New mom- need advice!

[StrawberryGirl]

Hello! I am a new mom to a preemie, born 6 days ago by c-section. She is being tube fed, and I am trying to pump enough that she is getting breastmilk exclusively. My milk came in on around the 4th day, and I seem to be producing enough for her for now (around 3 ounces at every pumping. No idea if this is okay or not).

Anyway, I was feeling okay about things, but one of the NICU nurses felt my breasts right after pumping, and said that I wasn't even close to emptying my breasts. The problem is, they never seem to empty! I pumped for 45 minutes last night (double pumping on a Lactina). Things slowed down a little, but never stopped, and the sides and tops of my breasts still felt hard. I've been massaging my breasts as I pump, and that speeds up the flow, but still doesn't seem to empty my breasts. The nurses seem to be concerned about the hindmilk my baby isn't getting if I can't empty my breasts. Also, they mentioned that my production would slow down if I didn't empty them.

I tried another 45 minutes session this morning, and I thought for a second the milk had stopped. But after pumping, I massaged down my left breast (this breast only produces 1/2 what the other one does, btw, and always feels hard), and little streams started jetting out. Obviously not empty!!!

Anyway, I would love any advice. I know I'm not really supposed to be pumping for that long, but it comes so slowly, and never seems to stop. I don't want to deprive my baby of the higher calorie hindmilk that she needs, or hurt my supply by not emptying the milk! Thanks in advance-

[@llli*andrea.wolford]

how old is baby? How early?

gosh I don't know about that nurse, most don't know much about breastfeeding.
do you have your local LLL leaders number? Get some real life help!
heres a good link about getting your milk supply off to a good start when baby is not nursing.
http://www.kellymom.com/bf/supply/ma...pply-pump.html

How many times in 24 hours are you pumping?
3 oz is wonderfull for a mom whos baby is 6 days old!

[Give Peas A Chance]

Hello! I am a new mom to a preemie, born 6 days ago by c-section. She is being tube fed, and I am trying to pump enough that she is getting breastmilk exclusively. My milk came in on around the 4th day, and I seem to be producing enough for her for now (around 3 ounces at every pumping. No idea if this is okay or not).

Congrats on your new arrival!

How frequently are you pumping? Three ounces sounds like a pretty good start!

Here's some information on maintaining a milk production when baby is not nursing:
http://www.kellymom.com/bf/supply/ma...pply-pump.html

Anyway, I was feeling okay about things, but one of the NICU nurses felt my breasts right after pumping, and said that I wasn't even close to emptying my breasts. The problem is, they never seem to empty! I pumped for 45 minutes last night (double pumping on a Lactina). Things slowed down a little, but never stopped, and the sides and tops of my breasts still felt hard. I've been massaging my breasts as I pump, and that speeds up the flow, but still doesn't seem to empty my breasts.

You might try hand expression. Sometimes, hand expression removes a lot more milk than a pump can (especially in the beginning). It's possible, too, that you're experiencing engorgement. Hand expression can help with this because as milk is removed from the breast, it allows room for the excess blood and lymph to leave the region. A pump is great for removing milk, but if you're engorged, chances are that it is also pulling excess fluid into the region.

So, my best suggestion is to continue pumping BUT hand express in addition to pumping. Here's a helpful video:
http://newborns.stanford.edu/Breastf...xpression.html

And here is a description of the Marmet technique of hand expression (same function, different technique):
http://www.lactationinstitute.org/MANUALEX.html
The tips for MER found on the above webpage are also helpful when pumping. If you try them, I'm sure you'll feel a difference!

Finally, here is some information about engorgement:
http://www.lalecheleague.org/FAQ/engorgement.html

The nurses seem to be concerned about the hindmilk my baby isn't getting if I can't empty my breasts. Also, they mentioned that my production would slow down if I didn't empty them.

It's possible that your nurses are worrying you for nothing. Your baby is six days old. Your milk has probably only been "in" for 2-3 days. Yes, residual milk can cause a reduction in production (over time!). But, right now, you're likely engorged. I would suggest focusing on removing more milk (with hand expression and pumping) and trying some home remedies to drecrease engorgement. That should help a lot.

As for the hindmilk issue, I think your nurses may be needlessly worrying you. As long as you're removing milk frequently and you're expressing as much as will come out, you're getting plenty of hindmilk. Here's a wonderful explanation of the the process:
http://www.kellymom.com/bf/supply/fo...-hindmilk.html

I tried another 45 minutes session this morning, and I thought for a second the milk had stopped. But after pumping, I massaged down my left breast (this breast only produces 1/2 what the other one does, btw, and always feels hard), and little streams started jetting out. Obviously not empty!!!

This is why hand expression can be helpful. Watch the video!

Anyway, I would love any advice. I know I'm not really supposed to be pumping for that long, but it comes so slowly, and never seems to stop. I don't want to deprive my baby of the higher calorie hindmilk that she needs, or hurt my supply by not emptying the milk! Thanks in advance-

Try some cool compresses between pumping (to bring down the swelling), warm compresses before pumping (to increase flow), tips for assisting MER (from the lactation institute link) before pumping, then RELAX and pump. Breast compressions as you see them neccessary. Then several times a day (in addition to pumping) hand express. Once your production is regulated, you'll no longer require hand expression.

You might also ask your IBCLC about trying another pump. Some mothers have better results with the Medela classic or Medela symphony.

You're doing GREAT! You're not depriving your daughter of anything (read the links!). Keep doing what you're doing.

Have you called your local LLL Leader for support?

You might find the info in this thread helpful, too:
http://forums.llli.org/showthread.php?t=24238

Best of luck to you! Keep us updated.

[babydsmommy]

how old is baby? How early?

gosh I don't know about that nurse, most don't know much about breastfeeding.
do you have your local LLL leaders number? Get some real life help!
heres a good link about getting your milk supply off to a good start when baby is not nursing.
http://www.kellymom.com/bf/supply/ma...pply-pump.html

How many times in 24 hours are you pumping?
3 oz is wonderfull for a mom whos baby is 6 days old!

Thats true.I definetely wasnt getting that each time when dyl was 6 days..I pumped every 2 hours.

[StrawberryGirl]

Thank you so much for your help! To answer your questions, I'm pumping every 3 hours during the day, and every 4 hours at night. Do you think that's okay?

My baby girl wasn't terribly early- 34 weeks. But she was growth restricted and weighed only 3 lb 9 oz.

Thanks again for all of the tips! So, in addition to all those things you've mentioned, is it okay to continue pumping for 45 minutes a session if the milk is still coming?

[babydsmommy]

Im not sure but I think you arent supposed to pump that long........

[babydsmommy]

I looked it up.15-20 for a double pump.10-15 each side for a single.

[StrawberryGirl]

Yikes- there's no way I'll come even close to getting all the milk! Plus, then I'll only be getting about 1.5 ounces at every pumping. Arg- I wish there was just a dial on my breast where I could order up exactly what I need!

What exactly is the problem with pumping for that long? (besides driving me crazy?) I'm not really sore or anything.

[babydsmommy]

Im not sure-I just looked it up. I know that it can cause you to have oversupply, but beyond that, Im not sure. I remember that they would stress to us the importance of 15 minutes on a lower setting, and I used to be thinking I wanted to do longer on the higher.If you are comfy,Id keep doin it.Its not like it cant be frozen

[sallykbeck]

Hi Mom,
Congratulations on your newborn!! We were in a similar situation 5 1/2 years ago. Our little one came at 33 weeks (3# 11 oz) They would not allow me to nurse her for the first 2 weeks in NICU. Be sure they are letting you hold that baby skin on skin (meaning she is only in a diaper and her skin is on your naked front.) There is a study on this, they call it kangarooing. We were one of the mom and babes in this study. It has a profound affect on baby and is very calming to them. When my baby's temp would be down we would strip her down put her skin on skin, cover both of us with a warm blanket and her temp would rise at least 1 degree!!! Make sure you have a hospital grade pump. Warm compresses before you pump, and gently massage or push on any hard spots as you are pumping. You are doing great!! When your little one first starts nursing, you may have to do that same thing for a little while. Also, have the lactation consultant with you and the baby, but shoo everyone else (nurses) out. Also, check with the lactation consultant at the hospital, they are usually a good advocate for you with the nurses. We had a wonderful nurse who told me to tell the doctor I wanted to try some "non-nutritive feeding". Apparently, this is what health care professionals call nursing a premie. They assume that baby won't be able to nurse. It allows the baby to be close to mom, skin on skin, and the baby to try to nurse. I made sure the lactation consultant was there the first time, as I knew it was probably not going to be NON-nutritive. She wrote a note in the chart that said how well baby latched on, and that the baby definitely got nutrition. That was the beginning of my daughter getting to nurse. Keep pushing for it, and get all of the advocates you can. You will run into those special nurses once in a while who are in NICU that are really your and the baby's advocate. Sorry for packing so much info into one note. Good Luck. Sally