Breasts engorged but very little milk coming out

[Natalia32]

I gave birth to a preemie a few days ago. He has been in Nicu ever since and as he was hooked up to a cpap mask, I have been trying to express. On 2nd to 3rd day I managed to express a reasonable amount of colostrum, 10 to 15 ml at a time, but afterwards my breasts became very engorged. They are very hard, painful and swollen now but when I express, very little milk comes out, 5-8mls at most. I have tried cabbage leaves (which seem to soothe my breasts), warm compresses, breast massage, before manually expressing. Manual expressing yields the 'best result' in that it comes out drop by drop, but pump gets me nowhere no matter what the setting. My nipples just don't respond. I try every 3 hours and it it feels as days go by that my breasts become harder and the flow is slowly shutting down. I assume it is not a case of blocked ducts as the milk is coming out when I squeeze hard, so my question is: how can i get my nipples to open up the valves, so to speak???
I should add I am getting a lot of help from midwives with this issue but they don't seem to be able to get the milk flowing much easier either, so it is not a question of technique.
I am obviously very worried as my baby really needs all the help he can get.

Thank you.

It sounds like you're doing all you can. Are your midwives concerned? Until your milk comes in you'll only get small amounts at a time, and baby only needs little and often due to tiny tummy.

Make sure you're on the lookout for any pain, redness or soreness as this can be a sign of mastitis. I'm sure you're being well looked after though.

You did mention pain in your OP, sorry. One thing you could try is to hand express in a warm shower. Especially if you think you need to clear it (rather than collecting the milk, as this is going to be tricky in a shower!)

Hi OP. Welcome to your little one, and sorry to hear he arrived early. My DS was born at 29 weeks, so I know how stressful things can be. I've been told that the situation in itself can make it difficult to express, although it didn't seem to affect me in that respect.

It's great that you're expressing so often! It sounds to me like your milk has come in and you've got a good supply so far, but you're having problems triggering the letdown reflex. Does that sounds right?

It also sounds like you've tried all the standard stuff for dealing with engorgement. I second the hot shower thing - doing breast massage and compression in the shower can work well. Direct the spray towards your breasts if you can (it should be hot, but not hot enough to burn!). Sometimes, the stimulation can trigger letdown.

Other things that can work to trigger letdown: trying to relax while expressing (listening to music you enjoy, etc. This is almost impossible in the NICU but can work at home), watching your baby/looking at a picture of your baby/thinking of your baby while you express, kangaroo care (are you able to hold him yet?), nipple stimulation (just kind of gently stroke them for a while - sometimes leaning forwards helps).

In terms of the pump, can I ask what type you're using? Is it working? Is the suction strong enough (there can still be some suction in malfunctioning pumps, just not enough to trigger letdown)? Are the flanges the right size?

With engorgement, the risk is getting blocked ducts or mastitis, so I'd say to carry on with the regular hand expression - and do press firmly on any particularly hard areas to try and drain them.

Thanks Kinky and Untamed. I will try the expressing in warm shower and the suggestions of looking at pictures. Unfortunately I was only able to hold him today for the first time so that probably didn't help. He is now off his mask so hopefully it should be a more regular occurrence. I like the suggestion of stimulating gently. Someone even told me to get the husband to help :-)
I am using the Medela pump. In hospital they had this industrial version which you'd think would be powerful enough.
At this stage I am starting to think it is due to the rough start we had and lack of contact, no feeding from the boob etc etc. hopefully we can get onto that soon!

Wow - fantastic that he's off cpap already! Hopefully you can start him on the boob soon then. Keep us updated on how you get on.

OP I was in your shoes. My baby needed Cpap and had a long stay in NICU. I had a C sec and tried from day 1 to express. It was 6 days before my milk came in properly. I had this phase where my breasts were painfully engorged but very little milk was coming out. My advice would be to just hang in there and keep breast feeding/expressing. It takes a bit of time for some of us, enough to make me doubt if my body was capable of producing enough milk. But it gets perfectly fine eventually. I am exclusively bf my baby now. BTW fenugreek supplements help. Kellymom.com is an excellent resource for bf information.