Expressing for NICU babies

[time2deal]

Can anyone give me some advice or reassurance about how to express for premmies?

My boy is only 24 hours old, arriving at 33 weeks so no chance of trying to breastfeed just yet. He is starting to suck, but not coordinated enough yet.

So I'm trying to hand express from a standing start, as my body wasn't ready. I've tried every 3 hours today and just getting so little colostrum. Max was 2ml in one hour, but tonight I spent two hours to get little over 1ml.

Is that about right?! Will it pick up tomorrow?? The nurses seem OK with it, but I think they are just being encouraging.

[SoonToBeSix]

Yes you are doing great, your milk won't come in properly till around day three. Congratulations on the birth of your little boy.

[Isabeller]

I was in a similar situation and it does sound about right for colostrum. I ended up on Domperidone to increase my milk supply as found getting enough from pumping quite a challenge, I've met some Mums who didn't have a problem with their milk supply in these circumstances so you may well be fine.

My baby was given some donated milk as well a mine initially as I wanted to keep him on breastmilk only. He did get some formula in the first day or so but after that only breastmilk and eventually my supply did catch up with his needs.

It was hard work, I rented a hospital grade breast pump (rental is discounted if you are in NICU) from Medela. I am really glad I was determined but it was very hard work.

Good luck and congratulations time I will be thinking of you x

[MsMarple]

Congratulations on your new baby boy!

My DS wasn't prem but in NICU for a couple of weeks, and I couldn't hold him for a few days. For the first couple of days I was expressing sweet f.a. just little bits of colostrum, but apparently this is absolutely normal. Milk did come in very slowly, but by the end of a week I was producing enough for him. Keep trying, realise that it won't be instant, and well done for trying so hard.

Everyone is different, but for me the hand-expressing didn't work at all, I didn't really get going until I got hooked up to the industrial style hospital pumps. Do they have a pumping room where you are? Or can they bring a mobile machine to you? Also I found that it got much much better once I'd held him - like double the amount after our first cuddle than I'd ever got before. If this isn't possible yet then try just after you have seen him, or maybe even look at a picture of him whilst you are pumping?

Finally, make sure you are taking in enough fluid and food yourself. I know it is a stressful time, but get someone to bring you some healthy food and drinks in. I started drinking loads of whole milk on the advice of a rellie, and this also seemed to coincide with increase in supply.

Wishing you lots of strength to get through this bit, and a happy homecoming for you both very soon.

[GTbaby]

I hand expressed first few days as lo wouldn't latch for long. I got 1ml at each feed during 1st 24hours. This went up over first few days. And I had a normal delivery at 39+3.

On day 3 I start using a sterile breast shield while expressing and or feeding. I'd catch any drips (on day 5 was getting 10ml per feed) and then top up my feed this way.
Not sure how easy it is to sterilise while in hospital. Maybe get sterilising microwaveable bags.

[TheGirlAtTheRockShow]

That sounds really good for colostrum! I would only get 0.6ml sometimes. I was told hand expression till milk comes in,then pump. Colostrum can block pumps as too thick apparently. You will need a double electric pump - hospital should have one you can use there. You may be able to hire one, otherwise I recommend Medela Freestyle.
Congratulations! NICU is stressful, but you will soon have your little one home.

[Honsandrevels]

My dd2 was born at 33 weeks and I found expressing really hard at first. I was getting tiny bits of colostrum - it was like a sneeze full! Getting it the right position to express is harder than it seems and I got really good advice from a few neo natal nurses. Ask if you are unsure!

The pumps in the hospital were amazing and within a week(although it felt like an absolute age) I was producing tons of milk the colour of Bird's custard.

Hope all goes well.

[time2deal]

Thanks all. I tried the machine today but I think it's too early.I put a bit on lanisoh on the breast (not nipple) which made it slightly more comfortable and nurses have told me just to express about 45 minutes and just take what I get instead of trying to aim for an amount.

Baby is getting a little formula, but I'm fine with that of course. They'll switch over as soon as I produce enough.

Gosh its so hard though! Theres so much to do as well. Eat, see baby, chat to visitors, get lectures on not eating/drinking/sleeping and I'm quite sick still too after the section. And then somehow find time to express too!

But he's so totally beautiful, its worth everything. Quieter day tomorrow so will just eat, sleep rave express, repeat.

[eurochick]

Time! I've just realised this is you! Congratulations.

I've just been through this. My daughter was born at 34 weeks. Hand expressing the colostrum was hard work - loads of effort for a tiny amount - but the nurses called it "liquid gold" and were very encouraging. My milk started to come in around 3 days after my section and went from next to nothing in the morning to hugely engorged by the evening (to the extent that my husband had to do a mad dash across London to borrow a pump from a friend). I rented a hospital grade pump for home from Ardo, on my midwife's recommendation. Expressing near your baby or looking at a photo is supposed to encourage production. Like the other poster, I found the amount I could pump went up after cuddles. It was exhausting but I forced myself to express once or preferably twice a night while my daughter was in NICU, to get my supply up.

Do make sure you eat well and drink loads. It's hard when you are hanging around the hospital.

Feel free to message me if you want any other advice, but I will try to check back here too. I am so happy your baby is safely here. x

[time2deal]

Is your baby home euro? I had a better go tonight - feeling slightly better. Tomorrow is day three so I hope milk comes in.

My uterus also painfully (very!) contracts when I express. Last night I ended up crying non stop trying to express while breathing through the pain. Got to hope that ends soon. Bowels finally moving so that pain should start to reduce too.

[SaggyAndLucy]

Time which machine are you using? is it the standard hospital grade Medela double? Big, yellow and oval with a handle on the top? they can be very fierce. If you're crying with pain, turn it down. try experimenting with the suction and speed dials.
Right.
Sterilising... your pump heads only need sterilising once a day. get some zip lock sandwich bags. give it a good rinse in hot water with maybe a dollop of the hand wash soap on the ward, shake or wipe dry with hand towels and stick in the bag.
If you really want to sterilise, see if the staff will find you a space for a water steriliser. They are dead easy. fill with cold water, add a tablet and away you go. Just immerse stuff in it for 15 minutes it's done. change the water once a day.
Supply...
Once your milk comes in, pump as often as you can. AT LEAST 6 to 8 times a day and at least once between 1am and 4am. That's when your milk hormone levels peak. The more milk you ask for the more you'll get.
Get as much sleep as you can. stress and worry will seriously fritz with your supply. If it does drop, domperidone from the gp is a god send.
EAT.
Try and pump near your baby if you can. Seeing them stimulates let down.
Pump 'dry' for a few minutes after milk stops flowing. This will ask for more next time.
Anything you pump that your LO doesn't need, stick in a BM storage bag and freeze for later.
You...If you're in the hospital a lot, keep up your fluid intake and watch your ankles. It's very common to retain fluid when you're in the warm dry atmosphere of the wards, if you sit, elevate your feet.

Does your hospital have breastfeeding support? give them a ring, have a chat, they may well be able to lend you a pump.

My LO was in NICU for 10 days and was tube fed for 5 months. Pumping seems like a massive mountain to climb at first, but it soon becomes run of the mill. Keep some decent nipple balm handy and keep them clean. Thrush is very uncomfortable and will affect supply.
Keep your chin up and I know it's bloody hard, but try not to stress. LO is in safe hands.

[SaggyAndLucy]

Oh and I notice you mentioned visitors. They're lovely, but they do disrupt expressing/eating/sleeping routines. Don't be afraid to use the ward rules to keep visits short if you need to.

[eurochick]

Time, she's home now, thanks. She was in hospital for three weeks and one day. Her main issue was learning to eat. She was too small or weak to take a bottle or boob and had to be tube fed until just before she came home. Otherwise she just needed cpap for a few hours initially and treatment for jaundice like most premmies. How is your baby doing?

Are you using the pump? It might be too early.

I got after pains when expressing too. I found them bearable and tried to see them as a good thing as I was eager to slim down once baby was out. The contractions do hurt though with all the stitches down there.

[time2deal]

Thanks for all the support. I was only manual expressing until today, but I think milk is in now as I managed to get almost 30ml (30!!!) Today with the hospital pumps. I'm still an inpatient so no worries there.

As you all said it suddenly gets so much easier. Husband saw me doing it manually today and said why - you get so much its hard to catch with the syringe! Should have seen me before..

Baby had a little setback today with canula moving and getting into his tiny hand, which is all swollen up. I'm sure its a minor thing, but like a punch to the stomach when they tell you something is wrong. We need to develop thicker skins I suspect.

[RJnomore]

Hi I'm a wee bit late but I have done this.

My dd2 was a 32 weeker. I had already successfully fed my first and I was upset when I first tried expressing as hardly anything came out.

About five days in and I was pumping enough to feed the ward!

I remember her hand getting tissued as well. It's horrible isn't it, but she is ten next month, a huge strapping sporty girl who does very well academically, loves people, and talks non stop. Before you know it, your boy will be growing up too.

Good luck x

[Honsandrevels]

I'm so glad to hear that expressing is getting easier. 30ml is brilliant! Make sure you get enough to drink.

Sorry to hear about the canula. The little set backs don't get easier to deal with but they become less surprising. Saying that some babies have no problems at all and just need to get a bit stronger and learn to feed. My dd had a few issues with her breathing and kept having to go back under the bili lights.

[eurochick]

I used to get very teary about stuff like that. It is so hard when they are tiny and helpless.

[bojangles]

I had a 32 weeker in April this year. Once my milk came in I settled into a little routine of pumping every 2-3hours. I was only kept in until day 3 after a section and it became more difficult once I was home as I couldn't drive and had older DC at home. The NICU lent me a hospital pump to use at home and I would express at least once during the night but ideally twice. During the day I would arrive at NICU with plenty of snacks and just spend the day pumping and trying to feed. To avoid my feet swelling up I took a small footstool in (plastic one for toddlers to use at sink) plus I took a feeding cushion in for more comfort when feeding. I kept putting DD to the breast before each tube feed and she showed interest by gently lapping and rooting. I think I was lucky as I have a good let down and if I could get her to open her mouth it would just drip in. Once the nurses saw she was actually taking some milk from me they were more encouraging about her being put to the breast before each feed. It took a while though before she actually latched on, she would just kind of open her mouth and swallow. Can't quite believe it looking back but she was discharged at 34 weeks fully breast feeding and is still exclusively BF now. It did take a lot of effort and a lot of tears but looking back it was worth it. Message me if you want to chat more.
X

[Heels99]

My milk never came in, similar circs, piping non stop for days, nothing! They gave me some medication which did generate a little bit, every little is helpful. Moved to formula after six weeks. Good luck!

[bojangles]

Meant to also say I had to be quite proactive with the nurses about feeding times so I could plan my day and arrival round them as I would find sometimes different nurses might move the feed time to suit the other babies and I would arrive to NICU ready to feed and they had just tube fed 60ml of formula. Her milk requirements also kept going up so I would think I was expressing enough then it would increase another 10ml. DD had formula as well but I asked that if possible they saved my milk for tube feeds during day when I could be there to try and encourage feeding and to give the formula during the night.

[bonzo77]

I think I'm a bit late to this...

Firstly, congratulations on your little bundle.

Your proper milk won't start til at least day 3. Until then you will get tiny tiny amounts of colostrum. You can hand express it straight into a syringe, which can then go straight into the NG tube if he has one, if not just drip into his mouth, or on your fingertip.

Once the colostrum changes colour from yellow to more white, that's milk. Then you can use the pump. I was told to pump for no longer than 15 minutes per side (or both together with the double pump), and to do it every 3 hours. Also, to pump next to the baby if possible (derrrr, of course you can't do this on NICU). The nurse also said to try to put baby to the breast first, even before they have a suck reflex, as it helps you make milk, and helps the baby to associate the smell and comfort with you. I was told they get the suckle reflex at 36 weeks, so if they are earlier than that it will come with time.

In the end I FF. i wanted to, it suited me better. But with DS2 in NICU, and me at home feeling useless, pumping for him made me feel like I was still connected to him. In the mean time, being separated over night meant that I recovered much faster from the CS than I had first time with a newborn to look after.