Sunday, August 13, 2006

Welcome to the Wacky World of Exclusively Pumping

Why do people exclusively pump?

Because we feel breastmilk is best even in a bottle. Women exclusively pump for various reasons including premature babies, babies in NICU, cleft palate, uncomfortable breast-feeding in public, tongue tied, or inverted/flat nipples. The list could go on forever. However, most of us that end up exclusively pumping would much prefer to directly breastfeed if that worked. Pumping is a ton of work. It is like combining breast and bottle feeding together. You will spend hours hooked up to a machine and others cleaning bottles and pump parts.

You will likely still get some of the joys of breast-feeding like plugged ducts, cracked nipples, engorgement, and even possibly mastitis. When you tell friends, family, other moms or even your own doctor they will probably look at you like you are crazy. Just to let you know you are not alone and no matter why you chose this you should be very proud of yourself. Some of us kept trying to get our babies back to our breast; some were successful and some not, others have chosen not to go there again as issues with breast-feeding couldn't be resolved or we chose to just let it go. Some of us have made it a week, others months and some miracle moms a year.

How do you answer, "Do you breastfeed?"

This can be an awkward thing for many exclusive pumpers. Often you feel you don't fit in with either breast-feeding or formula-feeding moms. Some people say yes, some no, sometimes you go into lengthy details on what you do and why. Remember this, it is no one's business unless you want it to be. You can explain your situation and people will just think you are crazy and may never understand why you just can't breastfeed or why, if it was so hard, you just don't formula feed.

Everyday you pump is a success. If you exclusively pump a day, a week, a month, 6 months or one year or more every drop of breastmilk your baby gets is a gift. So many moms give up on breast-feeding. We want people to know there is another option. We understand how hard it is so if you chose to supplement with formula or had enough of this crazy pump thing you also have our full support.

Congratulations on your new baby!

Pumping Rules

Here are the basic rules to exclusively pumping:

1.) Get a Pump: If you are going to do this you will need to invest some money in a pump. We recommend a double electric pump. Hospital grade would be best but as for most they are typically out of most people's price range. Pumpers have used the Medela Pump in Style and the Ameda Purely Yours with success. Some people do manage to get through with a manual pump such as the Avent Isis but according to the "experts" the best way to stimulate milk production is to double pump.

2.) Get pumping: For the first 12 weeks of your baby's life you will need to pump every 2-3 hours, 24 hours a day to establish a good supply. If you were breast-feeding that would be the same amount of times your baby would normally eat in a 24-hour period. You will need to pump a minimum of 15-20 minutes and will need to pump 5 minutes past flow to stimulate milk production. If you don't fully empty, it can decrease your supply or lead to problems like plugged ducts and mastitis. This means if it takes 45 minutes to empty your breasts you have to pump yet another 5 minutes. After the initial 12 weeks you can usually start to drop pumps. Most choose to drop the middle of the night pump first. For most the first pump in the morning will yield the most breastmilk.

After you pump you may want to use a product like Lansinoh to moisturize your nipples. Do not use just before you pump. It is sticky and can cause cuts. Some have used olive oil as a natural lubricant between their breasts and horns. Also letting yourself air dry or putting breast milk on cuts can be helpful. If you wear breastpads make sure you change them frequently.

3.) Storing: Please click on the following link for storage guidelines. Don't forget to date and rotate your stock. It may also be helpful, at a later date, if you include information on the label, such as the amount of breastmilk enclosed, any medications taken (ibuprofen, acetaminophen, etc.), and if a potentially gassy food was eaten that day. An example of this would be next month when your baby has an upset tummy, you will know that the culprit could be that broccoli casserole you had for dinner before you pumped and know to possibly eliminate that food while pumping.

4.) Cleaning and Sterilizing: You will need to clean and sterilize your pump parts daily. A trick us pumpers use is that between pumps we put our pump parts in the fridge in a Ziploc bag. If you choose this time-saving method, then once a day, you will need to either hand wash the parts with hot soapy water and let them air dry or run them through a cycle in the dishwasher.

5.) Supply: There are many things that can either hinder or help your supply.

In our experience this is what can be helpful:
-making sure you get enough calories (200-400 more than when you were pregnant)
-drinking a ton of water
-getting enough rest
-using herbal supplements, such as fenugreek, alfalfa, and/or mother’s milk tea (available at most vitamins stores such as GNC) or blessed thistle (available online) - please check with your doctor before starting one of these supplementations
-some doctors have even prescribed Reglan (metoclopramide)
-oatmeal (not the instant kind)
-relaxing while pumping (make yourself a handsfree bra by simply cutting holes, in an old bra, just big enough to slip the pump horns through)
-looking at a picture of your baby if you are not with your baby
-if your baby will comfort suck this can stimulate production
-warm compresses while pumping
-massage while pumping

This is what can hinder:
-not eating and drinking enough
-not sleeping enough
-not pumping long enough to empty breasts
-wearing underwire bras or bras that are too tight
-skipping pumping sessions (especially in the early weeks)

What do you do if your supply is slipping?

Have a Pumpathon. You will need to increase the number of minutes and sessions you pump in a day. We suggest, if you can, every 2 hours (or as much as your boobs can take) for a full 24 hours. You will likely see an increase in a day or two.

Thursday, August 10, 2006

Stories from the Pumping Trenches

Christine’s Story

Danielle Nicole was born on January 3, 2006. I start with her birthday because it differs from her due date, which was originally February 4th. I think that’s where my “exclusive pumping” existence began. Danielle was a normal sized baby at 7lbs, 13oz and 19.5 inches. However, since I was a gestational diabetic, the hospital staff watched her blood sugar like hawks and supplemented her with formula several times within the first 24 hours of life. Most of the nurses were great, supplementing with cup or syringe feedings, but I now know that a few bottles were given on those trips back to the nursery for sugar tests.

Danielle was very tired for the first 72 hours, as all babies are. We nursed on demand and woke her up for feedings while we were in the hospital, often calling on the nursing staff for support. Once again, most of the nurses were great, but others were so “pro-formula” that it was difficult to get their support. The Lactation Consultant was unavailable during my stay, so we tried to go at it alone. It wasn’t until her first check-up with the pediatrician on January 6th that we realized something wasn’t working.

Danielle was severely jaundiced by her 3rd day of life. Her pediatrician understood my desire to breastfeed. In fact, she encouraged me and continues to do so to this day. She set up an appointment for Danielle and I with a Lactation Consultant at another facility that day. Laurie, my new LC, checked Danielle’s Bilirubin and determined that I needed to start pumping and supplementing breast with pumped breast milk and/or formula. Unfortunately, Danielle also had developed a lazy suck and would not take in enough of my areola for an effective latch. I spent nearly 8 weeks with sore, cracked, blistered and bleeding nipples until my LC determined that “the damage was done” and it would be a “miracle” if I could get Danielle back to breast. She also said that it was “highly unlikely” that I would be able to provide her with enough breast milk by pumping. She was partially right. Danielle never did latch on. Although this “failure” was an incredible blow to my “super mom” ego, I refused to let Laurie be totally right!

I’ve been pumping since January 6, 2006. As I write this, I have been giving my daughter expressed breast milk exclusively for over 7 months. I plan on doing so until she is at least one year old. Her pediatrician thinks I am a hero, my family thinks I’m crazy…I think I’m a mom who’s trying to give her baby the best possible start at life. I’d do it all over again in a heartbeat.

Jen’s Story

Hayden was born November 22, 2005 at 10:05 pm. His due date was December 20, 2005. For being a month early he was of a fair size weighing in at 6 lbs 8 oz and measuring 19.5”. When I was admitted to the hospital I let the nurses know that if necessary I was ok with giving formula because I did not know if my son would have any medical issues but that I wanted to breastfeed as much as possible. I did everything I read in books about breastfeeding. I had a natural birth, as my son was ok physically so I put him immediately to my breast and had him on my bare chest. In those first moments he seemed to latch. We were sent to our recovery room and all went to bed. Due to him being premature the hospital watched his weight more closely. It is normal for a baby to lose weight after birth but due to him being premature they wanted him to lose as little as possible. The next morning when we woke our breastfeeding experience started.

Every time I tried to feed Hayden he would fall asleep. I swear just the sight or smell of my bare chest and he would be knocked out. We tried every trick in the book including; tickles, changing diaper, talking, and cool compresses but he would be out right away. Because of this I had to start to hand express to get the colostrum out then we would hand feed it to him in a dropper. We lived by a timer. Every 3 hours we would start the process of trying to get Hayden to nurse and each time I would end up hand expressing with the help of a nurse or lactation consultant. When they checked his weight later that day he had lost too much weight and they wouldn’t let us leave the hospital. I was determined to get this breastfeeding thing so I tried and tried and 3 days later we were still in the hospital. Each time we came to a feeding I was stressed and so became my son. The lactation consultant wasn’t very supportive and made me feel even worse like I wasn’t trying and my son should just get it.

I should add I have flat/inverted nipples. Yes it is out there for the whole world to know now. Nothing brings these girls out. Trust me I have tried everything. Even pumping for 60 minutes draws them out for maybe 3 seconds before they go back into hiding. I found out this may be an issue even before I had Hayden so for the week before I went into labor I started to wear shields that are supposed to draw your nipple out. Okay, enough about my nipples and back to the story.

On my fourth day at the hospital a new lactation consultant walked into my room. She was pulling a breast pump and had a nipple shield. We had to work at getting my milk in. So I started pumping and feeding my son formula with a dropper. When they finally let us out of the hospital after 5 days my milk still wasn’t in and Hayden’s weight had dropped to 5 lbs 10 oz.

My milk took a full 7 days to come in. I started to pump and breastfeed. I tried to breastfeed Hayden every time he needed to eat. I was using a nipple shield because he would not latch without it. Even if he did latch he would take 4 sucks and be asleep and we could not wake him. However, 10 minutes later he would wake up screaming for food. For the first 2 weeks we only ever gave Hayden milk with a dropper or put him to the breast. This took quite a bit of time so we switched to a bottle.

I was so disappointed in myself for not being able to breastfeed. I had a lactation consultant come and try to work with us and basically she told us we were a lost cause. Slowly I just started to pump and feed Hayden with a bottle. I did try several times a day to get him to latch up until the day I quit pumping. I hoped as he grew and got stronger he might get the strength to directly breastfeed so I tried everyday at least once a day.

So I survived pumping for 4 months. Until Hayden was almost 3 months old and due to his weight issue I had to feed him every 3 hours and pump a minimum of every 3 hours 24 hours a day to keep my supply up. As you can imagine this was very physically tiring. I got my first plugged duct at about 5 weeks postpartum. After that I had them constantly. I got mastitis the first time at about 10 weeks postpartum and was put on antibiotics. I always had cuts on my nipples and usually started to bleed every time I pumped. As soon as I would get rid of a plugged duct another would come.

At about 12 weeks postpartum my breasts magically knew my son would have a growth spurt so my supply grew. It actually exploded and didn’t calm down. I was pumping every 3 hours and I was pumping for 45- 60 minutes each time to empty myself. I would have to stop pumping to change over flowing bottles and was getting 50-60 oz a day. Hayden only ate about 28 oz. I never seemed to empty fully and my plugged ducts just got worse. At about 14 weeks postpartum I got mastitis for my second time. This time I got it really bad though and ended up in the hospital for a few days for IV antibiotics. When I was at the hospital my boyfriend and I made the decision I would stop pumping. This was one of the hardest decisions of my life. I slowly weaned and at 4 months postpartum Hayden had his first bottle of half formula and half breastmilk since he left the hospital. I am a firm believer in the power of breastmilk and was so disappointed in myself for first not being successful at breastfeeding and then not at pumping. I have learnt that I am not alone in these feelings of disapointment and guilt. I had quite a stash in my freezer though. I had enough breastmilk to give my son 8 oz of the 28 oz he ate a day in breastmilk until he was 6.5 months old.

Amy’s Story

After a difficult pregnancy and seven weeks of bedrest, I gave birth to my third child, Maegan, on October 7, 2005 at 36 weeks. She was 6 pounds 13.6 ounces and was 18 inches long. I immediately tried to breastfeed her, but she just would not latch, so I decided to just let it go until we were alone in our own room to try again. I was allowed to spend 2 hours with her after she was born, still in the delivery room - which is not normal protocol for my hospital - and the entire time I kept saying “something is not right, her mouth is purple...” Everyone was trying to reassure me that she was fine, but I knew, as only a mom knows, that there was something wrong and I would have to repeat the “black days” in the NICU once more. They finally got me into my postpartum room and not five minutes later a nurse came in and tells us that our baby has turned grayish and was not breathing properly so they had transferred her to the NICU and that they would let me know when I would be able to see her. I KNEW IT!!!

I was not allowed to hold her for the first 24 hours that she was in the NICU, so I immediately began pumping. She was fed my breastmilk through a tube and then once I was allowed to hold her, I attempted, again, to breastfeed. I was still unable to get her to latch and I could not relax and spend the necessary time learning how to breastfeed (I was only allowed to hold her for 30 minutes every 3 hours). They had strict rules about intake and output and because she was losing more weight, they were supplementing her with formula until my milk really came in a couple of days later. Every chance I got, I would put her to the breast, but it was such a struggle and I decided (once again), I would let it go until I got home and was alone with her to work on it. I continued to pump...

On the first day we were home, I put her to the breast at every feeding; still no latch and a lot of screaming. So I would break down and give her a bottle of my milk and try again the next time. I looked for different reasons why she was not able to latch, I figured it was because of her size and the size of my breasts or that her mouth was too small; my nipples would be out until she touched them and then they would go flat; too many people around (visitors), etc., but even looking for reasons was not fixing the fact that she was still not latching. I was painstakingly pumping with my manual pump after each failed attempt of breastfeeding and decided to buy breast shields. I thought they would do the trick, but she would only latch for a few seconds, pull off and start screaming again. Frustration really kicked in when I was so engorged that she stopped trying all together. I went to a breastfeeding shop and rented a hospital-grade pump (Medela Symphony) and I went home and pumped immediately - I pumped for an hour and got so much milk out that I had to switch bottles in the middle so as not to overflow. What a relief that was!

I continued over the next few days with bringing her to the breast, but because of her low weight (just over 6 pounds) and high bilirubin levels, we had to go to the pediatrician’s office every day that week for weight checks and blood work. Well, on her 11th day of life, her bilirubin went back up to an extreme level and she was admitted to the NICU at the children’s hospital. She was taken off of breastmilk and put on formula while having intense phototherapy again for a couple of days, thus further hindering our breastfeeding attempts. Even at that hospital, I continued to pump...

For the next two weeks, her bilirubin levels continued to escalate, so again she was taken off of the breastmilk and put on formula (arg!) for a weekend so that she could be tested again on the following Monday morning. You guessed it, I continued to pump...

The findings from the tests showed that she had no genetic issues, so they diagnosed her as having breastfeeding jaundice. She was finally allowed to have breastmilk again (that was the last time she ever had formula, too).

Over the next couple of months we tried to have a breastfeeding relationship, and had one glorious weekend of her actually latching on for every feeding, but just as quick as it started it ended. The stress of failing every single time we tried was just too much for me to handle and pumping was going so well, so I decided to stop torturing myself and pump exclusively.

At her six month checkup, we found out she was tongue tied, which explained a little more why she would not latch properly. At seven months, she had her tongue clipped. I attempted two more times to breastfeed after her surgery, but it was too late - *sigh* - she looked at me as if I were an alien!

I have only had a few issues while pumping; nothing like the ones I had with breastfeeding; I produced enough milk to have a large stockpile, which was eliminated when I had my hysterectomy and an extended hospital stay where they had me pump and dump (unnecessarily) for the entire time; I rebuilt my stockpile, thankfully; I have ripped parts of my nipple off twice; I have had to take herbal supplements to maintain my supply; and I have used so many Johnson’s breast pads and so much Lansinoh that I might as well own stock in both companies.

This has been the hardest thing I have ever done in my life (the most time consuming, too), but here I am, over 10 months later, still going strong and determined to make it to that one year mark with her only getting my milk!