Born Too Soon - Pumping Advice from "Pumping Mummy"

Pumping Mummy aka @zoewoodman exclusively pumped for her children and wanted to share some of her knowledge and experiences during the Keep Britain Breastfeeding Event.  I have offered to publish her two posts.  Zoe told me that she believs that Breastfeeding from the source should be the first option for Mums and Baby's but that exclusively pumping is a definite choice for those not able to breastfeed and wanted to share this method of feeding with you all.

Pumping Advice if baby is in NICU/SCBU

I was asked by the group admin of the born too soon group on www.babycentre.co.uk to respond to some common queries if baby is unable to feed and mum is pumping her milk.

Here is the link to response online

http://community.babycentre.co.uk/post/a9185145/pumping_advice__links?intcmp=SPGroupSearchResult_SPGroupSearch_textlink

  

My reasons for pumping were not due to an early baby however so my experience from the board has helped me have a great understanding of the topic across all reasons as to why mums have to or choose to pump.

My first knowledge came from a great book “Exclusively Pumping Breast Milk - A Guide to Providing Expressed Breast Milk For Your Baby" written by Stephanie Casemore.  She EP'd for her son and she researched the topic so it has lots of info on pumping and I found it was instrumental in me being able to pump long term for my baby and now toddler.

Firstly some of the issues you face as mums of early babies are different to those who have issues at full term, but most of the solutions are similar so firstly do check out the top tips which has been added to since the board was started. 

http://community.babycentre.co.uk/post/a1676995/top_pumping_tips?cpg=6&pd=-1

Also it helps to have an understanding of how milk production works to understand the whole process and how what you do can impact your supply: 

http://www.kellymom.com/bf/supply/milkproduction.html

This is also a great site for information on early babies and breastfeeding as its not always the case that mums go on to solely pump – many are able to breastfeed further down the line. This is a video showing how to pump as it’s not as straight forward as you would think and will help you get the most out of pumping it is a must watch for anyone that pumps.

http://newborns.stanford.edu/Breastfeeding/MaxProduction.html

There is some useful information on this page too for early babies or those low birth weight:

 http://newborns.stanford.edu/Breastfeeding/PMGs.html#sickbaby

There are also resources on this site for when attempting to breastfeed also:

http://newborns.stanford.edu/Breastfeeding/

These are the particular issues asked for advice on:

1) premature baby = premature mum so milk can take a while to come in (if it comes at all)

Colostrum is the first food you will produce untll milk comes in and this can be hard to express using a pump as its like custard often hand expressing is best – its recommended to syringe or cup feed this if possible, To help start pumping as often as you can to signal to body to produce this and milk. In order to help milk come in make sure you are eating and drinking well, I know at this time of stress this will be hard but you need the extra calories.

Ask to use donated breastmilk http://www.ukamb.org/

Some supplements may help this process along such as Fenugreek (herbal), as well as other herbal mixtures too (see www.expressyourselfmums.co.uk for these).  But this is in conjunction with pumping as need to remove milk to produce more. Failing herbal supplements you can take some medication to help such as domperidone which can be bought over the counter as Motilium or obtained on prescription although GP’s vary in opinion on this. Links to domperidone on www.kellymom.com print it off and take with you to GP.

Not pumping enough times a day is the most common reason for failing to produce enough milk – it is recommended at least 8-10 times a day I managed 6 and topped up with formula and this has meant I managed to pump for 21 months,  if I had tried to do it more I may well have given up sooner as its about finding a balance for you to work.

This is a great link on pumping whilst away from baby or not nursing:

http://www.kellymom.com/bf/supply/maintainsupply-pump.html

2) premature baby = stressed out mum = poor milk supply. Often the relationship is directly proportional in that if baby has a bad turn (gets unwell suddenly or requires specialist intervention like ventilation, transfusions etc) Mummy will usually get depressed/ tearful over it and milk supply can go down because she's demotivated to pump or the negative feelings make the milk supply reduce.

Some of the above will help for this issue but also what I found key to motivating me was to keep a detailed log of times and how much I produced each side and how much my little one fed and tallied it up each day day by day I could see it increasing minutely and gradually getting closer to being able to cut down on formula supplements. Although the need to supplement among pumping mummies is high due to a pump not being as effect as a baby as getting milk out so it can take a few weeks or months or perhaps you will always top up but any ebm your baby gets is worth while…I found having a timetable to pump to helped keep me focused on what I was doing otherwise the day just runs away and find you haven’t pumped enough.

3) babies who spend months in NICU often get breast milk from mummy for about 3-4 months max and then supply problems become too much of an issue to continue pumping so babies will often come home on formula once the freezer is emptied. 

Unfortunately there are no shortcuts to getting milk production going other than pumping lots and doing the above also, its common for mums to get a good supply for a couple of weeks then they drop pumps to 2-3 a day and this is not sufficient for keeping a good supply going and can result in milk drying up.

It is recommended to drop a session around 3-4 months with at least 6 times a day including once at night until then. This is as you need to mimic how a baby feeds and a 2 month old baby does not feed 2-3 times day.

Try a supplemental nursing system:

http://www.expressyourselfmums.co.uk/details1.asp/ProductID/292/sid//Medela-Supplemental-Nursing-System

http://www.expressyourselfmums.co.uk/UserFiles/File/medela-sns.pdf

4) Trying to keep milk production balanced to baby's needs. These babies are so tiny that they often only need miniscule amounts per hour to keep going. Some mums can end up in a funny situation that they're expressing full steam ahead and are now able to bring baby home but they have a foremilk to hindmilk ration problem because they've been expressing without a baby and are now producing litres of milk but baby only needs 50mls and when they're latching on as a result they only end up getting foremilk rather than a balance of the two resulting in poor weight gain in this especially vulnerable group of babies.

 If you wish to breastfeed, then start using a SNS as above and slow down the regime of pumping by reducing amount of time pumping for at each session by a minute or so a day over a week or more period to gradually change the balance of the milk. Again knowing how milk production works is key to be able to adjust accordingly to match needs of baby.

Also block feeding will help oversupply, so for a set period of time (depending on how big the oversupply is), feed off one side only ie 3 hrs keep to the left breast then after that switch, so for all feeds in that 3 hr period you do it off the same side. This helps them to get the richer milk and also slows down production.

You may well need to keep pumping to maintain supply as baby may well only be able to suckle limited amounts of time so try to do this consistently ie same feed each day so you can adjust one session only and pump the rest of the time..

http://www.kellymom.com/bf/supply/foremilk-hindmilk.html

Bottlefeeding your expressed breastmilk means this isn’t an issue and any extra milk can be donated for use with other early babies etc  http://www.ukamb.org/

Often mums feels it important to know how much their baby is taking per feed and pumping long term is a viable option.

The top 3 key factors for success

1. get a great pump it may well cost over £150 but this will save you time and help establish a good supply early

2. have a regular pumping station set up with everything ready to go at a drop of a hat, so have more the one set of pumping bits everything to hand such as bottle of water, snacks,  laptop, phone and do not bottle watch – do something else catch up on things chat, watch tv anything that takes your mind off what you are doing

3. have a good timetable to stick to – pump pump and pump some more…..

Other useful links:

http://www.expressyourselfmums.co.uk/shop-by-concern.asp/ConcernID/9/preemies.htm

http://www.breastfeeding.org/newsletter/v4i1/page2.html

http://www.medelabreastfeedingus.com/tips-and-solutions/107/expressing-milk-for-your-premature-baby

http://www.kellymom.com/bf/preemie/index.html

http://messageboards.ivillage.com/iv-ppbreastfeed/?msg=32708.11

http://messageboards.ivillage.com/iv-ppbreastfeed/?msg=11144.2

Links for storing breast milk, times, temps:
http://www.kellymom.com/bf/pumping/milkstorage.html

Reusing expressed milk:
http://www.kellymom.com/bf/pumping/reusing-expressedmilk.html

Mixing milk and storage info you can mix milks of different temps

http://www.breastfeedingessentials.net/storagehandling.html

http://www.youtube.com/watch?v=h4nr7hxToiY its a bit long but a great space saver for storing in the freezer!

great link of fore/hind milk myth:

http://thefunnyshapedwoman.blogspot.com/2011/05/foremilk-and-hindmilk-in-quest-of.html

http://milkmatters.org.uk/2010/12/27/foremilkhindmilk-and-a-lot-of-confusion/

http://blog.nurturedchild.ca/index.php/2010/12/10/baby-led-bottle-feeding/

This is the group I admin:

http://community.babycentre.co.uk/groups/a1669245/pumping_mummies

Our featured post with lots of great links related to pumping:

http://community.babycentre.co.uk/post/a13212885/links_and_info_on_pumping_storing_etc_pls_read?cpg=1&pd=-1

I hope you find it useful feel free to share.

Zoë Woodman

zwoodman@hotmail.co.uk

If you have enjoyed reading this post and would like to read more about breastfeeding consider reading articles written by these other participating bloggers in the Keep Britain Breastfeeding Internet Scavenger Hunt -

Diary of a First Child

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My Mummy's Pennies

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The Secret Life of Kate

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