Pumping for the NICU Advice from the mommas

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Pumping for the NICU Advice from the mommas

Postby Cindy » Fri Mar 12, 2010 9:45 am

I figure everyone here has some experience for pumping for the nicu, and I always see lots of women asking about pumping, so I`ll make this a sticky so it stays here for future uses. Please add
Last edited by Cindy on Sun Feb 06, 2011 7:59 am, edited 1 time in total.
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Postby Cindy » Fri Mar 12, 2010 6:50 pm

WOW...I did not know you could add to refrigerated milk! I can`t count the ounces I ended up losing because of this
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Postby Lmpete79 » Sat Mar 13, 2010 6:07 am

Pumping in the NICU can definitely be done. Advocate for yourself and your baby by making sure you have a quality pump. My NICU had a lactation room for pumping, and only women could go in there. There was a sink for washing hands and washing pump parts, and six or eight spots for pumping with curtains you could pull around you. They also supplied a fridge with drinks and snacks. I drank a lot of water while my DD was in the NICU but don't over drink. Just drink to thirst.

I pumped every 2 to 3 hours for as long as the milk flowed (once my milk was in). When it was just colostrum, I pumped until I didn't see anything coming out. Those first few drops were pretty amazing to see!

To those who are large-chested: I don't know if I'm just uncoordinated or what, but I could not pump both sides at once without a third hand. I could get one side set up, then I needed someone to hold that part of the pump for me while I got the other side ready. So, my mom or my MIL had to go in with me to pump in the lactation room.

Ask to pump bed-side. I didn't realize it at first, but once I found out I could pump right next to my DD, and get help from my DH, I pumped right in the NICU for the majority of her stay. There were plenty of privacy screens that I could use (also used when we would nurse) and I didn't have to leave my baby for 30 minutes while I did it.

I also had help from a fabulous lactation consultant (IBCLC). If it weren't for her, we never would have made it breastfeeding. I thought I may end up exclusively pumping, but her strategies, along with help from women in the BF forum and my own stubbornness and determination, we are still nursing at almost 2 years. :hb:
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Postby PixieB » Wed Apr 28, 2010 12:04 am

Pump early, and pump often, particularly overnight in the early weeks. I can't stress how important this is. It feels like sleep is important, but that milk if you can get home EBF could well save you many more sleepless nights in illnesses down the track.

Hand express into a syringe before your milk comes in (this may require assistance in syringe wrangling in the early days). This reduces wastage and minimises contamination risks with transfering the milk because it can go straight down the NGT. You waste a lot with splatter in the shield and pump and bottle otherwise and those early drops of colostrum are like gold for your baby.

If your brand name bags for milk split, contact the company, they'll often send out freebies to replace it as an apology ;)

Chilled milk can be added to frozen milk if it's within 24 hours.

Once they start suck feeds, push for breast first. Get them established at the breast before you give permission for the bottle. The sucking motion is very different and you don't want your baby to confuse or lose their breastfeeding suck reflex before you've had a chance to start. Your doc may try to use the reasoning of bottle feeding taking less energy for the baby; this is weak reasoning given the long term damage it does to breastfeeding. It's very rare for prems to be exclusively breastfed and this is often because mums are too worried about their baby getting 'enough' and being pushed into bottles more often without the IBLC support they deserve. It's hard, but it's worth the extra effort.

Get help. See a LC even if you think you're on track. Especially get LC help for your first suck feed at the breast.

Make your pumping routine inviolate. Visitors can get stuffed, your pumping routine is more important. Cleaning can wait. Cuddles with your baby do however take priority. ;)

Pump crib-side or whilst holding your baby if you can. Your output will be huge!

Learn how to hand express and use hand expression and manual breast massage at the end of your pumping sessions to boost output.

Keep a bottle of water within arm's reach of your pumping station, wherever you pump.

Get DH to back you up with holding to your pumping routine.

A little bit of oil inside the shields of your pump can do a lot to ease pain. Also make sure you have the right sized shields.

If your nipples are achingly sore and hard like raspberries from so much pumping, make every second session hand expressing. You don't touch your nipples in hand expressing so it's so much gentler and gives them a rest without sacrificing your supply.

And if you're really struggling, have a look on milkshare:
http://milkshare.birthingforlife.com/
Similarly, if you have an oversupply and you can't use it, consider milkshare as an option for donation.

If you're anticipating having a prem, get a good pump sooner rather than later, it's one less stress post birth if you already have a pump ready.

If they're a micro-prem or similarly early, a prem sized dummy can be a good thing. Sucking and sweet things can be pain-relievers for painful procedures. For me I was wary about dummies at first, but I do think they helped Tali develop her suck reflex. I only gave consent for them to be given with a drop of my milk on the teat though for painful procedures and during tube feeds so she could associate sucking with comfort with the taste of my milk and the feeling of a full belly.
Talia Grace: born Friday 13th of July, 2007, at 27w4d gestation, 700g/1.5lbs. Nursed for 4 years
and Violet Joy: born Thursday 19th, VBAC waterbirth, 39w2d, 3.35kg/7lbs 6oz, still a booby monster, just shared it with her big sister for 18 months.
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Postby irishsweetie2003 » Mon Aug 16, 2010 7:25 pm

1st: Have a good pump... I had two cheep pumps and ended up with Mastitis 3 times.... Once I got a Medla swing pump (Nice to use and portable with batteries), I never got mastitis again.
2nd: Use the freezing breastmilk bags. They take up less room, air tight, and last longer frozen.
3rd: I always hear that moms have a hard time getting a baby to nurse. I had two NICU babies that waiting for a long time before they were allowed to nurse and also they use bottles first.
-Inforce with your NICU that your breast is the first nipple they recieve other than a pacifier. During each gavage feeding, I requested that they offer the baby a breastmilk soaked q-tip to suck on and taste so they associated the feeding with the taste and suck.
4th: I would pump with a double pump for 20 min for both breasts untill the supply came in, and then 15 min when it did come in. I had a ton of breast milk saved up which made it easier to recover fromt he mastitis without worrying about not having milk.

Kangaroo Care:
This is the time that a NICU baby can lay skin to skin with mom or dad.... I insisted that my son recieved this care even on a ventilator. I think it really made a huge difference. Everytime we did kangaroo care, his saturation levels went up and they could turn down the oxygen on his machine....
I also feel this closeness helped with his ability to feel connected to me.

I nursed one NICU baby that was born @ 29 1/2 weeks (6 week NICU stay, and a level three cerebral hemorage that slowed down his motor skills for a while) for 13 months.
I nursed my second NICU baby born @ 28 1/2 weeks (11 week stay in NICU) for 14 months.
I nursed a 34 1/2 week preepie who never went to NICU for 13 months.
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Postby Cindy » Tue Aug 17, 2010 4:48 am

My advice is this
Pump your 15 minutes on btoh breasts. Then hand express one breast until none comes out, then do the next breast until none comes out. go back to the first breast again and express until no more comes out, and back to the other. then do them both one more time..You`ll likely get another ounce or two and it will increase your supply.

Also, 30 minutes after you pump, pump again and then hand express...you won`t get much at all..but it will help increase your supply too.

Cluster pumping like you would cluster feed a baby really helps.

I ended up taking domperidone by prescription as my supply took a hit..but it was easy to get off of for me.

I also suggest learning how to properly put on a nipple shield.

My fav advice..once you pump, and hand express until you feel you are completely empty , let your little one latch on. Most nicus will agree to this even if you are not on suck feeds.

My personal advice, call the nicu before you pump at night. or even any pumping when you are away. It always made me more relaxed knowing how she was and what she was doing.
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Postby PixieB » Sat May 07, 2011 1:46 am

Use manual breast expressing after pumping to boost your output; here's a NICU specific video:
http://newborns.stanford.edu/Breastfeed ... ction.html

And how to hand express:
http://newborns.stanford.edu/Breastfeed ... ssion.html
http://www.askdrsears.com/html/2/t024900.asp

And advice I've written up so many times on how to get a good latch the first time:
As one suggestion I got when we first started breastfeeding (utter gold NICU nurse, I wish I could tell her how often I've passed on her advice) you need to get him thinking about his mouth before you start. There's a lot of external stimulus around for these teeny little ones and it's all terribly distracting, so he needs some help to focus on his mouth when it's feeding time.

You start by stroking his cheek from the corner of his mouth outwards. Then you stroke his lips, then you rub his bottom gum, then you lightly tickle the roof of his mouth with a clean fingertip. Now keep in mind he'll probably get tetchy at you for this (Talia tended to gag on the tickling bit so I only used it the first 2-3 times) but all of his attention will be there on his mouth, so he'll have a better chance at latching right straight out and sucking better.

It's worth a try at least, and try it a few times before deciding whether or not it works.


I really can't stress how important the expressing session between 1-4am is. Having a session somewhere in that block makes the most of when the right hormones are at their highest. Whilst the sleep is nice, ditching that ungodly hour of the morning session too soon can really impact your supply. 2-3 weeks minimum of keeping that session going.

It's also really important to keep a rigid routine. Tie it to specific hours of the day so you don't delay and delay with distractions and it's easier to remember when you last pumped. (I still remember mine; 7am, 10am, 1pm, 4pm, 7pm, 10pm, 2:30am) Guests and cleaning can wait, pumping can't if you want to establish your supply.

See a LC asap post-birth, and see them again every time you struggle. In Australia at least you get free access to the hospital LC the entire time your child is in NICU. Make the most of the facilities available to you.

This is a really useful thread from a prem forum I'm on, essentially advice from prem mums of the things we wish we'd known/been told in those early pumping days:
http://www.lilaussieprems.com.au/premfo ... 47&t=17476
and more general good advice:
http://www.lilaussieprems.com.au/premfo ... 25&t=11634
Talia Grace: born Friday 13th of July, 2007, at 27w4d gestation, 700g/1.5lbs. Nursed for 4 years
and Violet Joy: born Thursday 19th, VBAC waterbirth, 39w2d, 3.35kg/7lbs 6oz, still a booby monster, just shared it with her big sister for 18 months.
http://pics.livejournal.com/littlebutto ... y/0000scpq
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Postby littletsunshine » Wed Jun 08, 2011 9:27 am

I made sure I woke up in the night to pump also. Make sure the cones/shelds(sorry cant remember right word) are the right size, that made a huge difference for me. I couldn't pump in the nicu cause my baby was a micro preemie and I couldnt be close enough to see him and be out of the way so I had pictures taken of him and added them to the walls and around me and looked at them when i pumped. Relax, hard to do but think of what it will be like to hold your little one and feel the closeness while feeding. That did it for me. Ohh and lots of beverages during the day. every 2 to 2.5 hours for at least 15 min was what I was told. Hope this helps...After all that I had so much milk I had to start sending it home to my freezer cause they ran out of space for me.
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8W4D Baby B 167 :hb: 1.71CRL
6W5D Baby A 128 :hb:
6W5D Baby B 120 :hb:
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