Pumping & The NICU - A Comprehensive Guide

When I started this blog, my heart and intention behind it was to be helpful and honest. This post so deeply reflects that desire, and I almost am in tears writing because my heart aches for any woman who needs to read this - because the NICU is not a place I would wish to see any baby. If you are reading this from a hospital room, desperate to figure out how to make this all work, I pray this is a helpful guide and that these words bring you a sense of solidarity, knowing that you are not alone. When searching online during our hospital stay, I found tons of articles on pumping, but I never found a post directed to NICU mamas, and wanted to put this out there for women who may be looking for similar advice or guidance.

I am by no means an expert at pumping, however, I did manage to pump almost all the nutrition Josephine needed while in the NICU, and we were able to transition into exclusively breastfeeding without needing supplementation. Much of our success was thanks to so many women who had walked the same path before me, and gave me such wonderful advice, as well as the lactation consultants at CHLA. This post is a mix of things I had learned during my time nursing Logan, as well as things other women shared with me. 

One last thing: If you end up choosing to supplement with formula, or being forced to because things just don't end up working, please, please, have confidence that your baby is no less cared for or loved because of this. You are a warrior for growing and supporting their precious life, and caring for them in the midst of such a storm of events. Your baby who you will take home with you - happy and healthy, is the biggest testament to that truth and he or she will love you all the same, and call you 'mama' until your last days, regardless of what they ate the first year of their little life. There is a lot of shaming that goes on between mothers, especially when it comes to nursing, and overall it is so unnecessary. We all make the choices that are best for us and our baby, and that looks different for each family. 

Now that you have some context, and hopefully feel a bit more encouraged, lets talk about pumping! When you envision birth, you may have, like me, pictured nursing your tiny baby right after they are born, as you enjoy lots of uninterrupted skin to skin time and stare into his or her newly opened eyes. Well, what happens when your baby is taken away from you right after being born and you don't have that time to bond together for days - maybe even weeks? Is all lost? Let me tell you, it is not; not in the least! If this is your case, the first thing to do it:

I. Talk To A Lactation Consultant

If your nurse doesn't set up a meeting for you, request that you see the consultant at the hospital ASAP. They will set you up with a pumping kit, and give you some helpful tips to get started. Josie was at Children's Hospital Los Angeles, and I was able to request help from a consultant they had on staff. See one when you are pumping, and when you transition to latching and nursing. For me, pumping was going great, but I needed some reassurance that our latch was okay and that she was getting enough from each feeding. Jessie (the angel LC at CHLA) watched her latch, weighed her on the breastfeeding scale, and gave me the confidence I needed to go home and exclusively breastfeed. Keep calling them back until YOU feel confident that all is working, and that you have the information you need to nurse on your own. 

II. Use A Hospital Grade Pump

Most hospitals will have the Madela Symphony pump on hand for you to use, or another very high quality pump. If you are unable to stay at the hospital with your baby, see if the hospital will loan or rent you one. If that isn't an option, Babies R Us has them for rent in store (I rented one for a month, which cost us $75), and you can find our more information here. These pumps are much higher quality than what you received from insurance, and can make a big difference, especially when starting out. They cost upward of $2,000 for a reason - they are much more effective and efficient at removing milk, thus stimulating further production.

III. Frequency, Timing, and Consistency

These three things are SO crucial when it comes to your success. One or two variations here or there will not mess everything up, but lack of consistency will set you up for a much more difficult journey in the long run. From all the people I talked to, it is almost universally recommended that your pump for 20 minutes, every 2-3 hours, 24 hours a day. You do need to set alarms at night, and yes, it is so exhausting. One thing that made it work for me was that at night I would wake up 30 minutes before the hospital had scheduled Josephine's next feeding. I would pump, store the milk and have the nurse feed her so I could go back to sleep. I gave her bottles during the day, but trying to do so at night literally meant that I would not get a single minute of sleep. I had major mom guilt until I realized that I did need to sleep in order to be healthy and keep producing milk. Josephine was a pill to wake up at night anyhow, and always snoozed through her feedings -barely taking the full amount because she was just too cozy, so it worked out well. 

This schedule may seem extreme, but it is realistic to how babies actually eat, and the frequent and consistent expression of milk tells your body to keep making more! No pump is as efficient as your baby is, so you need to keep demand really high while pumping so that the supply will follow. A new, and now very dear friend reached out to me during our stay in the hospital and so realistically said "I wish I could tell you it would be easy and would all work out, but pumping is hard work and its exhausting." She encouraged me to pray and rely on Jesus when I felt like I had no more strength of my own (this was often). Caring for a baby in any capacity is a hard task, and waking up to a machine rather than your sweet baby is not always easy, but the Lord kindly provides the strength we need as mothers. 

One more note on this - I was discharged from the hospital two hours after Josephine was born. I hadn't slept because I was laboring and giving birth. I got to CHLA around 7 am and walked a ton between going to the bathroom, getting food, talking to doctors; so the first night I overslept and only pumped every four hours. I literally didn't even wake to my alarm. I remember feeling so discouraged and like I had ruined everything for us, but this was my body's way of slowing down just a tad. This happened the first two nights, but after that I got on a better night routine. If you oversleep, know that it will be okay and just go back to your two hour schedule. After those first two nights I pumped every three hours from 10 pm - 7 am, and every two hours during the day. 

VI. Have Realistic Expectations

Before this, my only experience in pumping was pumping after Logan went to bed, to build a freezer stash. I started pumping when he was four months old, and consistently got anywhere from 2-10 oz each night. I kind of expected to get tons of milk right off the bat, but pumping colostrum is a whole different world. I honestly got nothing to speak of the first two days. The Lactation consultants assured me that even a few drops at this stage was an extremely good sign. Colostrum is difficult to express and at this age babies stomach is so small they don't take much anyways. Milk usually comes in on day three, but if you're a first time mom it can come a bit later too, so don't let that discourage you. Day three was when I started getting enough to store - this was sometimes only 5 mL, but it was a start! 

V. Massage & Hand Expression

This may seem strange, as you don't have to do either of these things when nursing your babe, but it really does make a huge difference. If you don't know how to hand express milk, have the lactation consultant teach you, or look on youtube for a tutorial. This was by far the #1 tip I received for getting more milk and stimulating supply. I would massage around my breast and all the way back to under my arms for about 10-15 seconds before each pumping session. This helps you "warm up" and stimulate the milk ducts telling your body its time to get going. I would hand express to get the milk going, then switch to pumping. These things are helpful because you want to extract as much milk as possible at each session in order to increase your body's supply. After pumping, continue to hand express for several minutes. This will signal your body to continue to make more milk. I noticed a significant increase in supply when I started hand expressing after a session.

VI. Have Supplements On Hand

Most people have varying views on whether or not diet and herbs actually affect milk supply. There is no hard and fast rule, and it really goes on a person by person basis. For me, I know from experience that eating certain things does boost my supply. Oatmeal was one of these foods for me, and many other women, so I tried to have oatmeal each morning when we were in the hospital. Feungreek is popular, but also notorious for causing gassiness in mom and baby, and I didn't find it's effects so spectacular.  My "holy grail" herb that I used with Logan, and now Josephine, was stinging nettle. I purchase this brand from Whole Foods for about $13. I would take two capsules three times a day. I started doing this on day 4 of pumping and my outputs went from 10-20 mL per session, to 40-70  mL. This did coincide with being able to do skin to skin, but I think the combination of both greatly helped, as I had seen it do this when pumping at night while nursing Logan. Per the recommendation of other mothers, I also purchased this "Let There Be Milk" supplement and these Maxi Milk Drops from Mountain Meadow Herbs. Both have worked really well, and I like that the Maxi Milk is an option without fenugreek. 

VII. Eat, Drink & Relax

Drink more water than you think you need to. Like, tons. Your body needs water to make milk, so this will help no matter what. Also, be sure you are eating plenty of food. Your body needs good carbs and fats to support the output of milk, also. Avocado, sweet potato, oatmeal, nuts and whole grains are good options. It can be hard to get these in the hospital, but I made sure to order one meal a day that included things I knew I needed (and wanted!). Lastly, you may be laughing at my suggestion to relax, but try to not stress yourself out over all this. It will be over soon, and your body does know what it's doing, just trust the process. If you have questions - ask! Being patient is so crucial and stress only will hinder your production and mental health. 

VIII. Power Pumping

I learned about this when pumping for Logan, and I swear it is worth the effort. I tried to do two sessions of this a day, or at very least, one in the evening, around 10 p.m. To do this you simply pump in the following sequence: Pump 20 minutes; Rest 10 minutes: Pump 10: Rest 10: Pump 10. It takes a full hour, but it is SO worth the extra time. The goal of this is to trigger multiple let downs, which stimulates milk production. My first power pumping session in the NICU didn't yield much, but the following sessions yielded much more, up to 2 oz. This also works well if you notice a supply drop later in your nursing journey. I wanted to build my freezer stash with Logan, so I did this three nights in a row, then switched over to normal pumping. By the third night I was getting over 9 oz in about 15 minutes, which was CRAZY for me. 

IX. Advocate For Yourself, And Baby

All NICU's take extreme caution, and changes are made very slowly. This is for baby's good, but can also be frustrating to go through as a mom. I was consistent to ask when Josie and I could do skin to skin, or when she was able to start nursing. Even when they still wanted her to be bottle fed, they did let me latch her to get her practicing and mostly "comfort nurse." This helped my supply, and it was so therapeutic for both of us, as we bonded. As for baby, make very sure they keep baby on a slow flow/preemie nipple for all bottle feedings. This is most realistic to how actual nursing is, and using a faster flow can cause baby to get impatient when they are able to nurse, and sometimes they will reject breast feeding in favor of a bottle. If this is the case, you can always bottle feed and pump, or work with a lactation consultant to get things straightened out. I was very adamant about this, and I am so thankful I was. 

This all may seem overwhelming, but I hope you find it helpful and that it gives you confidence to keep pressing on, even if you don't see results yet. Reach out to other women for stories of how it went for them. One gal who wrote to me said she pumped nothing for six days while her daughter was in the NICU. But then the next day everything clicked and she started pumping a ton of milk. After one or two nursing sessions with Josie I could tell my milk also greatly increased, so know that when you are able to start nursing, things will change.

There's so much more to be said depending on all the variables of your situation, and if you are reading this and have more questions or want to connect, shoot me a comment here or up at the contact tab and I would love to chat and be able to pray for you!

xx, B