Friday, October 4, 2013

Preemie Breast Feeding and Pumping Problems

I had a heck of a time providing my one pound eight ounce micro-preemie with breast milk, but was determined to do so.

About 12 hours after my c-section, I started pumping. My first pumping experience surreal and uncomfortable. Holding two plastic cones on my chest while a machine provided a sucking motion just didn't feel natural. And, I didn't enjoy having the top-half of my body exposed to doctors, nurses, cleaning staff, restaurant service staff, and others who were constantly floating in and out of my hospital room. 

I had given birth at 28 weeks -- and my body didn't feel "ready" to produce milk. I also didn't feel like a mom.  I had given birth to a baby that I couldn't touch -- and I had barely even seen. I saw my baby from a distance in the operating room -- where she was handled by a neonatologist. I also heard her issue a very soft cry, but I didn't get to hold her -- and she was promptly whisked away.  

Following my c-section and some recovery time, I was taken by stretcher to visit my baby in the Neonatal Intensive Care Unit (NICU). She was lying in a special bed, called a Giraffe, and hooked to multiple machines. My baby was perfectly formed but she was all translucent skin and bones.  There was no meat on her at all. 

I wanted to do everything I could to help my baby, so my number one priority was to make milk. The hospital provided a breast pump for use in my post-partum room, as well as in my daughter's NICU room. 

I pumped every three hours and was able to produce a few drops of milk after a few days. I collected each and every drop of milk in a small five cubic centimeter (cc) syringe. My husband ran the syringes to the NICU, which was on a different floor than the post-partum ward. The syringes were frozen until my baby was able to handle breast milk. Eventually, I produced enough breast milk to fill part of a small bottle. 

Once my baby was able to eat, she was fed through an orogastric (OG) tube, which is a tube that is inserted through the mouth and travels down the esophagus into the stomach. Breast milk alone didn't provide her with all of the nutrients she needed -- so the nurses fortified it. Our baby eventually graduated to a nasogastric (NG) tube, which is inserted through the nose instead of the mouth.

I was discharged from the hospital with a diagnosis of pre-eclampsia post-pregnancy and prescribed blood pressure medicine, along with multiple pain pills. After a week or so, I developed terrible sores all over my mouth and tongue. My gums were so swollen that my teeth looked like small stubs. I felt awful and had a difficult time breathing, let alone eating or drinking. I went to the dentist, oral surgeon, and an internist, and discovered that I was experiencing an allergic reaction -- possibly to the blood pressure medicine. Due to the sores, I wasn't able to visit the NICU for a week!  It was terrible.

My sickness, and the decision to return to work until my baby was discharged, really put a damper on milk production. I ended up being able to provide my baby with a pretty steady amount of breast milk for the bulk of her NICU stay. The breast milk was combined with fortification. Her meal concoction required more fortification than breast milk, so I was able to provide her with breast milk for quite some time.

When our baby was sent home, the NICU staff provided us with a special formula to make really high-calorie Neosure. Breast milk was only to be provided as a snack. Nevertheless, I continued to pump. I was only getting about five ccs of breast milk in an hour-long pumping session. It was frustrating. I talked with multiple lactation consultants, experimented with dietary supplements, and tried my best. After a few months, I stopped pumping. It was tough -- but I made peace with the fact that I wasn't producing milk any longer.

Trying to provide milk to a preemie is challenging, especially if you can't be with your baby 24-7 or hold him or her whenever you want -- immediately following birth. Although I would have liked to have provided my baby with breast milk for her entire first year of life, I am thankful for the amount of breast milk that I was able to give her. I believe that any milk you are able to produce and provide should be viewed positively. After all, your baby is small and has a teeny tiny tummy. Any amount of breast milk that your baby receives is helpful. 

In the event that that your cups don't runneth over, below are a few tips that may be useful:

Pumping Tips

Keep Your Chin Up, and Keep Pumping

Breast milk is all about supply and demand. If there is a demand for milk, then the supply will come.

pumped every three hours. Sometimes I was able to achieve milk in a pumping session, other times I was not able to do so.  
As hard as it is, try to be positive about each end every drop of breast milk that you are able to produce.

Rest, Eat, and Drink Plenty of Liquids

Having a baby in the NICU is stressful. Once I was discharged from the hospital, my schedule consisted of driving to and from work, going to and from the NICU, and sleeping restlessly. I am sure that I probably didn't get enough rest, food, or liquids.  

As hard as it is to make time for yourself, especially when all you can think about is your baby, I recommend that you try to carve-out at least ten minutes of time to go the hospital cafeteria for a real meal. You should also ask the NICU staff if you can bring bottled water into your baby's room so that you can stay hydrated.

Rent or Borrow a Hospital Grade Pump

I rented the Medela Symphony Hospital Grade Breast Pump from the hospital's lactation station. It was the same pump that was made available to me in my post-partum hospital room and in the NICU. I felt that it offered more suction power than the alternatives.

I only had one sets of pump parts (breastshields, tubes, valves and membranes). I learned that it was really important to keep track of them. On at least one occasion, I left the pump parts connected to the pump at the NICU -- and didn't realize it until I made the hour-long trip home. So, I ended up returning to the NICU and spent the night there.

Participate in Kangaroo Care

I wasn't able to hold my baby when she first came into the world. After awhile, I was able to provide her with kangaroo care, which is a special technique in which you hold your baby skin-to-skin.  

Kangaroo care is a scary, but amazing experience. Being able to hold my baby (wires, tubes, and all) actually made me feel more like a mom.

In my experience, kangaroo care wasn't frequent and was often limited to five minutes -- due to bradys and desats. However, the time in which we were able to hold one another was a precious gift that likely helped me with milk production.

Put Your Baby's Picture and Personal Effects to Use

I taped a picture of my baby on my hospital grade rental pump. I also asked the NICU staff if I could keep one of my baby's blankets. I looked at my baby's picture and held her blanket while pumping at home. This effort was intended to simulate being together, even when we were away from one another.

Visit with a Lactation Consultant

The NICU staff helped me arrange multiple appointments with lactation consultants. The consultants were able to offer advice and recommendations. I followed some, but not all of their suggestions.

Discuss the Use of Dietary Supplements with the Neonatologist

I discussed the use of dietary supplements, such as Fenugreek and More Milk Special Blend with the lactation consultants, as well as the neonatologist to determine if they might be helpful to me and my baby.

Buy a Hands-Free Bra Suitable for Pumping

Buying a hands-free bra was one of my best investments. I bought the Medela Easy Expression Bustier Hands Free Pumping Bra. It was nice to not have to hold the any pump parts and also allowed me to do other things while pumping.


Did you experience any breast feeding or pumping challenges?  What tips did you find to be helpful?


  1. I imagine many Moms of micro preemies and other babies who have long term NICU stays have similar experiences with breast feeding and low milk supply. You had many obstacles in your way, distance to the hospital, getting sick yourself, going back to work, and worrying about your little one. You did a great job.

  2. Thank you for your kind words. I did the best that I could. It is my hope that this blog post will be helpful to other moms who are experiencing breast feeding or pumping issues. Perhaps they will also be able to comment on the post and provide additional recommendations.

  3. I just found this blog post via a search and have to say that your experience directly mirrors my own. I experienced sudden onset, severe preeclampsia that developed into full-blown eclampsia at 30 weeks. My daughter was born at 2 lb. 5 oz. and spent 7 weeks in the NICU. Despite pumping every 3 hours with a hospital-grade pump, meeting with SIX lactation consultants and being on every supplment there was, my body refused to produce milk. When I was looking for resources on the internet, all I found were articles from breastfeeding advocates talking about how EVERYONE can breastfeed if they just try hard enough or relax. It made me want to scream. I wish I had found your blog when I was living through that feeling of failure.

    The good news now is that my daughter is a wonderfully healthy 20-month old who has only been sick once in her entire life, and I've learned to be a LOT less judgmental about those who formula feed for whatever reason they choose. Thank you for this post!

    1. Thank you to the anonymous woman who commented about my breast feeding and pumping blog post. I appreciate your note and kind words as there are times when I wonder if anyone, other than my mom, is reading my posts! You should be commended for doing everything in your power to provide your incredible daughter with breast milk. I think it's incredible that you pumped every three hours, met with not just one but SIX lactation consultants, and took supplements to try to provide your baby girl with breast milk. It sounds like our experiences are very similar in nature and I'm glad that you reached out and shared your experience with me. Thinking of you and your preemie warrior. -Michelle

  4. Great info, I G+ it :) This post could definitely help a lot of other families

  5. What an experience, Michelle. I can only imagine what you were going through in those early days. And going back to work! You are such a strong woman and mommy! I had to chuckle a little when you described the first pumping session - I remember that!! I had to pump postpartum, in the hospital, and I remember walking those syringes to the NICU, so proud at the drops! Hugs!

  6. This post was beautiful and helpful! As you know, I am a nurse and also a lactation consultant. It is good to hear the real and personal stories of mamas who provide breast milk for their babies through trial, hurdles, and pain. You did an awesome job, Michelle! This story is a story of pure love and dedication for your precious child. Amazing!

  7. I am going to be embarking on this difficult breast feeding journey soon. I am so scared that I won't be able to provide enough milk for my baby. I will take some of your advice and give it my best shot!

  8. Thank you for thos post. I too remember how excited O was just to get the first few drops on a pacifier and give them to my son at 1 lb. 12 oz. Pumping is sooo hard to do and it is exhausting especially since returning to work until our baby can come home, and I found this post at a time when I was starting to feel broken as a new mother. You've given me hope again for my situation because I'm not alone. I will keep going, I will not give up. Even if it is 5 mL at 4AM I know it is making a difference for my little boy!