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:

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.

2. 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.
Before 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

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
Cleaning 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. 

The Boob Wars

Okay, ladies (dads can weigh on this too, but moms are much more culpable in this particular matter)-

Reading GoodyBlog earlier this week, I realized that another volley has been launched in the boob wars with a recent Parents Magazine article on breastfeeding in public. I say wars rather than debate because debate suggests some level of dialog and attempts at mutual understanding.

Somehow any mundane discussion of breastfeeding or bottlefeeding or bottles themselves seems to eventually deteriorate into a gladiatorial battle with both breast-feeders and bottle-feeders feeling defensive.

Here are the indisputable facts of our shared maternal situation:

We (moms) all must choose how to feed our infants as they yet cannot choose how to feed themselves and are not yet sophisticated enough to go on the all-cracker diet. We all face incredible pressure and criticism in this decision from loved ones, acquaintances, and strangers on the street. We all choose a method- though some people have far more contributing factors than others- and proceed give our children life-giving sustenance. We are all losing sleep- lots of it- to late night feedings and general worry.

Breastfeeding is generally preferred and strongly recommended by physicians. It is however, not recommended in every medical situation. Chemotherapy, psychological drugs, heart medicine, and some antibiotics, for instance, do not mix well with babies. They actually hurt babies. People on drugs dangerous to babies should not breastfeed. Can we agree on this?

People caring for children who they did not birth tend not to breastfeed either. I've read about adoptive mothers who work to lactate for their newborn infants, but I don't think this practice is very common. Foster parents and guardians also seem to typically be outside the option of breastfeeding.

Breastfeeding, though a biologically natural process, is not always accomplished with every infant as some have unusual physical structures (palette issues, etc.). Some moms also have unusual physical structures that complicate nursing. Other moms may have nutritionally poor milk or poor milk production- in these cases infants face a risk of malnutrition.

Other moms may be particularly vulnerable to infections like mastitis.

Anyone reading social history- or even Little House on the Prairie- knows that mothers of newborns were susceptible to life-threatening "fevers" and some babies "never flourished" and lived very short lives. We have better medicine and far more information now.

By now, the lactators in the audience are surely starting to grumble... but hang on, I'm not done yet... Obviously, for the majority of people, breastfeeding is the healthiest option (as well as the most intimate, cheapest, and most convenient). This is why breastfeeding is great and easy to recommend to others.

But some healthy moms choose not to breastfeed- and they are the moms who militant lactivists would like to approach. Now, I agree with you that it's mind-bogglingly irritating when people remark that "It's [breastfeeding's] just NOT NATURAL." They are so inaccurate in this remark- and they do violence to the English language and logic simultaneously. [May I request that practitioners of this despicable phrase please adopt the more accurate criticism "It seems so primal." Thank you.]

Some formula feeding women simply followed the patterns of their mothers and grandmothers who became convinced breastfeeding was only for the poor, unsophisticated, and uncouth (thank you, formula advertisers of the early 20th century).

Some formula feeding moms are working moms. Sure you can pump- which is easy when you have clean, private office with a solid, locking door, some control of your work schedule, and convenient refrigeration facilities. However, in the small shampoo and tanning lotion factory and warehouse where I worked one college summer, the workers there didn't have regular breaks or any breakroom. The restrooms were shared with men who greatly outnumbered the women (and they were SOOOO gross). The plant was easily 90 degrees at its coolest. That work situation is far better than that of moms working in low-paying fields like hotel housekeeping (a high school summer job) or fast food (a couple college summers).

And not all office workers and professionals have it easy either. Cubicle dwellers and elementary through high school teachers may face problems finding a good pumping location, a regularly available time, and milk storage facilities. Even in a good office situation, it might become necessary to have an awkward disclosure of that innocuous bottle being expressed milk so it isn't poached for a colleague's coffee.

So why do we all turn into gladiators, ready to battle to the death, at the mere sight of a woman feeding her child in a different manner than the one we chose for ourselves? I never see moms rushing over at a restaurant to lecture another on how her child might benefit from a vegetable other than french fries or moms confronting each other about toddlers drinking soda.

Why is this topic fair game for public discussion? Well, truthfully it's not, but we justify our nosiness in two ways. It's either a) for the health of the child or b) it's a public place and it should be pleasant and free of boobs. Let's consider these justifications for a moment.

"It's for the health of the child." This assumes you know the medical history and life/work situation of the mom receiving unsolicited advice. With strangers, you don't. With acquaintances, there may be more going on than you know. Besides, our society loves to look the other way regarding children's health, so this is a somewhat disingenuous argument. Children's health care, for instance, is troubled by our labyrinthine medical insurance system. From 1997 to 2006, in my home state of Indiana, 136,ooo children lost private health coverage. These kids were fortunate to have health insurance in the first place which isn't true for kids whose parents work low-income jobs where health insurance is either not provided or not affordable after basic living expenses. So, maybe our concerns for the "health of the child" would be better applied in striking up conversations with people in suits about children's healthcare (especially those people in suits who we send to Washington) instead of attacking individual moms.

"It's a public place." Yes, it is, but it's not like breastfeeding moms are tabledancing topless for tips- they're feeding their kids. If you see a bit of boob accidentally, it's probably not a big deal for the nursing mom, so don't feel incredibly awkward. Breastfeeding moms are offended by staring, glaring, photography, and/or caustic comments. If you need to interact with a mom who is breastfeeding, just remember the advice proffered to young men trying to meet women "The eyes are up here, buddy." Make eye contact, and treat her normally; the whole experience will probably be exquisitely mundane.

Given the proliferation of adveritising and contemporary fashions, public places are already cleavage laden, and frankly one more boob isn't going to tilt the scale tipping this whole handbasket toward hell.

We moms have a lot more in common than just concerns about stretch marks and a future of baby-food splattered clothing. None of us should be worrying about public censure when feeding our children. So next time you see a mom who looks chagrined with a public feeding (breast OR bottle), smile and maybe say something nice, something comforting, something supportive. We've all been in those slightly spit-up splattered shoes.

Let's not all be boobs about this.

LilyPadz- Ditch those disposable nursing pads

Nursing pads are one of the things that I definitely didn't consider before becoming a new mom, but they are one of those necessities that can't be overlooked.

Generally, we avoid disposable things, so I started with the cloth nursing pads because they're better for the budget and the environment. They weren't however very good for my wardrobe or my willingness to be in public, and they were uncomfortable. I tried two major makers and gave up.

Next I tried disposable pads. They definitely kept my clothes drier- unless they moved. Funny, it's hard to keep them in place when you keep opening and closing a nursing bra throughout the day. Plus there was also the problem of what to do with an old one when you find (while publicly nursing) that you need a new one. Stick it under your seat like old gum? No good options came to mind.

The local hospital boutique carried LilyPadz in their lactation merchandise, so I felt they would be safe as a lactation staff had approved them for sale. They prevent leaks rather through constant (though not discomforting pressure). The silicone pads stay in place and "stick" to skin adhering with the slight tackiness of the silicone. They wash beautifully in tap temperatures and mild soap- regaining their tackiness with each washing. I disinfected them with boiling water (per manufacturer's instructions), but was disappointed with the end results. They gained a slight skin on the surface and the silicone felt more grainy rather than smooth. I would probably try disinfecting them with steam in the future (probably in a Medela micro-bag).

I had a great experience with LilyPadz and know many other women who have benefited from their use. Any infant's mother has plenty to occupy herself without public leaks and maintaining an adequate supply of breast pads. It's nice to leave the house in the morning with the only set of pads you'll need all day.

Breastfeeding with limited exposure: Hooter Hider/Bebe Au Lait

This is a bit of a blast from the past for our family as baby Geek is now enjoying the wonders of Enfamil (lactators, exhale, there was an insumountable medical reason for abandoning lactation before his 12th birthday).

Anyway, this geek family actually believes that the breast is best (this is actually probably a highly misunderstood phrase in many all-male geek societies). Belief in nurtitional best interests however, doesn't make the necessity of public breastfeeding in the conservative (yet ironically Hooters-loving) Midwest any less awkward. Seriously, if your screaming 2 month old wants sustenance NOW in a public place, you can assume that about half the women present will look at you like you're a hooker, and the men, well... it's closer to 90%. I sometimes found myself worrying that leering lurkers were going to start stuffing singles in my nursing bra.

So, if you don't like lots of attention or feel a bit shy about using phrases like "If you like this one, you should see the other: it's stupendous!" and "Is the baby blocking your view?" you may wonder what to do when you no longer want to sit in a room with just your darling suckling babe. Let's say you want to rejoin society for the few fleeting moments you aren't cleaning barf out of your hair and shoes and parts in between.

The alliteratively named Hooter Hider (later changed to the more upscale Bebe Au Lait in a disasterous marketing decision- really, who can resist saying Hooter Hider- I bet if you haven't heard it before, you're looking around for someone to point this page out to- just so you can say it aloud- repeatedly even) can help moms get back in public without feeling topless (although your child will find other ways to make you feel completely exposed despite a full complement of garments- see earlier reference to barfing for ideas).

Anyway, this wonderful large piece of cloth hides all your parts from the general viewing public. Many people didn't even realize that I was nursing a baby when they spoke with me. Some thought he was napping and others thought I was just a lumpy woman on break from Dippin' Dots (take this either as a warning against the Hot Dots pattern or nursing at the mall or both).


There is however, the limited possibility that your actions, especially with a difficult to nurse baby, will be taken by strangers as a subtle attempt on the baby's life (see baby posture in top photo).

None the less, you will be out in public and your breasts will not be.

The great features of this breastfeeding privacy tool over the ones you will find at Babies R Us and other mega-retailers are:

• a little terry cloth pocket that can hold a breast pad while you nurse.
  
• a non-burka like assortment of colors and styles. The mass market privacy covers are either 1) navy, 2) black, 3) navy plaid, or 4) black gingham.
  
  (the stylish navy cover shown here is actually called a "nursing veil" [no joke] available at Target packaged with a baby sized mystery restraint)
  
  I'm sure children nursed under such covers are melancholic and disproptionately drawn to the works of Edward Gorey in later life.
  
  
  Hooter Hider babies on the other hand have been shown to have a strange affinity for 1970s curtain patterns and Dippin' Dots.
  
  I have spoken out of turn. There is a new, exciting color infiltrating the otherwise bland mass market covers: Hold your breath, momma- you can now wear
  
  
  
  TAN!

• A plastic rib between the straps that gives momma (and pretty much momma alone) a view of baby. This is unique to the patented Hooter Hider and quite useful.
  
• The cover is lightweight (amazingly important when you consider how much body heat a newborn emits- think nuclear reactor). It's also easily packed into a coat pocket or diaper bag.
• Easily machine washable.
• Adjustable strap.
• Privacy for prevents baby distraction and resultant extended feedings.
  

This is easily one of the best baby gear purchases we made in baby geek's first year. It let us leave the house together for more than 2 hours at a time and made everyone more comfortable (us, baby, and innocent bystanders).

New from maker: $26-35 plus shipping. Sometimes on sale at other retailers.