Unsuccessful pumping for preemie in NICU - help!

[Dysgu]

DS arrived 6 weeks early and very quickly on Thursday morning - nearly a hospital car park delivery! He is my 3rd preemie (also have 32 and 34 weekers) and I am expressing whilst he gets used to being here.

He is in an incubator with jaundice and came out for his first cuddle today. We tried him at the breast but he just fell asleep.

I have been expressing (at least 8 times a day including at least once between 1-5am) but am no success.

I have spoken to the specialist midwives in NICU and they are very supportive - they are happy for me to persevere or stop and there is no pressure either way.

I am finding the whole thing very stressful and usually cry through every pumping attempt - I know this is likely to be a cause of the lack of success.

When I say I am having no success - I have just pumped and achieved a grand total amount of 1ml of colostrum. This is the first time ANY milk has actually appeared.

But now my breasts are extremely painful and lumpy. I have tried massaging them. I have tried hand expressing but cannot do it! I have tried crying HUGE amounts but strangely that doesn't really help either!

I think I do want to keep trying. With DD1 and DD2 I did manage a small amount of success and they had mixed feeding until their due dates.

I also have/had gestational diabetes which the NICU staff say has probably affected the supply but they say it should come in eventually.

If I just stop pumping, what will happen with my breasts? DS is fed on NG tube and I have no worries about him being FF is that is what has to happen.

Any ideas? Please help?

(Have to go out - is so hard balancing 3 children - but will be back to check any ideas in a couple of hours.)

Thanks

Quick questions until someone far more knowledgeable comes along.

What are you using to pump and how are you pumping? Are you near your DS (Huge congratulations btw!)

Although not a prememie I had to express for the 1st 2 weeks with dd2 (surgery related). I was absolutely convinced I coud not express due to my experiences with dd1 (like you 1ml at a time if I was lucky!) A fab mw sat with me and talked me through the expression Trying 5 mins on each breast then 4 mins then 3 mins then 1min. It also help massively to have a picture of dd or even better have her next to me so I could see and hear her. I tried a hand pump when I got home and I was still rubbish so i defineitley rate the hospital grade machines (I jokingly called myself daisy for the duration- black humour and all that!) I'm trying and failing to remember other tips she gave me she did have more but it's a while since (she's 5 now!).

Good luck and try not to beat yourself up over it (oh and drink drink drink I definitely expressed easier if I was really (think uber) hydrated).

You need to talk to someone about the state of your breasts, please DON'T let this go overnight. Congrats on no. 3. Sry one-handed on phone.

I think you need to have a go at hand expressing - I was told in SCBU that you should always hand express for the first three days as its so hard to shift colostrum. Heres a link with a leaflet and video on how to.

Its also just generally a more reliable way of moving milk than a pump, and amazingly efficient once you get the hang of it.

Congratulations on the birth of ds!

first, congratulations on your new DS, hope you get to take him home soon. DD was also 6 weeks early.

on the breastmilk production, it sounds like you HAVE succeeded! 1ml of colostrum is normal to start with (ok so it has taken you a couple of days to get to that point but that is not surprising given DS was early) and if your breasts are painful and lumpy it sounds like that is your milk coming in. so you really are getting there, well done! hopefully you will see more and more coming through in the next day or two. IME it was only a few days from the first tiny amounts of colostrum until I could produce lots of milk using the hospital pump.

i was told to stick with the hand expressing and not use the pump until it changes from thick colostrum to thinner and more copious milk. has someone shown you how to hand express? what worked for me was firm strokes from the edges of the breast towards the nipple, then hold boob with your hand in a C shape and squeeze towards the nipple, almost like you are squeezing icing out of an icing cone if that makes sense? if still no success, try hand expressing under a hot shower or in a hot bath, this softens the breasts and makes expressing easier IME. of course any milk you get out will be lost down the plughole but at the moment it's more important to get your supply going and to prevent engorgement than to capture every last drop. or use hot flannels before expressing.

do drink a lot and eat enough - it is easy to get dehydrated and go hungry if you are in hospital a lot, especially as the NICU is so hot. carry a bottle of water with you everywhere. maybe ask if there is a fridge you can use to keep food in (eg in a rooming in room)?

once it changes to milk rather than colostrum (probably tomorrow or the day after) get yourself on a hospital grade pump.

Congratulations

Welovegrapes "stress can definitely impact on pumping volumes" - is spot on.

When DS (not prem) was in SCBU I had an awful time expressing. Don't know why I decided to try this, but it worked. One night when they sent us home, I sat in a comfy chair with a pillow on my knee and one of DS's pre worn babygrows draped across (smelt of him). Was determined not to cry, instead I concentrated on lovely thoughts of DS and practiced breathing from yoga while hand expressing. DH walked in half way through and had to walk out for crying - he thought I was mad. I got ridiculous amounts of milk though, which was worth it. Couldn't replicate that relaxed state in hospital with a machine.

La Leche league phoneline were great.

Good luck, and hope you all make it home soon.

I'm your new FB friend - listen, 1ml on day three is great and perfectly normal!

If your breasts feel painful and lumpy try massaging them in a hot shower, from the edges towards the nipple. In fact, maybe massage them all the time, I had to, pretty much for a week and a half. Mine have settled down now thankfully but the hot shower gave the best relief. Express after if possible!

There's no harm in feeding whichever way works out for you this time, it is different when you have two more at home, it's so much harder, so whatever happens don't beat yourself up about it. You are doing the best for your family. I'll write more tomorrow but have to sleep now as I'll be up in two hours pumping!

I know how lonely it is. :(

Our DS's will both be home soon enough. We've both been here before. Must remember it isn't forever. x

Congratulations.
Can't link from phone but if you search my name I recently linked to a PDF of Mamet hand expression and massage techniques - the hand expressing never worked for me but the massage made a huge difference. Stay warm and comfortable, make sure you have privacy if on the unit, try a hot flannel on your boobs before hand, make sure the pump is set up right (hospital ones not always perfect), eat and drink as much as you can.
Thinking of you, it is hard hard hard.

Oh and I totally remember howling at a midwife that I couldn't do it. She, bless her heart, popped a pic of DS up on my bedside table to help, but I rapidly discovered that I pumped best when relaxed and distracted, usually by watching e4!

Congratulations on your new dc. Scbu will be stressful no matter how many times you go through it.

1ml of colostrum is a decent amount, you have to remember it is very rich and thick so you do not get big amounts of it. Try and express every 2 - 3 hours, 5 minutes on left, 5 minutes right then repeat (20 min total). Keep your jaw loose, make sure you're not clenching your teeth together, it sounds silly, but it helps relax you.

When you sit to express try and have a photo to look at, a bottle of water and a nice calm room. A warm bath also helps with the let down and collection, especially when your milk comes in.

Try not to fret about your expressing amounts, hand expressing is fantastic once you've found your own technique. My ds was prem and in scbu, It's a horrible time, but no matter what you decide to do feeding wise it doesn't make a difference to your new baby.

The midwife milked me in the end so I could get a hang of it. Tiny amounts to start with though. Then hospital pump. Takes a few days though. Congratulations

Congrats on your new little baby :)

I never got anything with a pump when it was only colostrum being produced. Like many posters on here, I found hand-expressing much more effective when in the colostrum stage.

When milk came in.... gallons! Yours probably hasn't yet. When it does, I think you will find it much, much easier.

Having said that, some women find it very difficult to express at all, ever. IT's just how they're made. If that's you, don't worry - is there a milk bank at your hospital? Your scrummy new baby could have donated milk maybe?

IIRC stress does not impact on actual supply, but can cause problems with letdown. Is a glass of wine when you try pumping an option?

Also, you are nearly day 3 post-partum and that's when the weepies set in. Don't underestimate the power of the weepies... Maybe that is why you're finding it all so hard ATM too.

Thank you to everyone for your kind words and advice. We have just got home (DD1 had a dance performance - she was very nervous but for the duration I barely noticed how painful my breasts were).

I have run a bath and just holding warm flannels over my breasts has brought on some drops of milk/.colostrum. Of course, it is being wasted but if it helps to ease the pain and then I can try expressing afterwards it will all be worth it.

Off to sit in the bath with a glass of water and see what happens....

It took ages for me to get anything significant out when I had DS. I used the hospital pump at the hospital and a bog standard Medela pump at home until I hired a double pump. Don't give up as the milk will come and the lumpiness sounds like it is coming in. I didn't use a photo as I didn't find that helped but just watched telly / MNed / sent emails / whatever while the pump went on.

Can I also recommend drinking a large bottle of finest ale or beer? I found beer (not lager) did wonders for my milk supply. Wine had the opposite effect, btw, so I would avoid that.

My friend's wife expressed for 8 months as she couldn't get her daughter to latch and I might still have the advice she sent - I will FB you it if I can find it.

I eventually got DS out of SCBU on bottles of expressed milk, established him on the breast at home at the equivalent of term + 1.5 weeks and then bfed him till 12mo. Equally all the time I was quite happy that he had formula through his NG tube and wouldn't have beaten myself up about not managing had we not got bfing established.

Best of luck.

oh well done! it doesn't matter if it is wasted, your body will produce more the more stimulation it gets :) good luck. do gently massage your boobs while in the bath, use fingertips to massage any lumps and bumps and stroke towards the nipple.

if you can face it, set your alarm and try hand expressing some time between 11pm and 4am as that is when prolactin levels are highest, plus it will help avoid any engorgement getting worse overnight.

Found the stuff from my friend's wife - going to try and PM it to you on FB now.

Thank you Floss will go have a look now!

I found the bath a bit useful - was relaxing anyway - and I did some massaging which seemed to get some more drops coming. Didn't feel good to waste it but I just let it drip into the water and figure there will be lots more if I keep trying.

After a short while in the bath, I then managed to hand express a few drops into a cup but it wasn't very successful.

Going to try a bit more massage now and then some expressing - will try hand expressing first and then the pump and see what happens.

Will then set my alarm for about 2 or 3 am and have another go.

If anything, I am feeling much more relaxed about the whole thing and it is good to know it is normal, even if it is getting really painful again.

Thank you again to all for help, support and advice...

Although best ever early on was when I could have a hand on ds in his incubator.

Guinness was suggested to me, dunno if it worked but it chilled me out!

Congratulations on the birth of your son!

I expressed for my DS who was born at 29 weeks, for 3 months. PLEASE be reassured that the amounts of colostrum you are getting at this stage are completely normal.

I think it took me about an hour to get 1ml when I first expressed. I would collect this in syringes rather than using a pump. I hand expressed 6 x daily using syringes until I was getting 5 mls at a time, then moved onto an electric double pump. Double pumping can increase supply.

If your breasts are hard & full, that suggests your milk is coming in :-). The hot showers/baths & lots of hand massage are the way to go.

It sounds like your unit are supportive. Mine were pretty awful & the mums put under a lot of pressure, at an extremely difficult time.

As said up thread, some women just don't have a supply. A nicu friend of mine used Domperidone (prescribed by GP) to increase supply - you could ask your unit if they have a GP letter. Having said that, it's early days yet - I think my friend tried it after a month or so & it worked.