all about the milk

pumping (read: giving your baby breastmilk. because eventually you'll probably choose to breastfeed rather than pump) is the best thing you can possibly do for your little one.

some information about preemie benefits to bm:
better immunities- your breast milk passes all the protection to your little one that they can get and need. at the beginning the colostrum is a power boost to babies. so even if you only get a few drops, SAVE it! and tell them to give it to your tiny little one. even if you have to freeze it initially, which you probably will, it will be so beneficial to them. about 80% of the cells in breast milk are macrophages, cells that kill bacteria, fungi, and viruses. breastfed babies are protected in varying degrees from a number of illnesses including, pneumonia, botulism, bronchitis, staphylococcal infections, influenza, ear infections, and german measles. and mothers produce antibodies to what ever disease is present in their environment
making their milk custom-designed to fight diseases their babies are exposed to as well. (breastfeed and spend a few hours a week in your child's daycare- and they won't get sick!)
perfect nutrition- a preemie mommy's milk is specially designed for just her preemie. depending on the gestational age of your baby your milk will have different nutritional values. isn't that amazing!? in fact, your preemie milk maintains levels like colostrum for about the first month! don't let the neos fool you. your baby does NOT need fortifier! there are very few cases when fortifier is actually necessary. it is just standard practice in most nicus, so they scoff when you question them about it. milk is easier to digest, and they'll grow just like they should with exclusive breastmilk. (in most cases.) if they really push for fortification try prolacta. it's made with human milk.

bowel safety- the dreaded NEC is one sixth to one tenth less likely to effect breastfed babies. one australian study says that up to 83% of cases could be prevented by breastfeeding.
improved mental performance- think of breast milk as redbull for infants. well, minus the crazy energy part, and the crash later in the afternoon. ok, think of it as brain booster. countless studies have shown that babies score higher on tests and developmentally on breast milk. kids can actually benefit from it up to age 4! (i know, you're thinking, gross!) a study by brown university in 2006 showed that- guess what?- preemies benefit as well. extremely low birth weight infants that were given even some breastmilk were better off at 18 months than those strictly formula fed. they're starting out so far behind anyway that the milk gives them a leg up. the fatty acids contained in the milk are necessary for proper brain development. (if that's not enough, one study showed that 7 and 8 year olds who were given breast milk by tube when born prematurely scored 10 points higher on their IQ tests than formula fed counterparts.)
check it out yourself the information is overwhelming:
HMortensen EL et al (2002). "The association between duration of breastfeeding and adult intelligence" JAMA 287: 2365-71
Anderson JW et al (1999) "Breastfeeding and cognitive development: a meta-analysis" Am J Clin Nutr 70: 525-35
Horwood and Fergusson, "Breastfeeding and Later Cognitive and Academic Outcomes" Jan 1998 Pediatrics Vol. 101, No. 1
Lucas A., "Breast Milk and Subsequent Intelligence Quotient in Children Born Preterm". Lancet 1992;339:261-62
Wang YS, Wu SY. "The effect of exclusive breastfeeding on development and incidence of infection in infants." J Hum Lactation. 1996; 12:27-30

getting started:
sessions- you should pump every 3 hours, sleeping 4-5 at night after your supply is established and output is good. sessions should last about 15-20 minutes. you need at least 15 minutes to get to the fatty hind milk that is so important. if you're worried about supply add an extra session rather than making a session longer.

a pump- i have a medela pump in style.. it works wonderfully. i can't tell a difference between it and the hospital grade. there are others that work well, but this is the only one that i can personally vouch for. most states now have a program through wic that will give you a pump on loan for free. you'll have to check with your local wic to see if they participate. (if you're getting the pump deal- they will not cover formula... but breast milk is better anyway- right?)

parts- you will need at least 4 sets of parts. (except tubing, maybe only 2 sets of tubing.) depending on what pump and what style of what pump you may need different things. check out the pump you have and see what you'll need. make sure you have the proper sized parts. you can check with a lactation consultant on this. it will definitely effect how much you're able to get if you use parts that are too large or too small. i've never been able to get the hands free thing to work. it might be a function of having gigantic boobs. but if you happen to get one that works- it will be priceless!

foooood- you will think you just might be starving to death! the first night i was feeling well after my c-section i was crying for food- literally. i thought i might not make it to breakfast, so my dearest love got to roam the hallways looking for a vending machine at 3 am. when he brought back a vending machine hamburger i cried in joy. (that was the first and last time that i cried over a vending machine hamburger.) all that to say, keep something around for nibbling on. especially at the hospital where you can spend a bank on candy bars and chips. granola bars are good, and oatmeal boosts supply. also, drink lots and lots of water. i've never felt so dehydrated in my entire life as i do almost everyday now. you'd think i'm on the verge of water poisoning- but i'm not, i'm just feeding an extra person. this isn't the time to diet- embrace that baby fat... dieting can lead to a decreased supply. a breastfeeding mommy will use about 400 extra calories a day.

nursing cover- most aren't wide enough or long enough to pump under, so check the size before you spend $35 on one. you'll probably want to pump both boobs at once, so make sure all the goodies are covered for a proper nursing cover fit. as a bonus, if it fits for pumping you will have great coverage when breastfeeding. now that i'm bfing my daughter, the cover covers not only the front, but my exposed back when i lift up my shirt to get her to the goodies in front. :) here's a link to an extra large. hint: they're also pretty easy to make.

bags bags bags- you'll need about a million of these. well, maybe only a thousand. i went through these things almost like i go through water! and they get expensive! for full time pumpers i would recommend lansinoh bags. they're cheaper, and freeze flat. but the measurement is completely off, and they don't stand on their own. generally lower quality. for periodic pumpers who also get to nurse, i would recommend the medela. you can pump directly into them, the measurements are accurate, and they stand on their own in the fridge. a mommy who will be in the nicu for months to come is going to have LOTS of milk and need something that is a logical use of space- so use the bags that will freeze flat.

lansinoh cream- i never needed this much. but it's the sort of thing that you want around when you need it.

breast pads- like kotex for your boobies. they're usually bulky and show through clothes. i've never much needed them, but liked the lansinoh brand best because they were thinnest...of course, if you have lots of leakage- that probably won't work for you. i've had lilypadz highly recommended. they actually use suction on the breast, rather than regular absorbent pads that attach to the bra.


bottle drying rack/bottle brush- totally priceless! here's the rack that i have. it works great- though it doesn't look as cool as some of the others. for the brush, make sure you get the cheapest one you can find. you'll go through them pretty quick- but you need the cheap ones to fit inside all the annoying parts. i splurged and got the extra nice one with the soap in it- only to find it was too fat to fit inside the horns. (it barely even fit in the bottles.)






pain:
do your horns fit?
do you need some cream, like lansinoh?
do you have an infection like mastitis, or plugged ducts?
do you have cracked or dry nipples?
no matter what- keep pumping!! pump through the pain!

supply issues:
here's what no termie mommies know... it's the inside scoop on preemieness.. you're going to feel totally detached from the feeding of your baby. you're going to HATE pumping. you're going to find it almost completely unrewarding. but, just remember, this is one of the only things you can do to actively help your little one grow and get healthy. so, when it's 3am and you roll out of bed only to be greeted by cold plastic and the whir of a machine, remember that special little hand that held yours. also, remember, no pump can remove milk as effectively as your baby.. so even if you feel like you aren't getting enough, you still may be producing enough for baby.
for me, "think of your baby", or "smell something of your baby" etc. never worked. i think it's because having a preemie keeps them so isolated from you. heck, they're in an isolette! i would actually get my letdown from the beeping of the monitors! after having my daughter home for a week, breastfeeding for a month and a half, i'm just now getting to the point where crying will give me a letdown. welcome to a strange world.
your supply will tank around 4-6 weeks. your body isn't stupid, and eventually it will catch on. don't be alarmed (though you will be anyway) just keep pumping! it will come back.
did you recently start a hormonal birth control? even ones that are "approved" for breastfeeding mommies can drop your supply.. it just depends on how sensitive your body is to the hormones.
this applies to starting your period and getting pregnant as well- both will also drop your supply.
are you stressed out? or in pain? sick? all these can contribute to lack of milk.

if you're pumping and it's still tanking you can try:
fenugreek
mother's milk tea
blessed thistle
brewer's yeast (many people recommend drinking a beer- you can take this instead)
oatmeal
yes, MORE water

try:
massaging breasts before and during pumping
check your horns, make sure you have a good latch, and the right amount of space around the nipple
change the angle of the horns, this can get to different ducts that you may not be getting to.
if you're breast feeding already, pump after feeding.

if it still doesn't work you can get an Rx:
reglan- oops, may cause parkinsons
domperidone- uh, oh, cardiac side effects, and... not legal in the US.
but hey, they work. i actually took reglan. here's what happened.

not enough for baby? still want to give her breastmilk? try a milkbank or donation service like milkshare.

here's a great article on kellymom.com. they are a wealth of information.