Public Health: Breastfeeding/Chestfeeding Support
Lactation Support for Parents of Premature Babies
(and others who exclusively pump)
Please note that I wrote this as a record of everything that in sum eventually helped me in my situation. This advice may be adapted to lactating parents of term babies by, for example, substituting 'nursing' for 'pumping' in some cases. I am not a lactation consultant, it is best to consult one who can become familiar with your particular circumstances and anatomy. I do not know if everything I did was necessary or even contributed to my breastfeeding success, nor did I know in advance what a challenge it would be and how hard I would have to work to succeed.
Breastmilk is the perfect food for all infants and is of utmost importance for premature babies (born before 37-39 weeks gestational age). Expressing or pumping milk is taxing and tiring but may be personally rewarding to the lactating parent, and has tangible health benefits above all else for the preemie. These are all the steps I took to increase my supply and later transition my baby to exclusively nursing.
Tips for increasing milk supply
Start pumping as soon as possible after giving birth.
Frequently express fully. Milk supply is entirely dependent on milk removal.
Stay hydrated. Hydrate while pumping.
Engage the support of a lactation consultant (LC)— better yet, an International Board Certified Lactation Consultant (IBCLC).
Kangaroo care! This means skin-to-skin contact with your baby whenever possible for as long as possible.
Fenugreek pills!!! And try other galactagogues.
Listen to a relaxing pumping/nursing music playlist (the music will help condition your body and will help you relax).
Pump both sides at the same time. (Use a hands-free pumping bra!)
Compress / massage your breasts as you pump.
Make sure your flanges are the correct size. Note that flanges are fitted to the nipple size, not to the breast size.
Pump every 2-4 hours.
Pump 8-10 times per day. If your supply is waning, pump 10-12 times per day. Do this for at least the first 8-12 weeks until you reach ~600ml (20oz) per day. You may decide that pumping frequently is more important than visiting your baby in the NICU if the two are mutually exclusive (if so, consider recruiting a family member or friend to kangaroo care for your baby in your stead).
Pump for at least 15-20 minutes at a time.
Pump at least once between 1am and 5am. This is when your prolactin levels are highest!
Avoid becoming engorged-- pump before you feel full. An empty breast produces milk faster than a full breast!
"Cluster pump": leave your hands-free bra on, pump for 20 minutes, stop for 20 minutes, pump for 15 minutes, stop for 15 minutes, pump for 10 minutes. By the third cluster you might get nary a drop, but you're still sending the signal to your brain to produce more milk! Cluster pumping is especially good at the end of the day when you realize you haven't yet hit your minimum 8-10 pumping sessions.
Hand express after using the pump.
Look at photos or videos or listen to audio of your baby (or any baby) as you pump.
De-stress however possible.
Skip a middle-of-the-night pumping so you can get enough rest. Nap during the day. (Similar to above in regard to frequency, you may find that resting is more important than visiting your baby in the NICU if the two are mutually exclusive. Don't feel guilty— you are giving your little one your milk! Liquid gold!)
Avoid mint, sage, parsley— they are used to stop lactation!
Eat foods made with whole grains, rich in vitamin B6. Oatmeal in particular is good, instant is not as good as the slow-cook stuff. (You can make it in a rice cooker or a slow cooker.) Brewer's yeast is good too. Lactation cookies, usually made of oatmeal, brewer's yeast, and ground flax seed are a fun way to include these in your diet.
Drink beer malt soda (non-alcoholic). (I like Nesher or Gold Star brands from Israel.) It is an acquired taste.
Use warm compresses while pumping and/or resting.
Non-nutritive nursing! This means letting your preemie lick, sniff, or even suckle and just feel around. You might have to pump first to empty your breasts as much as possible if your preemie has not yet developed the reflex to coordinate suck-swallow-breathe.
Get moral and social support. Talk with your partner, family, and friends. Attend LLL meetings.
Remember that you're doing an amazing thing. Any little amount you can produce will help your baby.
Don't look at the bottles as you pump (this is how I almost spilled milk the first time I pumped more than 2oz, but it's worth it!). It's hard to relax while pumping, do whatever you can to not stress about quantities.
Avoid getting frustrated at downward trends, they may just be temporary. (See the chart of my own progress, right. I regularly had three-day cycles of decreasing daily totals within an overall increasing trend.)
Request a used swaddle cloth or flannel from your baby's incubator or bassinet, inhale its scent before or while pumping. (Bonus: leave a T-shirt or other cloth with your scent in your baby's incubator or bassinet.)
Additionally:
There are prescription drugs (e.g. domperidone) that increase milk supply.
Rent a hospital-grade breast pump. Medela has a 'preemie' setting.
Products
my list of Breastfeeding & Exclusive Pumping Essentials
my list of Great Gear for Preemies
Resources for Exclusive Pumpers
Tips for transitioning from exclusive pumping to exclusive nursing
Ensure you have a good milk supply (see above). Note that relactation is possible with the help of a lactation consultant and dedicated effort, but it's much easier to build the supply from the start. If you do not have a 'full' supply you would not be able to exclusively nurse but even some nursing is beneficial and rewarding (and most women actually have no supply issues).
Engage the support of a lactation consultant (LC)— better yet, an International Board Certified Lactation Consultant (IBCLC). Make sure you have a good latch!
Kangaroo care! This means skin-to-skin contact with your baby whenever possible for as long as possible.
Make nursing easily accessible so you're ready to go as soon as your baby shows interest. When you're at home you may find it easiest to just be topless so your baby does not get frustrated during the 10 seconds it takes you to unbutton your shirt or unclasp your nursing bra. Nursing halter tops are great because you can just push them aside.
You may need to start working on your latch with a nipple shield.
Dribble some freshly expressed milk across your nipple while your baby is trying to latch. Milk is yummy, help them get instant gratification for his efforts.
Try non-nutritive nursing at first-- just let your baby explore! Sniffing, licking, touching is great.
Keep trying! Try regularly! Be aware that it may take a while (several months, even), and that progress could be slow until suddenly one day it clicks.
Only try nursing when baby is most awake and alert, even if it means you only do it once a day or even not at all in a day. Right after a bath is the perfect time because they'll be most awake but quickly relax.
Only try nursing up to the point before one of you starts getting frustrated.
Avoid getting frustrated! Despite all the mammals in the world who have nursed their young for hundreds of thousands of years, this is not easy. It's not just you.
Relax and de-stress however you can.
Try laid-back nursing positions. Think beyond the 'cradle', 'cross-cradle', and 'football' holds. Try reclining in bed with your baby draped over your tummy on his tummy. This is especially good if your letdown is otherwise overwhelming.
Make sure your baby's head is in neutral position— they should not have to crane or turn their head to eat.
Talk or sing to your baby (in soothing tones) if they want to be social. Be quiet if they want to focus on learning to eat. Let them fall asleep at the breast if they're relaxed enough. Just make breastfeeding an enjoyable experience. It's not all about milk.
Avoid using soap to wash your breasts. Just use water. Similarly, avoid using perfume or any other scents. Just smell like you.
Get moral and social support. Talk with your partner, family, and friends. Attend LLL meetings.
Remember that you're doing an amazing thing. Even if you just end up snuggling, it is a wonderful bonding experience for both you and your baby.
Nurse on demand. If you want to sleep train your baby you can try it later; if you want to successfully breastfeed your preemie, let them nurse whenever he wants, at least at first.
Kelly N. Z. Rickard, MPH
Mother of a premature baby born at 28w6d gestational age who is now gaining well, doing great, and exclusively nursed for three years after having started life on IV nutrients, then feeding by gastric tube, then by bottle, and only then directly breastfeeding.
See also resource files at the bottom of the page!
Chart of my own EP progress
