Wednesday, April 13, 2011

Extreme Breastfeeding: Pumping for NICU Without Losing Your Mind

-or- Free Your Hands and Your Mind Will Follow

When our littlest geek (locally dubbed the Baby Detective) ended up in the NICU, I found myself back in familiar breastfeeding territory.  My role on supply side of breastfeeding began in the NICU.  As a first time mom who gave birth by c-section, my milk didn't come in for days.  That newborn, a "sugar baby" in NICU lingo, had low blood sugar and a low body temperature, so my first attempts at breastfeeding were bedside in the NICU.

It was awful.  There's no just way to prepare for breastfeeding or the hormonal postpartum roller-coaster.  Throw in the physical separation, heightened anxieties, and lack of privacy of NICU, and the natural act of breastfeeding dials itself up to an 11 (on a scale of 10 for those who haven't had the senseless pleasure of This is Spinal Tap [available on Netflix streaming]).

I won't tax you with all the gory details (although keywords like nipple shield coupled with a multitude of synonyms for breast might spice up my Google hits).


When we decided to grow our family to five, I assumed the third round of nursing would be without surprises. Then BabyGeek 1.3 arrived six weeks early after swift and furious pregnancy complications.


Instead of a bassineted baby in my hospital room, our teeny geek was an isolette half a building away.  She was challenged to digest liquid food, much less consume it.  While she drew most of her nutrition from IVs and lipids from a feeding tube, I pumped every 3 hours in an attempt to provide breastmilk that she could consume by bottle.

The only things previous breastfeeding experiences had taught me were I hated pumping, I didn't have much success with it, and with growing sleep deprivation, the low moan of the pump motor turned into crazy words that made me loathe pumping all the more.

With 8 pumping sessions a day on the horizon, things had to be different this time.

In order of importance, here are the big changes:

Easy Expression Bustier Hands Free Pumping Bra (Large 38-40 D-f, Black)1. Go hands-free: this list-topper may seem painfully obvious to the working moms, but somehow I managed to miss the advantages with earlier infants.  Maybe it was the early '90s era models in their shoulder padded power suits, but somehow hands-free seemed inappropriate for someone who spends most days in jeans, tees, and a sea of Cheerios.

Prior to this baby, I loathed pumping and avoided it at all costs.  The deeply bovine feeling of hooking up to a milking machine felt humiliating (especially in the hospital with people walking into the room all the times).  Holding the flanges in place kept my hands and mind focused on the pumping process.

This time, with the phone ringing off the hook, and hardly a moment to bolt a meal, I walked my hospital gown clad self into the lactation boutique and bought an Easy Expressions hands-free bustier.

Suddenly, I had my hands back, and along with them came a solid measure of dignity.  Yes, I was still fastened to a very dairy machine, but I felt more 80s throwback (think Madonna) or crazy fashion forward (Lady Gaga) and even a bit Amazing Stories.  It was the best kind of ridiculous.  When my hands were unshackled, my brain and soul were now free to contemplate something, ANYTHING, other than the pumping process.  Pure awesome.  Worth every penny.

Man vs. Food: Season One2. Kick back and watch something distracting.
I hesitate to offer this advice as television kills brain cells and such, but there are times in life where really senseless shows can be blessedly soothing and distracting.  While I couldn't sleep and pump, I could pump while watching every episode of Sons of Tuscon, Doc Martin, The IT Crowd, Toddlers & Tiaras, and Man v. Food on Netflix streaming.

3 . Hospital grade pumps should be considered.
Medela Symphony Breast PumpBefore Ranger was born, we bought a Medela Pump-In-Style Advanced pump.  I still own it, but I instead opted to rent a Medela Symphony from the hospital boutique.  When pumping 8 times a day, it's important that the pump works well- 10 minutes more per session adds up to 80 more minutes per sleepless day.

4.  Lactation consultants can help immensely, but tend toward generalizations.
I love the lactation department at our hospital.  The consultants have helped me over the years.  This time they lent me a DVD copy of Hands-On Pumping (the 3 videos are available free online at http://newborns.stanford.edu/Breastfeeding/).  Those techniques improved my supply quickly.  Pumping every 3 hours (at the hospital or at home) is an insane challenge.  Undersupply broke my heart because (in my hormonal insanity) it felt like the only thing I could do for my vulnerable baby (in more reflective moments I realized the error in that thinking, but I'll save that for a later post).

While I appreciate their expertise and enthusiasm, I've also been given general advice that didn't apply to my specific situation and made me feel like I was failing.  Go breastfeeding, but skin-to-skin contact, homeopathic supplements, and 2 hour pumping schedules just weren't options I could consider.  They really wanted my baby to feed directly before leaving the NICU, but it was simply too difficult for her and taxed her limited energy.  I understand their concerns that breastfeeding might not last as long if she's bottle-fed, but I also knew my daughter was overtaxed by breastfeeding.  The neonatologist agreed that the baby would come home sooner if bottle-fed, so I focused on more effectively pumping and bottle-feeding.  For us, bringing the baby home sooner was a much higher priority than direct breastfeeding (or even breastfeeding).

Once the baby was bigger and stronger, the transition to regular breastfeeding was easy.  We were so glad to say goodbye to bottles.

5.  The White Wave -or- What to do with all the milk

Lansinoh 20435 Breastmilk Storage Bags, 25-Count Boxes (Pack of 3)During time I pumped daily, the surplus milk quickly engulfed our fridge's freezer.  The hospital can only store so much per patient, and the nurses told me about other moms buying deep freezers.  I started freezing the surplus in Lansinoh breastmilk storage bags instead of the space-hogging NICU bottles.  They freeze flat, and 10 can be neatly stowed in a gallon freezer bag .  With Amazon Mom and Subscribe and Save, I was able to get cases of these delivered to my doorstep at an excellent price.

6. Washing Up
Munchkin Deluxe Bottle Brush, Colors May VaryCleaning the pump parts after every session brought to mind Sisyphus forever rolling the stone up the hill to watch it immediately roll back down.  In this sleepless rendition of the classic tale, it's easy to feel that the stone is actually rolling over you on its disheartening downward fall.  This is where a kindly clan of magic bottle-washing elves would come in handy, but my neighborhood owl seems to have taken them out (along with the toilet paper fairy).  Wash up all the parts as soon as you put the milk in cold storage.  It feels even worse to start the whole process with the washing.

We went through 3 different bottle brushes before again settling on the Munchkin's Deluxe Bottle Brush which we liked back when Ranger was formula fed.

All in all, it's no small feat to pump for a NICU baby.  If you are a parent who is going through this now, take care of yourself as much as you can.  Your kiddo needs YOU more than breastmilk.  Sleep as often as you can, eat, and drink lots of water.

If you know someone else going through this, feed them a meal (or, even better, set up a food registry for them at mealbaby.com).

***Baby Toolkit is the ongoing story of a couple of Midwestern geeks and their kids.  We are not affiliated with Medela, Munchkin, Ziploc, Meal Baby, nor Netflix, but we are Amazon affiliates (so a small portion of purchases made through our Amazon links go toward the Baby Toolkit jet fleet).

And be sure to check out related post The Boob Wars. 

13 comments:

Cindy said...

Wow, thank you! You are talking to me right now! Kid #2, working mom (no stranger to the bovine feeding process), and 2 week old baby in his second NICU althat I still haven't held! Worst part is we are over an hour away from home, but thankfully @ a Ronald McDonald house. Their freezer too, has limitations... I own the Medela Freestyle pump and a nice apron-like hootie hider and have become a pro at hooking up under cover in the car! Just gotta watch not to spill when unhooking... My older son watches me hook up and says "mommy, what u wearing?" lol... In the mirror it looks ridiculous but I can read my blogs and comment while I pump *ahem* ;). Here's prayers for sanity for everyone else going through this - and of course for all of the babies to grow stronger & head home :)

adrienne said...

Hi Cindy-

Pumping in the car is HARDCORE Extreme Breastfeeding- especially with an older sibling in tow. My kids were fascinated by the pump and wanted to know everything about it.

My Hooter Hider has tiny pastel dots on a pale blue background. A pregnant stranger at the mall (now one of my closest friends) came over to ask about it. She said "at first I thought you were just on break from Dippin' Dots."

I would love to hear more about the Ronald McDonald House experience for a NICU mom. Email me at babytoolkit [at] gmail [dot] com if you want to chat.

Anonymous said...

Can you describe how the hands-free bustier actually works? Do you have to change your clothes during the day to use it? I ended up using the same kind of pump Cindy has, the Freestyle-- my pumping area at work was only "sort of" private, so being able to just pull on a nursing cover and pump without a lot of fuss was pretty important to me. (I too pumped in cars, while typing emails at work, on planes, and behind bushes on archaeological sites... and managed to do it for a year, huzzah!) The bustiers are a lot cheaper than a hands-free pump, though. Do you think they work in those types of situations?

adrienne said...

from Jodi, by email:

I spent 1 year pumping everyday for my son. He was born at 25 weeks, along with his twin. My son spent 100 days in the NICU. My husband created a hands-free bra using a sports bra (much less expensive than the store bought one). One thing we did was have about 4 sets of the pumping parts and a big bin with water in it for the dirty parts. That way we did two washes a day (I was pumping about 6-8 times daily). The hospital grade pump was so much more efficient and the lactation consultant - well, not the best for my situation. We used the same bottle brush you recommended - I think we went through 6 of them!

I pumped in the car all the time. The car adapter saved me from having to be home all the time. My husband even tried to convince me to pump while I was driving one time. Did not happen.

adrienne said...

Anonymous-

The hands free bustier/band is a long piece of stretchy material with a front closure and openings for the flange horns. It slips on over a nursing bra.

I could put it on under my shirt and just look a little bulkier while wearing it. It was easy to discreetly slip off while clothed. Putting it on requires threading it behind the torso and then fastening in the front with hook & eye closure or a zipper (depending on the maker).

Anonymous said...

Thanks for describing the bustier, I could never figure out how they worked. Another item I found useful was Medela Quickclean wipes. They're on the expensive side, but I had no convenient place to wash my pump at work and no fridge space to store the parts between uses during the day, so I really liked having them.

Mimi-n-Moe's Mom said...

I love your commitment to this blog and its' readers. You even posted a pic of you pumping!

Karen

adrienne said...

Mimi-n-Moe's Mom:

The hard part was convincing Amazon to use my photos.

This other Amazon image totally cracks me up: http://www.amazon.com/gp/product/B002NUWQUM/ref=as_li_ss_tl?ie=UTF8&tag=babytoolkit-20&linkCode=as2&camp=217145&creative=399349&creativeASIN=B002NUWQUM

Every mom sits on the floor and plays with toys while pumping. Yup.

famousamy said...

Good post. I actually choose to exclusively pump because my babies never latched. I'm sure they would've eventually but I think I would've had to have a lactation consultant by my side 24 hours for the first few weeks to get it right.

So I chose to pump exclusively and I love it! I made my own bra for hands-free and I agree that it saves your sanity. I would've never continued pumping without it.

I'm 4 months in and still going strong. I only have to pump 4 times a day now (after 12 weeks they say your supply is established and the 7-8 times a day pumping isn't necessary). Plan to pump until she's one and switches to cows milk.

Anonymous said...

I wish I read this month ago. It took me a few weeks to buy the hands-free bra and I gave up on breastfeeding largely due to the time/energy required to pump without a hospital grade pump. I think if I had thought of renting I could have kept up milk production. It's so different to pump and freeze for a baby not at home with you (i would sleep in instead of keeping up the pumping frequency) and I know I could have done it if my baby had been home and crying for milk.

I also did not know too much about sterilization, so important!!! Sadly one of my babies (twins) had breastfed successfully before I ran into issues with production and sterilization. If I had known, he could have benefitted from breast milk. To this day, I have regrets but try not to dwell on it.

adrienne said...

Anonymous:

Breastfeeding under these conditions is so very hard, and it doesn't always work out. You should give yourself more credit for trying.

It is so difficult to wake up for those witching hour pumpings when your mind and body are so thoroughly taxed during the endless waking hours.

I had to quit breastfeeding one baby before I was ready. It was so disappointing, but the baby has grown to be healthy and bright (as are many exclusively formula fed babies). Sometimes breastfeeding just doesn't work, and that's fine.

Remember how much your babies(!) need a healthy momma to care for them. That's far more important than breastfeeding.

Love to you and your family. <3

Anonymous said...

Thank you so much!! Our baby has been in the nicu for 2 and a half months now. I had quite a bit of milk at the beginning but my supply has really gone down! I bought the medela freestyle pump. When I wasn't producing as much the lactation consultant recommended that I rent a heavy duty pump. It is huge and looks ancient! It helped a little bit but not much. I've also been taking mothers milk plus but I'm still not producing much milk. It has been stressing me out so much! I make sure I pump at least 8-10 times a day but it is really starting to take a toll on me! I want to be able to give my daughter breast milk but I'm starting to lose my mind. I'm so tired all the time. I swear it'll be so much easier when she is home.

adrienne said...

Anonymous 10/2,

After 2 and 1/2 months of a NICU-parent lifestyle, you must be so exhausted. It's hard to keep your milk up when you're so tired, but there's not much you can do to change your schedule.

Whatever milk you can get is a win, but it is surely not the most you can do for your sweet baby girl.

She has known you exclusively until the time she rocketed into this part of the universe.

You have been her entire world for all of her consciousness and everything that came before it.

She knows your voice and your laugh, how you shift your body, your warmth, and your smell.

Milk or not, she knows you as her world- and she loves you.

There is comfort and familiarity you give her that no one else could ever supply. Be good to yourself, physically and emotionally. She will not remember if she was breastfed, but she will remember who gave her comfort.

I hope she'll be home with you soon. Feel free to say hi by email or on Twitter if you need to talk.