The Pump Room

by Stephanie Sleeper

Quiet, curtained, sweet milk smell. Antiseptic soap, rocking chairs, stacks and stacks of tiny little bottles. Classical music, warm, whoosing sound of mothers pumping. These are my memories of the pumping room at the NICU where I pumped for my son, every three hours, every day, while he slept, hot, monitored, and still, in his hospital bed, waiting for open heart surgery.

My son, my first baby, was born with a congenital heart defect called tetralogy of fallot, which is the most common of congenital heart defects. We had no idea of his defect before his birth as prenatal testing doesn't often detect it. When he was born on Christmas eve, pale and gasping, and the murmur was heard, we learned the news. Luckily, so very luckily, it is correctable-with two surgeries, one temporary and soon to place a shunt to allow blood flow to the lungs, and a permanent repair in a few months. I began pumping the morning after his birth. So strange, attaching plastic to my nipples, turning on the pump, and staring and waiting for something to come out of them.

When nothing came out that day, I began to worry. Why no colostrum? Finally, the next day, a few sticky drops, not even enough to go into the bottles. My son's NICU nurse told me not to worry, that soon there would be a "flood" of milk. I kept pumping, dragging myself down to his empty room every three hours, all night long, freezing in the winter cold, to the rented pump on his dresser. I stared at the bottles, willing something to go into them. Finally, six days after his birth, yellowish sticky milk, about 5ccs worth. I proudly froze them and carried them into the NICU each day, where they were able to combine one whole day's worth of pumping into one single feeding for my son.

In the pump room I cried, wishing for more milk. My son needed it, why could I not make any more? The nurses told me to eat oatmeal, alfalfa, and drink vegetable juice. "Eat like a cow," they said. Lactation consultants told me to pump more often and take fenugreek. And to relax! Nothing worked. How could I relax? I finally was able to pump about an ounce total from both breasts every three hours, and my supply settled there.

At ten days old he latched on for the first time. He had received a blood transfusion that morning, and had a little more energy. He did so well the NICU's lactation consultant said "he really wants to be a breastfed baby!" It felt so wonderful, I could hear him swallowing and he felt so heavy and solid in my arms.

On the day of his first surgery I went to the pump room every two hours. "Simulate a growth spurt" the LC told me. I felt so helpless just waiting in the waiting room, I had to do something. So I pumped. And pumped some more. I was determined that there would be a freezer full of milk waiting for him when he was ready to eat again.

He did very well in surgery, though he looked like a tiny pale vampire rather than a baby when he came out. He did drink all my milk starting the next afternoon. They let me breastfeed him once, when he was nearly ready to come home. And the cardiac nurses (he was no longer in the NICU but the pediatric cardiac ICU) were very rigid in their advice: "nurse no more than twice per day, no more than twenty minutes or you'll tire him out! He needs all his energy for growing and recovering." His cardiologist's advice was even more dire: "Make sure he eats every three hours or he might get dehydrated and the shunt will close. If that happens it will be disastrous. That shunt is keeping him alive." What was I to do? I knew from watching his oxygen monitor that breastfeeding didn't "tire him out" like they said, in fact, his oxygen levels went up when he breastfed. But I also knew I didn't have enough milk to keep him hydrated. And the lactation consultant told me that my supply would increase the more he nursed. I was in a breastfeeding Catch-22. If he didn't nurse I wouldn't make more milk, but if he did nurse he might turn blue and die!

So I didn't nurse, I continued to pump. I latched him on 3-4 times a day, then fed him a bottle of formula to keep him hydrated. Then I pumped. Our "feeding ritual" took at least an hour. I could so easily have given up at this point-latching on was difficult, I had so little milk, and the hour-plus feeds were sucking the life out of me. But I would not accept defeat. His cardiologist told me that his fragile immune system needed the immunities in my breastmilk, and I was so angry at my body for failing him. I couldn't quit, I would not quit.

Finally my OB prescribed reglan, which gave me twice as much milk, and I then switched to domperidone to avoid side effects of depression and nausea. After many weeks we finally figured out how to nurse side-lying at night and he began to love it. We nursed around the clock, especially at night. I tried, on the advice of yet another lactation consultant, to gradually reduce the formula supplements, with no luck. By this point he was beginning to love nursing so much he would refuse bottles. (Some weeks later we finally figured out a dairy allergy was likely responsible for this.)

At the time of his second surgery, at three months old, I nursed him the night before (until his food was cut off) and afterwards, as soon as he was able to eat again. One of the proudest moments I have ever had was overhearing his night nurse inform the next shift that my son "was primarily breastfed, and sometimes gets a bottle of good start, but he hasn't gotten one tonight." Before this point I had been thinking of him as primarily formula-fed, with breastmilk as his supplement. When I heard the nurse I realized this wasn't true, and it helped so much to hear it. The cardiac unit team leader told me that she rarely sees "heart babies" succeed with breastfeeding, and she proudly pasted a "Mom is breastfeeding" label on his monitor. I was so proud of that label, I asked to take it home.

Even though we haven't been able to exclusively breastfeed, I am still nursing and supplementing at seven months. My son is fully recovered from both surgeries and is not expected to need any more. I am very active on boards for "heart babies" to try to encourage moms to breastfeed, and to tell them that even if they aren't able to do it exclusively, it is so worthwhile to see that look of ecstasy when his eyes roll back in his head and he slurps happily. I am so very glad-and proud-I did not give up.