Advice on Lactation

If you are the parent of a new preemie, you will find yourself having to learn many new things at a time when you are stressed, tired and scared beyond belief about the survival of your child. One of the things that you may have never considered doing is obtaining breast milk by pumping, in order to provide this valuable nutrition for your preemie. I would like to share my experience with you because I remember the feeling of bewilderment I felt when they wheeled the breast pump into my room within hours of the stressfull birth of my son. Disclaimer

I pumped from Sammy's birth, continued to pump while I transitioned him on to the breast over and over after each rehospitalization and sepsis, then finally pumped exclusively for bottle feeding until he was over 21 months old.

There were two main reasons why I pumped for so long. The first reason was that the breastmilk is rich in immunity and is much easier for the preemie's very immature digestive system to digest than formula. Our NICU nurses called it "white gold." It is so important that the preemies get the immunoprotection from the breast milk during this critical time; preemies that are born before 32 weeks, do not receive their mother's antibodies across the placenta which usually occurs around the thirty-second week of pregnancy.

We didn't find out until five months after his birth that Sammy had immunodeficiency called hypogammaglobulinemia which resulted from his severe prematurity. We were so glad that we had been able to give him the immune-rich breastmilk even before we found out about his serious immunodeficiency. We both knew how important it was that Sammy continue to receive the immunity from the breastmilk, so that helped keep us going for those 21 months. I was able to transition Sammy to nursing, but then he kept getting too sick to nurse and had to be rehospitalized. Finally, after one lengthly hospitalization, he refused to go back on the breast. So, we just made the commitment to keep pumping. We are convinced that the breastmilk played a key role in keeping him alive and preventing him from getting NEC. This was a powerful motivation for continuing to pump for so long.

The other reason I continued to pump was the incredible support of my husband. From the very beginning he was there with me. We learned together. He never once made me feel wierd when I was sitting attached to this machine countless times during the day. He knew that it was something only I could do. He could see what a tiring job it was, so he became my pumping partner and did the round the clock schedule with me.

Here are some specific suggestions regarding expressing breastmilk:

When you are transitioning to breastfeeding, it is often scary because the breastmilk that your child has been receiving either through gavage or the bottle has been so quantified. I remember being so concerned that Sammy wasn't getting enough nutrition when I had him eating completely from the breast. I think it was because I couldn't measure the exact input, the way I could when I was giving him breastmilk from a bottle or a syringe. There are, however, several things you can do to determine if your child is receiving adequate nutrition from exclusive breastfeeding.

First, check the feces to see if it is yellow with a seedlike consistency (the best analogy is grey poupon mustard -hmmm, I wonder if that is why they call it poupon? sorry!) Anyway, if it is, then this means that the baby is actually getting to the hindmilk and is getting enough of the fat. Second, your baby's weight gain will be a good indicator of obtaining adequate milk. My lactation consultant would tell me " he isn't gaining weight by swallowing air!"

If you feel that your baby isn't getting enough hindmilk because the stool isn't yellow, or he isn't gaining enough weight - you might want to try having the baby nurse on only one breast at a time. Sammy would get so tired while nursing that he would fall asleep rather quickly. I would have him nurse only at one breast because I knew that if I switched, he would only get the fore-milk from both breasts, and fall alseep before getting any cream. This worked very well. Sammy would nurse from one breast, we'd put him to bed, and then hubby would bring in the pumping equipment which he sterilized while I was nursing. Then I would double pump. This helped me keep up my milk supply and I was able to freeze that milk for a rainy day.

I was very glad that I continued pumping, because there were several times that Sammy had to be bottlefed rather than breastfed either because he was rehospitalized or because he was too sick to nurse. I was able to bring breastmilk to the hospital so that he only received breastmilk. Unfortunately, after this cycle between bottle and breast, he absolutely refused to go back on the breast so I continued to pump until he was over 21 months old.

I wish you the very best in your efforts to do the very best for your precious child.

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