able to transition to breastfeeding. If you find your supply is becoming extremely large- 45 to 50 oz. per day or more- it is better to decrease the length of your pumping sessions by a minute or two than to decrease the number of sessions you are pumping per day. The frequent stimulation is still very important. It is also better to establish as strong a supply as you can as opposed to only reaching the amount that your baby currently needs or is projected to need upon discharge from the hospital. While your baby’s intake is low, your milk production needs to continue on as though your baby was born full-term. Trying to increase your supply later on once your baby’s intake increases can be difficult with a breast pump since it will require you to start pumping more frequently than you already are. It is much easier to decrease your production once your baby starts breastfeeding. It is also important to continue to pump at least once during the night at least for the first couple of months post-partum (or until your baby starts to breastfeed exclusively): until a full-term baby would start sleeping through the night. However, some women choose to continue pumping at night as a way of reducing the sessions through the day and some women find that by eliminating the night session their supply declines. Mothers of premature babies can sometimes have more difficulty establishing their milk supply. This may simply be a result of the premature birth since the mother’s hormone levels may not be optimum for lactation. This is particularly true for mothers of extremely early preemies and micro preemies. Difficulties can also sometimes be a result of the medical interventions necessary with a premature delivery: IVs, cesarean sections, pain medication, pitocin, etc. Usually, given time, mothers of preemies are able to establish a good milk supply. Sometimes though, it may take longer for your milk supply to increase. If however, even with diligent pumping habits, you are unable to establish a sufficient supply, there are medical interventions that can sometimes be effective. Domperidone and Reglan are the most common prescription medications used to increase milk supply. Before turning to the use of these drugs though, it is best to exhaust all other means of increasing milk supply. www.kellymom.com is a valuable evidence-based website and has extensive information on increasing milk supply. The frequent pumping that is required to initiate your milk supply with a breast pump can be very overwhelming, especially when you are already trying to cope with the issues surrounding the premature birth of your baby. But remember how important breast milk is to babies and even more important to babies that are born premature. Often it can feel very isolating in the NICU and you may feel as though there is little you can do for your child, but you can provide breast milk for your baby. You can provide your child with something that only you can give; something that is made especially for your baby and something that meets your baby’s very particular needs. Copyright Stephanie Casemore, 2005 |
 
 
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April 10th, 2008 at 12:05 pm
Stephanie,
What a wonderful site this is! I too am struggling with the bi-hourly pumping for my now 3 week old son who was born at 28 weeks. I continue to pump, but my milk supply is definitely dwindling, I did not even have enough expressed milk to put into a small container for him. I have pumped since birth and was doing good up until a week ago, I started taking an herbal supplement but it seems to have made my milk supply worse? I’ve tried talking to the lactation nurse, but her advice is still the same. I don’t know what’s wrong, but I fear if I don’t find an answer soon, my son won’t have any breastmilk that he needs! I am desperate for answers, can you help me? I am using a Medela pump rented from the hospital. I hope you can help me. Thank you.
April 10th, 2008 at 6:38 pm
Hi Wendi,
Thanks for your question. Since your question is quite specific to your personal situation, I’d like to answer it via email. I have tried to contact you through the email address you gave, but it keeps getting bounced back to me. If you can email me via the contact link above, I’ll try again
Thanks,
Stephanie
April 17th, 2008 at 8:09 am
Stephanie,
I am in almost exactly the same situation as Wendi. My son was born at 28 weeks 5 days and is 3 weeks old. I also have a hospital grade pump that I am renting. I started out making enough milk for my son but my supply seems to be slowly dwindling too just as his demand is increasing rapidly. I double-pump every 2 hours during the day with one 4 hour break at night. I would like to avoid taking herbal supplements/drugs if possible. I recently switched from the Medela Symphony pump to the Medela Classic pump and my supply seems to have decreased even more. I am planning to go back to the Symphony in the next few days. Any advice for other things I can do to help my supply increase?
Many thanks,
Amy
May 8th, 2008 at 6:44 pm
Hi Amy,
First off, congratulations on the birth of your son. I hope he is doing well. Take care of yourself during this time. It is very stressful having a preemie in the hospital and hard enough just being post-partum yourself.
It would be helpful to know when you started expressing after your son was born and for how long you pump every session. Also helpful to have the daily volumes that you have been pumping from the start to most recently.
If you are pumping every 2 hours with one 4 hour break then you are pumping about 10 times/day? Is this correct? How long are you pumping per session? Generally you should aim to pump approximately 120 minutes per day but this does depend to some extend on the pump you are using and how you are responding to it.
At 3 weeks, your milk production is switching from endocrine (hormone driven) to autocrine (locally controlled supply and demand). You must ensure that the demand is maintained. It is also crucial that milk is removed as fully as possible and as frequently as possible.
Some general things to try or keep in mind are:
Use breast massage prior to pumping and masssage and compressions while pumping to help remove milk.
Ensure that the flanges you are using fit you well. Is there a lactation consultant working at the hospital? Perhaps they could help with this? Flanges come in various diameters. Your nipple should not be touching the side of the tunnel of the flange (although when pumping it will swell to fill it often). If the nipple totally fills the tube, you may need a larger size. If you find too much of the areola is being pulled into the flange, you may need a smaller diameter.
You may want to try a different make of pump. I really like the Ameda Elite and from my experience, are much different than the Medela Classic. Do try other pumps if at all possible. They are sometimes very different and can work differently for different women.
Be sure you are not using too high a suction level. This can actually hinder your efforts. Key is to elicit a let-down in order to release the milk.
If you find your supply is dropping, add time to your sessions- increase the demand.
Have you spoken to your doctor? A lactation consultant? Are your prolactin levels and other hormone levels within normal range?
Is your son stable? Have you started doing Kangaroo Mother Care (KMC) http://www.kangaroomothercare.com/ with him? This can be wonderful! Not only is it great to just sit and hold your baby, it can be really good for your milk production as it helps to boost prolactin levels. And it is great for baby helping to stabilize respiration, heart rate, body temperature, etc. and they tend to grow better/faster when doing KMC. And by being placed skin to skin on your chest, babies are exactly where they need to be to start figuring out how to nurse. Your son is close to 32 weeks now and will be getting to the point where he is able to at least lick and nuzzle the breast/nipple and start figuring out things. No rush for him, but the practice and closeness will help him to nurse down the road.
It can be challenging for some moms of preemies to maintain a strong supply but this isn’t to say that you can’t do it or can not increase it from where it is. Sometimes, using a drug such as domperidone can be helpful since it works to increase prolactin levels. It doesn’t usually need to be continued long-term. I know you said you would like to avoid herbal supplements, but if you do decide to go that route, I would speak to your neonatologist prior to trying anything to ensure that it is okay for your babe. Some herbs such as fenugreek which is often use to boost milk supply can cause tummy upset and for some preemies this may not be worth the risk.
While it is perhaps not very comforting, remember that any amount of breast milk you are able to provide your son is priceless and immensely important to him.
Hope this helps some.
Best wishes,
Stephanie