Pumping Breast Milk for Your Hospitalized Baby

QUESTION

Dear Experts,
Hi. I could desperately use some advice on pumping. My daughter is 15 days old and in the intensive care unit. She will most likely be there for months and I have been pumping, trying to build up a supply for her. She currently has a feeding tube and is only getting 3cc an hour, so even the little I have been able to get should last a while.

However, after 15 days, I am still having difficulty with supply. For almost a week I was only getting about 1/2 oz total from both breasts and then slowly went up to 1 oz and then even 1 1/2 to 2 oz. But now, I am back down to 1/2 oz total. I am using a hospital grade pump and pumping every three hours during the day and sleeping about 5 hours at night. I pump 7 times in a 24 hour period. I am also having problems with very sore and sensitive nipples.

I consulted the lactation consultants at the hospital and they gave me some suggestions, but nothing seems to be working. I purchased larger flanges and it seemed to be working at first, but now I am back to where I was. I also purchased the comfort gel pads and use lanolin every time I pump. I have even tried eating extra protein and just yesterday started taking fenugreek.

I am extremely frustrated and about to give up, but I am torn because I really want my baby to have my breast milk, especially because she is sick. I feel like I have done everything and am still seeing no results. Despite the larger flanges, I am still seeing some swelling of the nipple in my left breast when I pump and almost wonder if the large flange is still too small for that breast (I have to use the insert that comes with the large flange for the right nipple).

I know stress can play a role in supply issues, but unfortunately, with my daughter in the hospital, I can't do a whole lot about the stress. I would appreciate any advice you can give because I am at the end of my rope with this and am about the give up.

Thanks so much.

ANSWER

We applaud your persistence and devotion to providing breast milk for your baby daughter. It sounds like you've done a great job of looking into resources, getting assistance, trying alternatives, and generally having the courage and strength to try to overcome this. We are not lactation consultants, so cannot really comment on the mechanics of flanges and nipple swelling, so we encourage you to get a second opinion about this issue. But we have a number of suggestions that address the emotional aspects of what you are experiencing and coping with.

Our first suggestion is to do kangaroo care. Kangaroo care is when your diapered baby is laid on your bare chest, and this skin-to-skin contact can stimulate milk production in moms of hospitalized babies. Many neonatal intensive care units accommodate kangaroo care readily, and even babies on ventilators can be positioned for kangaroo care. So if your baby's health care team resists, you can persist and advocate for your desire to do kangaroo care by pointing to the fact that it is considered standard care in many NICU's. You can also point your caregivers to the article, "Holding the very low birth weight infant: skin-to-skin techniques," by Theresa Kledzik, RN, in the January/February 2005 issue of Neonatal Network, one of the premiere professional journals for neonatal nurses. This article acknowledges that some NICU's don't practice kangaroo care because they lack protocol and techniques, and then describes how to successfully implement this care for technology-dependent infants. She points out that because kangaroo care improves the infant's physiologic stability, it is an appropriate and valuable intervention for the "unstable" infant, who stands to benefit the most.

Besides stimulating milk production in mothers, kangaroo care is good for babies, promoting weight gain, temperature maintenance, and oxygen saturation levels. It is also good for you, the mother, fostering your bond and letting you feel how intimately necessary you are to your baby's comfort and well-being. Dads can benefit in these ways too.Secondly, make sure that pumping time is a time out for yourself. Rather than focusing on the amount you're producing, establish a soothing ritual that conditions your body to relax. You might sit in the same chair, drink from the same tall glass of water, do some deep breathing, and allow yourself some soothing distraction. When you do what you need to in order to calm your body, you may find that your milk will let down more easily. Find the routine that works for you.

Thirdly, remind yourself that even when you are producing only small amounts, whatever you can provide is liquid gold for your baby. Instead of measuring your success in number of cc's, measure your success in the fact that you are pumping for your baby. Also, it is normal for you, the mother of a hospitalized infant, to have scant production. But by continuing to pump, you are keeping your breasts primed, so that when your body is so inclined, your milk production will increase. That is the reward for your persistence. Many moms who find the initial weeks of pumping difficult and unproductive go on to successfully supply breast milk for their NICU babies.

Fourth, remember that there are so many ways to be "a good mother" to your baby. Providing breast milk is just one way. Your comforting presence, gentle touch, soothing voice, and loving thoughts are some of the other nurturing, mothering things you can give your daughter. And by taking care of yourself too, you ensure your emotional attentiveness and physical availability to your daughter.Indeed, if continuing to pump becomes more stressful to you than the thought of stopping, then by all means, stop. Part of nurturing your baby is making sure that you are not draining your emotional and physical reserves at the breast pump, so that when you're able to be with her, you have something to give her besides just milk. As you get to know her and how to take care of her, you will find the balance that works best for both of you.

Finally, we are so sorry that your baby daughter is hospitalized. This is undoubtedly an incredibly stressful situation that holds many layers of loss for you, and an important key to taking care of yourself is to face your grief. Your grief over your daughter's condition. Your grief over your separation from your baby, and the barriers posed by her hospitalization. Your grief over your lost plans and wishes for this baby and yourself as a mother during the precious newborn period. Your grief over the fact that her prognosis may be uncertain. Your grief over feelings of betrayal-by modern medicine, by your body, by Mother Nature or fate or God. Your grief over what should have been but may never be. Your grief over what is. If you can name your losses and feel your grief -- including shock, sorrow, yearning, guilt, regret, anger, failure, and fear-you can ultimately feel a sense of relief. Holding your grief doesn't control it, but merely ensures that it controls you. It is quite possible that your milk will flow when you let your tears flow.

With warm hugs,
-- Debbie and Mara
The Crisis Pregnancy Expert Team

Davis and Stein

Deborah L. Davis, Ph.D. and Mara Tesler Stein, Psy.D. are the authors of Parenting Your Premature Baby and Child: The Emotional Journey, a 2004 National Parenting Publications Awards "Gold Award" winner. They also collaborated on Parent: You and Your Baby in the NICU (2002), as part of the nationwide March of Dimes NICU Project. They.ve been invited to regularly contribute to Advances in Neonatal Care, a neonatal nursing journal; their first article appears in Spring 2005. They are the founding members of Partners in Perinatal and Pediatric Consulting, which promotes developmentally supportive care for babies and parents, as well as collaboration between families and health care professionals.

Dr. Stein is a clinical psychologist in private practice, specializing in the emotional aspects of coping with crisis and adjustment around pregnancy and parenting. She is regularly invited to lecture and give workshops on these issues throughout the country to conferences of physician and nursing groups, doulas, and lactation consultants. Since 1997, she has been consulting with organizations and providing training to health care providers, guiding their efforts to improve the level of psychological support and developmentally supportive care to families during and subsequent to perinatal crisis.

Dr. Davis is a developmental psychologist, researcher, and writer who specializes in perinatal and neonatal crisis, medical ethics, parental bereavement, parent education, and child development. Dr. Davis is the author of four books for bereaved parents, Empty Cradle, Broken Heart (Fulcrum, 1991; 1996), Loving and Letting Go (Centering, 1993; 2002), Fly Away Home (Centering, 2000) and Stillbirth, Yet Still Born (PILC, 2000). She is also on the Board of the Pregnancy Loss and Infant Death Alliance (PLIDA.org) and is regularly invited to write articles for professional periodicals and parent support materials.