Pumping for a Preemie

This is a long post about breast feeding, which you may or may not be interested in reading (and I totally understand if you don't). There are pictures of Jackson all over the post so just scroll on through if you'd rather just see pictures of Jack when he was a tiny little 5 pounder.

I've seen a counselor for six months now, and one of the best nuggets she's given me about new motherhood (in addition to the immeasurable amount of support) is that "If you don't want advice about something, don't talk about it."

For some reason, when it comes to parenting, there's a lot of things I don't want advice about. It's not because I know it all or that I'm stuck in my ways. It's that the person giving the advice usually is coming from a completely different place than me. I am admittedly over-sensitive and at times, very defensive of my parenting because the choices I've had to make as a mother of an eight-weeks-premature baby whose twin passed away are coming from a MUCH different perspective than someone who didn't go through anything remotely similar.

With that being said, the thing I'm most sensitive about is discussing is breast feeding. I don't want breast feeding advice from women who got to start that relationship minutes after they gave birth. So I don't talk about breast feeding pretty much ever. See? I'm sensitive and defensive - I know this. But what I have been doing has worked for me and Jackson for seven months now, so I thought I would do a post about it because I found very few resources when I figured out what route we were going to take and I thought I could add to the discussion.

Breast feeding is such a hot topic and no matter what end of the spectrum you fall on, everyone has an opinion about it. Women who haven't given birth and aren't mothers have an opinion about it. I sure did while I was pregnant - I was bound and determined to breast feed. Denton shares my viewpoint, and together we went to a general breast feeding class and a class specifically for multiples. The multiples class gave us a lot more information about pumping for premature babies than the general class did, and as a result I knew to ask for a pump when I was in the recovery room, since the twins both needed to be handed off to a NICU team and I couldn't nurse immediately.

The five days I spent in the hospital with the twins in separate NICUs is cloudy, but as weird as it sounds, pumping got me through it. I was able to hold Jackson in the NICU and we got to do things like give him a bottle, change his diaper, and do Kangaroo Care (KC is skin-to-skin time and you can put on this special pouch and hold the baby to your chest - the wonderful pouch I had is here). Jackson was (and is) and incredibly healthy baby for having been born eight weeks early. His main issues were temperature regulation and getting enough to eat. Those are so minor in terms of what lands a baby in the NICU - it's the one area where I feel we lucked out those first few weeks. But because of his temperature issues (he would get cold quickly when taken out of his incubator), we had to keep him completely swaddled in a blanket while holding and feeding him, unless they were giving me skin-to-skin/Kangaroo Care, which the doctors allowed twice a day.

Lil Nugget - 9 days old - taking a bottle from his Gran all swaddled up

My milk came in after about two days of pumping, but because Jack was premature they had to supplement my expressed milk with a special formula. Breast milk on average is about 20 calories, and so they put less than a tablespoon in each bottle to pump it up to 22. Jackson got the hang of keeping his temp up and got moved to an open-air crib on Day 10 in the NICU, and at that point the doctors "prescribed" breast feeding. My first experience breast feeding Jackson was in the NICU, with two screens around his crib. I had a lactation consultant there for about 15 minutes, and after getting Jack to latch and take in probably less than half an ounce of milk, we gave him a bottle and the LC said she'd be back tomorrow. The next day I tried again, and Jack pooped out pretty quickly. Breast feeding takes way more energy out of the baby than bottle feeding does. A few hours after that consultation, we were told that Jack was going to be definitely discharged that evening (we had some idea - we were told earlier that it would be within a week). We were on our own.

Home for about 24 hours and not sure what to think

It's your right as a parent to do whatever you feel is best for your children. I could have taken Jack home that Friday and switched immediately to exclusive breast feeding, but we chose to follow the advice given by the neonatologists and our pediatrician, which was to continue bottle feeding Jack with expressed milk and a tiny boost of formula until he was at an average birthweight (around 8 pounds) or until his due day (July 1), whichever came first. So, I tried breast feeding Jack once a day, and then would give him a bottle for the other 7 feedings. I took all of the organizational skills I had acquired in school and in business and meticulously kept track of Jack's every bottle and bowel movement in a very detailed chart.

After about a month, Jack made it to 8 pounds, and the doctor took him off his prescribed formula supplement. The pediatrician recommended that we slowly switch from bottle to breast, replacing a bottle feed every couple of days. For the first time, I started to breast feed more than once or twice a day. It was bad. Jack was crying, I was in A LOT pain, and the advice started coming in. "It's supposed to hurt." "I had struggled with breast feeding too (said by someone who got to start this relationship in the delivery room)." "Sometimes as a mother we have to do things that are better for our child than us."

I was so insulted by this, because I had been pumping since day one, and pumping is one of the least easy and fun ways to spend your time in the history of motherhood. And after all I had been through, it was amazing that I kept pumping during those first days in the hospital when Jackson had to have formula anyway. People also weren't at doctors appointments with me - my pediatrician has been very supportive of my pumping/breast feeding, but he was also going to be very quick to supplement with formula if we saw any dip in Jackson's weight gain, because we needed Jack to grow, and hopefully catch up, with the curve as quickly as possible.

After a month of trying, being exhausted, and having some really bad pain that had not been there with pumping, I had a lactation consultant come out to the apartment. The first thing she did after I gave her my whole sad story was "I wouldn't have pumped past that first week." THANK YOU. She was very supportive, checked Jackson's latch, weighed him to see how much he was getting in a feed (less than half of what he was taking in a bottle), and suggested we get checked out for thrush. Thrush is an infection that is really common among babies who got antibiotics in their first days of life, which Jackson had. It also explains my pain. I took him to the pediatrician, who agreed that both Jack and I had thrush. That wasn't pain I was supposed to push through during breast feeding - I wish I had caught it earlier.

Once we were both cleared I decided to do a whole day of breast feeding and not give Jack a bottle at all and I'd feed on demand. I don't want to get into details, but it did not go well and I got very concerned about Jack's weight and intake. At that point I decided that this wasn't healthy for either of us, but I was still committed to Jackson getting mother's milk, so I decided I would exclusively pump and that would be that.

So, but for the pockets where I attempted breast feeding, Jackson has been bottle fed with breast milk exclusively for six months now, plus the month were he was getting my milk with a tiny bit of formula supplemented. I wish so badly that breast feeding had worked out for us, but it didn't, and I've been in a healthier place mentally since making that decision. Aside from my sanity, here are some of the other reasons why pumping has worked for me:

• A huge benefit is that I can do things like go to the office one day a week, go for the occasional nail or hair appointment on the weekend, or go out on a date with my husband when my Mom is in town to watch Jack because there's a bottle of milk ready for him, and he takes a bottle from anyone.
• I think it's been great to be able to measure the amount of milk Jackson gets and see the steady increase. As a result, supplementing with formula has never come up for discussion since and Jackson is on the growth chart with children born at 40 weeks and it does not need to be adjusted for his prematurity (when it is, he is over the 90th percentile in height and weight).
• Denton was able to help with middle-of-the-night feeds when Jack was still waking up (when he came home, he was eating every three hours, 24 hours a day). Denton might say this is a negative, but his help was invaluable when we first got home and I could finally rest and recover from my c-section without having to go back out to the hospital.
• You still get the weight loss benefits of pumping. I've been doing Weight Watchers for the past four months and I get extra points on my Daily Points Target to account for nursing, and losing weight is so much easier when you get to eat a lot of food.
• Babies get all of the benefits of breast milk - I have had a terrible cold for over a week now and Jackson has not so much as sneezed. I truly believe he is getting my antibodies and but for the visit to the pediatrician for thrush Jackson has never been to the doctor for anything other than a wellness visit.
• I have a pretty healthy freezer stash, so when I'm ready to stop pumping Jackson can still be on breast milk for a few extra weeks

A few drawbacks are:

• I was seriously not exaggerating when I say pumping is the least fun aspect of motherhood ever. Cleaning up an accident, watching your baby get a shot, poops that come with solid foods - all better than pumping. At the end of the month I'm always ready to quit, but then I make it to the next month and am in awe that I've made it however many months, and I keep going. At seven months I almost threw in the towel. I take it month-to-month at this point with no real goal (although making it to a year would be fantastic - I said that about making it to six months).
• You don't get the same rush of endorphins you get from directly breast feeding your baby. Although, like my sage friend Shelly said to me early on, it's not like you are never holding your baby.
• With exclusive breast feeding there are no bottles or pump parts to clean and you don't have to lug a pump around. I managed to keep pumping through two out-of-town vacations and we are going out of town next week for Christmas, and it just adds to the luggage you have to haul. And even though you have to clean bottles with formula feeding, at least you don't have the pump.





• I have some serious privacy and modesty issues after some things that happened while I was in the hospital, and as a result I can't pump in a room with people. Denton is the only person I am truly comfortable pumping around without anxiety, and anxiety has a huge effect on my supply. So when we have visitors everyone has to clear the room. This might be my own issues though, not relating to pumping in general.
• You know the status of your milk supply at all times. When you are breast feeding, your supply waxes and wanes, but you don't know that because a baby is attached. When you are pumping and measuring your breast milk you know exactly how much you make, and so when there is a supply dip you know all about it. I have gone to great lengths to keep my supply up (most effective - controlling stress when possible, fenugeek and blessed thistle supplements or Mother's Milk tea, and Milkmakers).

My best advice (if solicited, of course) should someone need to pump exclusively is to rent a hospital grade pump - I rented a Medela Symphony and it established my milk supply and is a powerful pump. I rented it for six months.

I bought the Medela Pump in Style Advanced to use when traveling and for the one day a week I'm in the office, and in November I turned in the Symphony and now only use the PIS. If I saw a major drop in my supply I would go back to renting the Symphony, but for now the PIS works great.

Other absolute must haves for exclusive pumpers are a pumping bra, two sets of pump parts (so you can wash one and have the other ready), and at the very least a double pump, if not a hospital grade pump to start.

The absolute best resource for feeding preemies and exclusive pumping (and probably breast feeding in general) is kellymom.com. Their page on exclusive pumping is here.

Like I said, I have no idea how long I will keep this up. I know that formula would not change Jackson's health and happiness at this point, and that he has already received so many benefits from my milk. Now that I'm a mother and have had problems with breast feeding, I feel very strongly that whatever is best for the mom is what's best for the baby, and that includes formula. Do what you got to do, girl.

I told Jackson I was writing a ten page essay on pumping and this is what his 18-pound-self (as of his flu booster nurse visit last Friday) had to say:

This was actually Denton's handiwork, so he was looking at Denton like that, not me. If you've made it this far in the post, tell me how you handle unsolicited mothering advice (I'm asking for it) and what you are most sensitive about to make me feel better. Or, just leave a comment about how cute Jack was when he was a swaddled newborn with a scrunched up face.