Pumping Breast Milk for NICU Moms

The benefits of your milk can be crucial to your ill or premature baby. Woman's neonatologists and nursing staff encourage you to initially provide your own milk, even if you don't plan to breastfeed later.

Until your baby is able to nurse directly from your breast, express your milk (pump milk from your breasts) to start and maintain breast milk production. Milk expression gives your high-risk baby the benefits of your milk as soon as his stomach is ready to handle feedings.

Plan on expressing your milk until your baby is able to breastfeed well. Generally, the smaller or more ill your baby is, the longer you'll need to express your milk.

You'll have to depend on a breast pump to tell your body to start and keep producing milk. Continue to use the pump until your baby nurses regularly and he's able to maintain a plentiful milk supply at each feeding.

The most effective type of breast pump for this is a hospital-grade, electric breast pump with a double-collection kit. Most moms find it takes less time to get more milk when using this type of pump. The automatic suction and release action of electric pumps more closely imitates the way your baby sucks than do other pumps.

You'll find other kinds of breast pumps on the market, including manual or battery-powered pumps. While these pumps work well for moms who only need to pump once or twice a week, they aren't enough to start and keep producing enough milk for your special baby.

If you have questions about the type of pump to purchase or rent, call our lactation consultants on our Lactation Warmline at 225-924-8239.

The most important part of starting and keeping a milk supply is to express your milk frequently and completely. The time to establish a milk supply that's enough to feed your baby as he grows is the first 3 to 4 weeks after your baby is born.

To have enough milk for your baby for 6 weeks or longer after delivery, pump frequently for the first 3 to 4 weeks using the pumping schedule recommended below.

• Pump at least 8-12 times per day including at night.

The length of time between your pumping sessions at night is especially important. If your breasts are very full when you wake to pump during the night, shorten the amount of time you sleep between pumping sessions and wake earlier in the morning to pump.

When your breasts stay full for an extended time, your body decreases its production of prolactin, which reduces milk production. If you don't pump frequently during the first 3 to 4 weeks, you may not have enough breast milk to feed your baby after 6 to 8 weeks. If this does happen, you'll need to supplement breast milk with formula.

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, relax your pumping schedule. Slowly lengthen the amount of time you go without pumping at night up to 5 hours. However, if you drop all the nightly pumpings, your milk supply will decrease.

Try to continue pumping for a total of eight times each day. It's helpful to 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 after changing your pumping times, go back to a more frequent pumping schedule.

You may find it helpful to set up a milk collection schedule and pump at set times throughout the day. Try keeping a pumping diary of the times and amounts you pump throughout the day and night. The diary helps you easily track your supply and spot a decreasing supply early so you can increase your supply as needed. Ask your lactation consultant or nurse for a diary.

The amount of milk you express will change over time. Don't be discouraged by the small amount of milk produced in the first 3 to 5 days after delivery. This happens to most moms. You might not see any milk during the first several sessions. After that, you may see only drops for several sessions or days after delivery until your milk comes in.

The milk produced in the first days after your baby's birth is called colostrum. Although it is normally produced in small amounts, colostrum is especially high in nutrients that help protect your baby against infections. Even if you pump only a few drops of colostrum, it can be saved and fed to your baby.

Pumping in the Hospital

As soon as you feel up to it after the birth of your baby, begin expressing your milk. Most moms feel nervous the first time they try to pump, but with practice you’ll become more comfortable.

While you are in the hospital, we provide a double-collection kit that 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 directly touches your breast. It's centered over the nipple and areola of the breast. The bottle attached to the flange collects your milk as it's expressed from your breast. This collection kit is yours to take home.

You can rent breast pumps on a weekly or monthly basis. If you decide to rent a pump, be sure that it's a hospital-grade pump that works with your collection kit. 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 may decide to a rent a pump from store near your home that offers breastfeeding supplies and information. Mothers who qualify for the Women, Infants, and Children (WIC) program may 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 until you get the pump from WIC. This way you won't miss any pumping sessions.

Either your nurse or one of our lactation consultants will help you set up the pump and position it on your breast. If this is a new experience for you, be sure to ask questions and try to relax. Read all the instructions about your pump before using it.

The more you pump, the more confident you’ll feel. To make your pumping session more effective, pump in a place where you feel relaxed and comfortable. Have everything you need within reach, including something to drink. The following tips may help stimulate let-down:

• Gently stimulate the nipples before you begin.
• 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 your baby while pumping or smell an article of your baby's clothing.

• Wash your hands with soap and water before you begin.
• Assemble all the pump parts.
• Plug the pump in and check the suction setting before placing it on your 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, then gradually increase to the setting that removes milk completely in the shortest time. You should not feel any pinching or pain. If you experience sore nipples, it may help to pump more often but for shorter times, or to use a lower setting.
• When using a single-collection kit, you should pump each breast 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 your breast gently each time you switch sides. This helps your milk flow more easily.
• If you use a double-collection kit, 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 while pumping helps your milk flow more easily. Double pumping is much faster than single pumping. It also helps increase your prolactin levels and increase your milk supply.
• Place pump milk 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 our staff.
• If you express more than 2 oz per side at each pumping session, pump into the larger collection bottles first. Next, pour 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 are 1 oz = 30cc and 2 oz = 60cc.
• If you are pumping more than 2 oz per side at each session, it’s important to pump into the larger collection bottle first so that all of the milk is 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, known as hindmilk, is higher in calories and fat.
• 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 they stay sterile.
• Attach a label to each bottle of breast milk opposite the graduated markings. 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, immediately place the milk in the freezer. DO NOT add freshly pumped milk to milk that’s already been refrigerated or frozen.
• Let your nipples air dry when you have finished pumping. Massage expressed breast milk into sore nipples. Some moms apply a small amount of pure hydrous lanolin to sore nipples after pumping. Lanolin does not have to be washed off before the next pumping.
• When you need to take expressed milk with you, use a small cooler-carrier with a frozen reusable cold pack. Wrap the cold or frozen milk in a soft cloth but don’t put ice cubes directly around the containers of frozen milk.

• After each use, rinse the breast flange in cold water.
• Use a bottlebrush and hot, soapy water to wash all reusable bottles.
• Rinse the bottles with hot water.
• Place bottles upside down on a clean towel to air-dry.

You don't need to wash prepackaged bottles unless they were contaminated after being opened. These bottles are for single-use only. Be sure to sterilize all pump parts that touch milk and all reusable bottles once a day by boiling them for 20 minutes. Air-dry them upside down on a clean towel. You can also use a bottle sterilizer or a microwave sterilizer made especially for bottles.

Even though your breasts are not sterile, there are some things you can do to keep your baby's milk as clean as possible:

• Wash your hands before you begin to pump.
• Try to express or pump directly into the container used for storage. This helps avoid contamination that may occur when transferring milk from one container to another.
• When traveling, always keep your milk refrigerated. A small ice chest with reusable ice packages is good for this.

Freshly pumped breast milk that's never been refrigerated can remain at room temperature for only an hour before you either fed it to your baby or store it. After one hour, it should be refrigerated or frozen. Your milk can be stored for:

• 2 to 4 weeks in a freezer section inside a refrigerator
• 4 to 6 months in a freezer that is not frost-free
• 12 months in a deep-freeze freezer set at 0 degrees Fahrenheit

Any thawed breast milk should be used within 24 hours and never be refrozen.

Initially, your baby may be too immature or ill to receive any feedings. Your milk will be stored in the freezer of the newborn and infant care center until it is needed.

Early feedings are given to your baby through a small tube inserted through his mouth and into the stomach. This tube is necessary until your baby is mature enough and well enough to suck and receive feedings by mouth. Some babies, especially smaller ones, 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 their medical condition.

When your milk is needed for feedings, it's thawed in the refrigerator, at room temperature or in a warm water bath. Your milk is prepared with any necessary additives and used within 24 hours. If breast milk is given by continuous infusion, only four hours of milk is removed from the refrigerator at a time.

All tubing and syringes are changed every four hours. This minimizes the growth of bacteria in the milk or tubing. As your baby matures and improves, he gets a combination of feedings from the tube, bottle and breast, depending on his medical condition.

Your baby receives a special pacifier during these "tube" feedings so he's prepared for oral feedings in the future. The pacifier helps your baby associate sucking with fullness in his stomach. It also strengthens muscles in the mouth for oral feedings. Don't be concerned about giving your premature or ill baby a pacifier. It's a good way for your baby to calm himself.

Nutrients in the milk from moms who deliver premature babies are the same as in moms 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. However, these nutrients are better absorbed from breast milk than formula. Nutrient levels and calories in breast milk are usually enough for older or bigger premature babies and for many other high-risk babies.

Babies weighing less than 3-1/2 lbs. or with certain health conditions may not get enough calories or minerals (such as calcium, phosphorous and iron) from their mothers' milk alone.

Although your milk is best, it is not always complete for the nutritional needs of very small or sick babies. Fortunately, fortifying (adding nutrients and calories) to a mother's milk doesn’t appear to lessen the nutritional benefits and extra protection your baby gains from your milk. Fortifying your milk ensures your high-risk baby receives all the nutrients he needs.

How long your baby receives added nutrients and calories depends on your baby's age, weight, physical condition and ability to breastfeed well. Here are common ways to fortify breast milk:

• Human milk fortifier (HMF): This contains several nutrients, especially certain minerals, needed for proper bone development in low birth weight babies. It also increases the overall caloric content of your milk. Human milk fortifier is a powder added directly to breast milk.
• Premature infant formulas: If your milk supply isn't enough for all your baby's feedings, the milk is mixed with liquid formula as needed. Occasionally, your baby may also have powdered formula mixed with breast milk.
• Single-nutrient supplements: Sometimes your breast milk may be supplemented with a single nutrient to enhance a specific component of your milk (such as a carbohydrate or fat) and to increase calories.
• Hindmilk supplementation: Some moms have a large supply of breast milk well in excess of their baby's needs. If this happens, 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 (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 eats is higher. Your nurse or lactation consultant will instructed you about separating your milk if this is needed.