QUESTION: Dear Friends-with-Wisdom:  I am the father of a prematurely born infant who must remain in Intensive Care for perhaps another two months. The little angel grows steadily and seems well though just trying to catch up on growth. The complication that ushered her out of Mother's womb was a sudden strike of pre-eclampsia.

The issue now, for the mother and me, is how can we maintain breastmilk production? We are adamant that we breast feed as long as biology allows.  For the past month, my wife has pumped a supply to be fed to our daughter in the ICU. In this hospital, breast feeding is not done but rather the milk is fed through a syringe (as Natalia, the baby, is too small?). I have sought you out for your wisdom as my wife has increasing difficulty expressing her milk in any volume. It appears we are losing the effort to keep up with Natalia's growing appetite. This then portends greater difficulty as Natalia will not be out of ICU until, at least, 2 more months.

Is there anything we can do to keep up production so that we can supply her now and have a rich source waiting for her release? Please, any wise insight you might send our way would gain us all great fortune.

With Very Great Gratitude,

Andrew & Hua Sutherland
Taiwan

What kind of breastpump are you using? Most Lactation Consultants (LCs) recommend using a hospital grade, piston driven breastpump like a Medela Classic or Ameda-Egnell Elite; and pumping both breasts at the same time (double pumping). There may already by one in the NICU at your baby's hospital, and you will want to rent one for your use at home.

It is important that you follow specific guidelines for pumping for your baby: (1) wash your hands thoroughly before expressing your milk; (2) each mother uses her own personal collection kit (the tubes and bottles); (3) all the parts of the collection kit that touch the milk need to be cleaned after each use with hot soapy water and thoroughly rinsed then placed on a clean paper towel, covered with another clean paper towel, and allowed to air dry; (4) the expressed milk should be labeled with the date, the baby's name, the baby's hospital ID number, etc; (5) the milk from each pumping should be kept in its own container and not mixed with milk from other pumpings; (6) milk should be stored in feeding sized portions.

You should be pumping every 2 to 3 hours during the day and once or twice at night. You may be pumping more than your baby is eating right now, and that is okay. Your baby will grow quickly, and soon be placed at your breast for his first nursing!

Remember that your milk let-down response (MER) is crucial to your milk expression. Stress, tension, fatigue, etc. can produce hormones which can reduce your MER. Try to set up a milk expression routine, so that your MERs are more productive. Here are some ideas: (1) Allow enough time so you don't feel rushed; (2) Try to express milk in a familiar and comfortable setting - privacy and comfortable seating promotes relaxation, which enhances your MER; (3) try to minimize distractions - take the phone off the hook, etc.; (4) follow a pre-expression routine - use warmth to relax and stimulate milk flow by applying heat to your breasts or putting a warm wrap around your shoulders - stimulate your breasts and nipples through massage - relax with deep breathing and visualizations; (4) think about the baby - look at his picture, smell the blanket that he was wrapped in recently - imagine him at your breast while you are expressing your milk; (5) interrupt your pumping several times to pause and massage your breasts.

The important thing is to establish a daily routine and stick to it. Pump at least 10 to 15 minutes, and pump every 2 to 3 hours during the day and 2 to 3 times at night. Some women find that they only need to pump once at night. It is important to listen to your body and do what feels right to you. If you drop to once per night, and your breasts become overly full, you may want to consider increasing to twice a night. Some women find that if they only express the small amount that their baby needs, their breasts begin to revert to their pre-pregnancy state, and milk supply is difficult to increase later. There are herbs that are known as galactogogues -- fennel, fenugreek... Please see:

http://www.erols.com/cindyrn/fenuhugg.htm
http://www.erols.com/cindyrn/feungr.htm
http://www.erols.com/cindyrn/24.htm

And there are medications that are known to increase milk supply -- Reglan (metoclopramide) and Motilium (domperidone). Please ask your physicians about them.

The easiest way to increase your milk is to nurse your baby more frequently, and to pump more frequently. Think of it this way - Your total capacity of milk production = 100%. What your baby takes on a day to day basis is about 80%. That leaves a "residual" of about 20%. As a baby eats more solids and slowly weans, he takes less than the 80%, so the mother's supply decreases slowly. You are trying to increase your milk, so you will need to dip into that 20% residual with extra pumpings.

Congratulations again on the birth of your son. He is such a lucky little baby to have such a dedicated mother willing to provide her milk for him! Please feel free to contact me again if you have any further questions!  

Andrea Eastman, MA, CCE, IBCLC

Important Disclaimer

This Breastfeeding.com service is designed to help visitors obtain advice and guidance. You are solely responsible for the outcome of any services and/or advice you are given.   Breastfeeding.com is not responsible for any services and/or advice given by the consultants, and shall not be liable or responsible to any person or entity for any loss or damage caused, or alleged to be have been caused, directly or indirectly by the information or ideas contained, suggested, or referenced. Your participation in this service is solely at your own risk