Pumping Breast Milk for NICU Moms
You will have to depend on a breast pump to both tell your body to start producing milk and to keep producing milk. You will have to continue to use the pump until your high-risk baby can nurse regularly and is able to maintain a plentiful milk supply by nursing effectively at each feeding. The most effective type of breast pump for this purpose is a hospital-grade, electric breast pump with a double-collection kit. Most mothers find it takes less time to get more milk when using this type of pump. The automatic suction and release action of this type of pump more closely imitates the way a baby sucks than do other pumps.
You will find other types of breast pumps on the market, such as small manual or battery-powered pumps. While these pumps work well for mothers who only need to pump once or twice a week, they are not enough to start and keep producing enough milk for a high-risk baby. If you have questions about the type of pump to purchase or rent, or have questions about a breast pump you are considering, talk with our lactation consultants.
The most important part of starting and keeping a milk supply is to express your milk frequently and completely. The most important time for you to establish a milk supply that will be enough to feed your baby as he/she grows is the first 3 to 4 weeks after your baby is born. If you want to have enough milk for your baby for 6 weeks or longer after delivery, you must pump frequently for the first 3 to 4 weeks using the pumping schedule recommended in the next paragraph. This is important even if your baby is not taking all of your milk.
- You will need to pump at least 8 times a day.
- Pump for a total of at least 100 minutes of pumping in every 24-hour period.
- Pump every 2-1/2 to 3 hours when you are awake and at least once at night.
- Do not go longer than 4 hours without pumping at night.
- Make sure you have at least 1 pumping session between the hours of 10 PM and 2 AM.
The length of the time between your pumping sessions at night is especially important. If your breasts are very full when you wake to pump during the night, you need to shorten the amount of time you sleep between pumping sessions. You should also wake earlier in the morning to pump. When your breasts stay full for an extended time, at night or during the day, your body will decrease its production of prolactin. This, in turn, decreases your milk production. If you do not keep a frequent pumping schedule during the first 3 to 4 weeks, you may not have enough breast milk to feed your baby after 6 to 8 weeks. This means you will need to supplement breast milk with formula to give your baby the amount of milk he needs.
After pumping your breasts for 3 to 4 weeks, if you are able to express at least 24 ounces of milk in a 24-hour period, you may relax your pumping schedule somewhat. You can slightly lengthen the amount of time you go without pumping at night up to 5 hours. However, do not entirely drop the nighttime pumpings, or your milk supply will diminish. Make sure to continue to pump for a total of 8 times each day. Keep track of your daily milk totals. Your average daily supply should not decrease because you have changed your pumping times. If you notice a decrease in your daily milk totals when changing your pumping times, return to a more frequent pumping schedule.
Many mothers find it helpful to set up a milk collection schedule and pump at set times throughout the day. You may also find it helpful to keep a pumping diary of the times and amounts you pump throughout the day and night. The diary will allow you to easily track your supply and be able to spot a decreasing supply early so that you can try ways to increase your supply. Your lactation consultants or nurses can give you copies of the diary.
The amount of milk you will be able to express will change over time. Do not be discouraged by the small amount of milk produced in the first 3 to 5 days after delivery. You may not see any milk during the first several sessions, and then you may see only drops for several sessions or days after delivery until your milk comes in. The milk produced in these first days after your baby's birth is called colostrum. Although it is normally produced in small amounts, colostrum is especially high in the properties that help protect your high-risk baby against infections. If you are able to pump only a few drops of colostrum, it can still be saved and fed to your baby.
Finding a pump
You can begin expressing your milk as soon as you feel up to it after the birth of your baby. The hospital has appropriate breast pumps available for you to use before you leave the hospital. We can provide you with a double-collection kit for the type of pump you will be using. The collection kit includes tubing, breast flanges, and collection bottles. The tubing attaches to the pump itself and transfers suction to the breast flange. The flange is the piece that is in direct contact with the breast. It will be centered over the nipple and areola of the breast. The collection bottle then attaches to the flange to collect the milk as it is expressed from your breast. This collection kit is yours to take with you when you leave the hospital.
You can rent breast pumps on a weekly or monthly basis. If you decide to rent a pump, be sure that it is a hospital-grade pump and that it will work with the collection kit you already have. Breast pumps can be rented through the Woman's Mom & Baby Boutique located on the first floor of the Physician Office Building, next to Woman's Hospital. Call 225-231-5578. You can also locate a rental store near your home by looking in the phone book under "breastfeeding supplies and information." Mothers who qualify for the WIC program may also be able to get a breast pump from their parish health unit. If you plan to get a pump from WIC, it may be a good idea to rent a pump for the first week or so which will allow you some time to get the pump from WIC. This way you will not miss any pumping sessions.
Preparing to pump
Your first pumping session will be performed while you are still in the hospital. Either your nurse or one of the lactation consultants will help you set up the pump and position it on your breast. Make sure to ask any questions you have about the procedure. You will need to follow the same process after you have been discharged from the hospital. Make sure you read all the instructions about your pump before using it. To make your pumping session more effective and comfortable, pump in a place where you can relax. Make yourself comfortable before pumping by sitting with your shoulders relaxed and your back comfortable.
Have everything you need within reach, including something to drink. The following tips may also help stimulate let-down:
- Gently stimulate the nipples before you begin.
- Have something to eat or drink just before pumping and while pumping.
- Massage your breasts before you begin and periodically during the pumping session.
- Think of your baby, pump in the baby's room, look at a picture of the baby while pumping, or smell an article of clothing your baby has recently worn.
Wash your hands with soap and water before you begin.
Assemble all pump parts. Plug the pump in and check the suction setting before placing it on the breast.
Before you turn the pump on, center the shield over your nipple so the nipple can move freely without rubbing against the sides.
Always begin pumping with the suction regulator set on a level that is comfortable for you. Use this setting for the first few minutes of pumping. Gradually increase to the setting that removes milk completely in the shortest time. You should not feel any pinching or pain.
You should pump each breast for 10 to 15 minutes and for at least 2 full minutes after the milk flow stops.
Mothers using a single-collection kit will need to pump each breast for about 10 to 15 minutes and for at least 2 full minutes after the milk flow stops. You may want to switch the pump from side to side occasionally during the pumping session, massaging the breast gently each time you switch sides. This may help the milk to flow more easily.
Mothers using a double-collection kit will need to pump both breasts for a total of 10 to 15 minutes and for at least 2 full minutes after the milk flow stops. You may find that massaging the breasts from time to time during the pumping session will help milk flow more easily. You will find double-pumping is much faster than single-pumping. Double-pumping will also help increase your prolactin levels and may in turn help increase your milk supply.
Milk should be pumped into clean plastic bottles. You may pump into either the collection bottles supplied with your pumping kit or directly into the graduated bottles given to you by the staff. If you express more than 2 oz per side at each pumping session, you will need to pump into the larger collection bottles first, then pour the milk into the smaller graduated bottles, adding no more than 60cc per bottle to allow for expansion as the milk freezes. If you pump into the larger bottles first, be sure that these bottles have been thoroughly washed and boiled before using them.
The graduated markings are on the side of the feeders:
- 1 oz = 30cc
- 2 oz = 60cc
If you are pumping more than 2 oz per side at each session, it is important for your baby that you pump into the larger collection bottle first so that all of the milk will be equal in calories. Milk pumped early in the session is very low in calories and fat. This is called foremilk. Milk pumped later in the session is higher in calories and fat. This is called hindmilk.
If your baby is just getting started on feedings, you may want to pour only 1 oz per bottle to waste as little breast milk as possible. Talk with your baby's nurse for suggestions on amounts to store.
Recap each bottle. Try not to handle the caps too much so that they stay sterile.
Attach a label onto each bottle of breast milk opposite the graduated markings. We will also give you labels. You can ask for more whenever you need them. Be sure to fill in the date and time the milk is pumped and any medicine you are taking.
Place the milk in the refrigerator or freezer (not in the door). If your milk is not going to be used within 24 hours and your baby is still in the hospital, you should immediately place the milk in the freezer. DO NOT add freshly pumped milk to milk that has already been refrigerated or frozen.
When you have finished pumping, allow your nipples to air dry. If you experience sore nipples, it may help to pump more often but for shorter times or to use a lower setting. Expressed breast milk can be massaged into sore nipples after pumping. A small amount of pure hydrous lanolin can be applied to the nipples after pumping. Lanolin does not have to be washed off before the next pumping.
Transport your milk to the hospital in a small cooler-carrier. Wrap the cold or frozen milk in a soft cloth and place a frozen reusable cold pack into the cooler-carrier with the milk. Do not put ice cubes around your containers of frozen milk. Ice will cause your milk to thaw more quickly.
Cleaning your pump
After each use, rinse the breast flange in cold water first, then use a bottlebrush and hot, soapy water to wash all pump parts that touch milk. Rinse the pieces with hot water, and allow them to air-dry upside down on a clean towel.
Use a bottlebrush and hot, soapy water to wash all reusable bottles. Rinse the bottles with hot water, place them upside down on a clean towel, and allow them to air-dry. There is no need to wash the prepackaged bottles given to you unless they have been contaminated after they have been opened and before you use them. These bottles are for single-use only.
Sterilize all pump parts that touch milk and all reusable bottles once a day by boiling for 20 minutes. Allow them to air dry upside down on a clean towel. There is no need to boil the prepackaged bottles unless they have been contaminated after they have been opened or before you use them. You can also use a bottle sterilizer or a microwave sterilizer made especially for bottles.
Storing your milk
Freshly pumped breast milk that has never been refrigerated can remain at room temperature for only 1 hour before it must either be fed to your baby or stored for future use. If your baby will not receive the milk within 1 hour, it should be refrigerated or frozen immediately. Your milk can be stored for:
- 2 to 4 weeks in a freezer section that is inside a refrigerator
- 4 to 6 months in a freezer that is not frost-free
- 12 months in a deep-freeze freezer set at 0ºF
Thawed breast milk should be used within 24 hours and should never be refrozen.
How Will My Baby Be Fed My Milk?
Initially, your baby may be too immature or ill to receive any feedings. Your milk will be stored in the freezer in the newborn and infant care center until it is needed for feedings. Early feedings will most likely be given to your baby through a small tube that is inserted into your baby's mouth and advanced into the stomach. This tube will be necessary until your baby is mature enough and well enough to actually suck to receive feedings by mouth. Some babies, especially smaller babies, receive their feedings continuously through this tube, similar to the way intravenous fluids are given through a tube inserted into a vein. Other babies receive feedings every 2 to 4 hours, depending on the status of their medical condition.
When your milk is needed for feedings, it will be thawed, either in the refrigerator, at room temperature, or in a warm water bath. Once thawed, your milk will be prepared with any necessary additives and used within 24 hours. If breast milk is given by continuous infusion, only 4 hours of milk will be removed from the refrigerator at a time, and all tubing and syringes will be changed every 4 hours. This minimizes any growth of bacteria in the milk or tubing. As your baby matures and improves, he or she will slowly start to receive a combination of feedings from the tube, bottle, and breast, depending on his or her medical condition.
A special pacifier will be offered to your baby during these "tube" feedings to prepare your baby for oral feedings at a later date. This pacifier will help your baby associate sucking with a fullness in the stomach, as well as strengthen muscles in the mouth for later oral feedings. It is fine to give premature and ill babies a pacifier. It offers a way for your baby to calm himself.
Is My Milk Enough?
Nutrients occur at the same or higher levels in milk from mothers that deliver premature babies as they do in mothers who deliver full-term babies. Also, the overall calorie count is usually the same for both, especially after the first few weeks. Human milk contains lower levels of some nutrients than artificial formulas contain. However, these nutrients are better absorbed by your baby's body from breast milk than from formula. The nutrient levels and the available calories in breast milk are often enough for older or bigger premature babies, and for many other high-risk babies. However, higher nutrient and calorie needs may create problems for babies weighing less than 3-1/2 lbs or for babies with certain health conditions affecting digestion or the use of nutrients. These babies may not get enough of the minerals such as calcium, phosphorous, and iron, from their mothers' milk alone. They also may need additional calories.
Although your milk is best, it is not always complete for the nutritional needs of very small or sick babies. Fortunately, adding nutrients and calories to, or "fortifying," a mother's milk does not appear to lessen the nutritional benefits and extra protection against infection that your baby will gain from receiving your milk. Fortifying your milk will make sure your high-risk baby receives ALL of the nutrients he or she needs at this time. How long your baby receives added nutrients and calories will depend on your baby's age, weight, physical condition, and ability to breastfeed well. Here are the most common ways nutrients and calories are added to breast milk.
Common Ways to Fortify Breast Milk
Human milk fortifier (HMF): Human milk fortifier contains several nutrients, especially certain minerals, that are needed for proper bone development in low birth weight babies. It also increases the overall calorie content of your milk. Human milk fortifier is a powder that is added directly to breast milk.
Premature infant formulas: If your milk supply is not enough to provide all of your baby's feedings, the milk will be mixed with liquid formula as needed. Occasionally, your baby may also have powdered formula mixed with breast milk.
Single-nutrient supplements: Occasionally your breast milk may be supplemented with a single nutrient to increase a specific component of your milk, such as a carbohydrate or fat supplement, to increase calories.
Hindmilk supplementation: If you have a large supply of breast milk well in excess of your baby's needs, you may be asked to separate your milk into milk pumped early in the session and milk pumped later in the session. The milk pumped later in a single pumping session, called hindmilk, is very high in fat content compared to the first milk you express in that session. If your baby only receives hindmilk, the overall calories your baby consumes will be higher. You will be instructed about separating your milk if this is needed.
How Much Milk Should I Be Pumping?
The amount of milk you produce will vary from day to day and, sometimes, within a single day. In the first few days after your baby's birth, you may not be able to express more than a few drops to a tablespoon or so of milk at each pumping session. This is normal production of the early milk or colostrum. About 3 to 5 days after birth, you will probably start to notice a steady increase in the amount of milk you are able to express at each session. After 7 to 10 days of frequent pumping sessions-at least 8 times and for a total of 100 minutes or more each day-expect to produce about 16 to 32 oz, or about 500 to 1000cc, of breast milk a day. Another way to look at this volume is approximately 1 oz every hour. If you are pumping every 2 to 3 hours, this means you should expect to get 2 to 3 oz or more at each pumping.
This may be more milk than your baby needs just now, but you will be glad to have extra milk in the freezer. Milk production usually drops at some point, especially 4 to 6 weeks after the birth of your baby. Do not be discouraged with this drop in your milk production. Continue to pump frequently and you may resume normal milk production in a few days to a week. Occasionally, a mother must also take a medicine or receive a treatment that may make milk unusable for a few days. Stored milk can be used at that time. Do not be surprised if you pump more milk at some pumping sessions than during others. Expect some variation in the total amount pumped from day to day. Talk to your lactation consultant if you find the daily total of milk keeps dropping for several days in a row or if you are not expressing at least 16 oz a day by the middle of the second week after your baby's birth.
Maintaining Your Milk Supply
The most important factor for keeping your milk supply steady is frequent and complete emptying of the breast. It is normal for the amount of milk you express to vary from day to day and from one pumping session to another. Many mothers produce more milk at the beginning of the day and less at the end of the day. Some mothers also produce different amounts of milk from each breast. There are many factors that can affect your milk supply.