Pumping for your preemie isn’t for the faint of heart. I started off this series on breastfeeding a preemie in NICU by talking about why doing so is crucial to the health of the premature baby. And the many barriers having a preemie presents to starting off breastfeeding.

Yet after spending many hours reading preemie parenting message forums, books and blogs authored by moms of preemies, however, I’ve noticed that most moms aren’t breastfeeding their preemies, or if they are, they’re exclusively pumping.

Why is that?

Because of all of the reasons I mentioned earlier. Breastfeeding is highly tied up with emotions for one, and it’s just plain hard to get all the hormones flowing correctly when you have a preemie. Often you can’t even hold your baby for days after their birth. You fear constantly for their survival, and they’re too small to suckle at the breast.

Here’s a picture of me holding my little guy just a couple of days after he was born. It’s difficult to tell just how tiny he was from the photos. (He was still swollen from the IV fluids at this point and got even smaller later on.) But his little head was just a bit bigger than a clementine orange. The entire length of his body was not much longer than a burrito. I easily lifted him with one hand, and the nurses often did (having to untangle a dozen wires with the other).

The act of breastfeeding is supposed to happen with two people who love each other. There’s lots of skin to skin contact and mutual adoration going on. It’s accompanied by warm, snuggly feelings of relaxation.

Pumping for your preemie is a completely different experience from normal breastfeeding.

Pumping for your preemie has nothing resembling the normal breastfeeding experience. Since stress can inhibit oxytocin (which controls milk ejection), and premature births are accompanied by difficult, negative emotions bad enough to meet the diagnosis of PTSD, it’s no wonder so many moms struggle mightily.

I’ve heard several moms (when you have a preemie, people come out of the woodwork to tell you their preemie stories) who gave birth prematurely say that they never managed to pump one drop. Seriously. Some tried pumping for days, weeks even. And not one drop.

Dr. Jack Newman, MD, world-renowned breastfeeding expert, author of several books on breastfeeding, and founder of the International Breastfeeding Centre, puts it this way:

“Yes, the milk is there even if someone has proved to you with the big pump that there isn’t any. How much does or does not come out in the pump proves nothing—it is irrelevant. Many mothers with abundant milk supplies have difficulty expressing or pumping more than a small amount of milk.” (emphasis mine) – The Importance of Skin to Skin Contact

So there.

I would probably have been one of those women, except I had a secret weapon: my 2 year old was still nursing occasionally.

While I was in the hospital, I didn’t get a single drop from the fancy hospital-provided pump.

It was only once I was discharged, and at home with my cuddly, beautiful nursing toddler, that I was able to pump any milk. My body simply doesn’t respond to the pump well, even though I have nourished 6 children exclusively on breastmilk for at least the first 6 months of their life. I was also a La Leche League leader for several years. Clearly I know what I’m doing.

None of that mattered.

I did manage to hand express colostrum onto a spoon while still in the hospital. I used this video to get the technique down. If pumping for your preemie proves impossible for you, you might do better with manual expression.

My pumping “inadequacy” was a source of extreme grief to me. Despite pumping every 2-3 hours around the clock (yes, even setting an alarm to wake me 3-4 times a night), I never pumped enough to provide for my little one.

I remember clearly the first time the NICU staff had to give my child formula. It was 1 cc – which is 1/30 of an ounce. Still, I cried big, ugly, shaking tears. None of my other kids had ever had one drop of formula.

It was just another thing to grieve about what was going wrong with the entire experience with this baby.

I say all this to point out that, while I have worked extremely hard to get this little one to the breast, and it’s required more stubbornness than I knew I had in me, I don’t fault a mother one bit for chucking the whole idea and deciding to bottle feed.  Or, if she is that rare and lucky bird whose body responds beautifully to the pump, for pumping and breast milk feeding.

Now that I’ve said all that, there are a few things I learned during my “exclusive pumping” weeks. I hope they’re helpful to someone. (Update 2017 : my preemie is now a perfectly healthy 2 1/2 year old. He’s still nursing occasionally. This is a source of much joy for me.)

Pumping For Your Preemie

– Just keep pumping

You need to pump a minimum of 8 times in 24 hours to establish your milk supply. (Don’t go longer than a 4-5 hour stretch at night, either.) Remember that you’re trying to mimic the actions of a baby. Newborns nurse 10-12 times in 24 hours.

Even if you get more milk than baby needs, keep pumping. An oversupply can quickly become low supply if you drop pumping sessions too soon.

Even if you get no milk, keep pumping. Pumping, even if no milk is flowing, sends the message to the pituitary gland to make milk.

With breastfeeding, it generally takes 48-72 hours for a change in breastfeeding to affect supply. In other words, if your baby hits a growth spurt and starts nursing more to stimulate your supply, you’ll see a change in 2-3 days. With pumping, it’s more like 1-2 weeks. So keep pumping.

– Invest in your own pump

While I was still admitted to the hospital, they provided a pump for me. Once I was discharged, however, I had to pay $75 a month to rent one. That was stressful for several reasons. If I had it to do over again, I would have invested in my own pump once my supply was established.

Note: A hospital grade pump is best for bringing in your milk supply, but once you’re pumping well, you can switch to a double electric. I used this one.

Owning your own pump means you get acclimated to it, and getting your body accustomed to a routine is important with pumping. You also don’t have to stress about breaking parts of the pump (AHEM) when your toddler trips over it. And since you’ll likely be pumping for months, even after your baby is home (more on this later), it’s worth it financially to buy. I bought a Medela Pump In Style Advanced.

Finances are tight? I hear that many insurance companies are now covering pumps. It’s worth a shot. And if it’s prescribed by your OB or baby’s Dr, it’s likely a legitimate tax deduction, so keep your receipts and ask your accountant.

– Combine hand expression with pumping

Hand expression is best for getting colostrum. It’s also useful because it augments pumping and increases output. Breast compression and massage also help.

– Eat milk-making foods

Here’s a list. Here’s an entire book on the subject. Foods are safe, but galactagogues aren’t always a good idea. Here’s a great article about why: Why you won’t hear me suggest galactogogues. From personal experience, taking galactagogues when I didn’t actually need them caused me to have mastitis, three times in the span of three weeks.  ugh.

Still, I do eat a huge bowl of steel-cut oatmeal every morning, topped with flax seed and brewer’s yeast. All 3 are classic lactogenic foods. Do they do anything? I have no clue. But, they’re delicious and nutritive, so who cares.

Brewer’s yeast and/or nutritional yeast are very high in B vitamins. They’re cheap and convenient to sprinkle on food. (Nutritional yeast tastes a bit like Parmesan cheese to me. We have found it’s absolutely delicious on popcorn.) And if you hate the taste, capsules are cheap.

– Develop a pumping routine

The milk ejection reflex is a conditioned response to certain stimuli. Which is exactly why I had such a hard time pumping – my body is trained to “respond” to a baby wriggling in my arms, not a plastic machine that pinches my breasts.

So in order to develop that Pavlovian response, it’s a good idea to develop a routine around pumping that is exactly the same each time. You might get a large glass of water in the same container to drink, take a few deep breaths to relax, pick up the same book to read while pumping, pump in the same part of the house, etc.

One important tip: studies have shown that a woman’s letdown reflex is slowed by doing mental gymnastics, so avoid thinking about or doing anything stressful while you pump. Don’t focus on the empty bottles. Do something pleasurable such as reading a light or fun book that doesn’t make you think too hard, listen to a favorite band, sniff relaxing essential oils.

If you’re pumping because you’re going back to work, you’ll hear the suggestion to look at pictures or videos of your baby. But I think this tip could backfire on a preemie mom. Our babies, if they’re extremely premature like mine, are often skinny and rather alien-looking in the first couple of weeks of life.  Seeing all those tubes coming out will remind you of the painful things your little one is enduring every day, and of the agonizing separation you’re enduring. Looking at pictures or video of my baby stressed me out terribly.

– Get (or make) thee a hands free pumping bra!!

Bras designed for hands free pumping are easy enough to obtain online, but you can also make your own. Buy a cheap sports bra, use a Sharpie to mark lines on the bra where your nipples are, take the bra off, and cut slits. When you put the bra on, you detach your breast flanges from the connectors and slip the small ends of the flanges out of the holes. When you’re not pumping, just use breast pads inside your bra to cover the holes and prevent peek-a-boos.

– Use coconut or olive oil for lubricating flanges.

This helps make a better seal for greater suction, make breast massage easier, as well as protecting you from friction pain. Coconut oil also helps prevent yeast troubles. I love CapriClear sprayable coconut oil for this purpose. 

– After pumping, put your flanges and connectors in the fridge. 

This way, you can get away with only washing them once a day instead of after each use.

– Sleep.

At one point I was waking up every 2 hours to pump. But when I allowed myself a 4 hour stretch of sleep, I got more milk. Prolactin levels are higher during sleep, and many women find they can pump more first thing in the morning or after a nap. Naps should be de riguer for all new moms, NICU moms especially, because they are keeping an exhausting schedule.

– Try essential oils for relaxation.

I talked about how stress delays the milk ejection reflex. Do whatever you can to relax and soothe yourself. I sniffed relaxing essential oils and did deep-breathing, similar to what I would do during labor.

– Do Kangaroo care in the NICU as often and as soon as possible, and pump right afterwards. 

Finally, do as much kangaroo care as you can. Take advantage of the hormones that flow when you’re skin-to-skin with your baby. Pump right after kangaroo care (or during if you can pull that off – I did many times).

– If you have a latching toddler…

This tip won’t apply to everyone. I was fortunate in that my 2 year old was still nursing a few times a day. I could pump more out of ONE breast when she nursed on the other side, than I could out of BOTH breasts without her help.

That’s how powerfully the body responds to the real live baby, compared to the pump.

If you don’t have a latching toddler who can help establish your supply, you could do what one of the NICU nurses suggested to me. Have hubby help.

I didn’t press for details, but I do know at least one mom who said she could pump more after being intimate with her husband. Oxytocin, one of the big hormonal players involved with lactation, is also responsible for orgasm. It’s the “cuddle” hormone. Maybe ask your husband for a neck rub before you pump?

If you have experience pumping for a preemie, what would you recommend?

All of the posts on this topic:

• Breastfeeding a preemie in NICU – why it’s so hard, why it’s so important
• Pumping for your preemie (this post)
• Using the Lact-Aid supplementer, my frenemy