Bonding in the NICU

In Dr. Sears The Attachment Parenting Book, he talks about Birth Bonding. There are 8 "steps" he gives and I know that personally, I would have loved to more than anything to be able to do these immediately after birth with my babies but it wasn't possible. They were rushed to the NICU immediately after I briefly got to lay eyes on them. However, that doesn't mean you can't still have the experience of bonding with your baby and attaching to each other. I'm going to go through each "step" or tip that Dr. Sears gives and talk about how you could still do these while having a baby in the NICU. His suggestions are meant for the first hour after birth and while this generally isn't possible with preemies, these tips can still be incredibly helpful as you struggle to get to know your baby and bond with him/her while you're in the crazy world of the NICU. Some of these tips that Dr. Sears offers are nearly impossible to do with a preemie that is rushed to the NICU, but I will offer possible alternatives or suggestions that can still help.

Dr. Sears *does* talk about premature babies and I highly recommend checking out his book The Premature Baby Book.

1. Hold your baby skin-to-skin immediately after birth.
Dr. Sears says: "The needs of your newborn after birth are...:peace, quiet, warmth and the arms of someone who cares. This is not just good psychology, this is good medicine. Draping baby over the mother allows natural heat transfer from other to infant that is at least as effective as putting baby in an artificial warmer. Skin to skin contact also soothes the newborn."

In the NICU, this is known as Kangaroo Care (from here on out, I'll refer to this as K-care). The benefits of K-care are plentiful.

For baby, they include:

Stabilization of the baby's heart rate 

Improved (more regular) breathing pattern/ less episodes of apnea (75% decrease!)
Improved oxygen saturation levels (an indicator of how well oxygen is being delivered to all the infants organs and tissues)
Gain in sleep time
More rapid weight gain
Decreased crying
More successful breastfeeding episodes
Earlier hospital discharge

For mom:
Improved bonding, feelings of closeness with their babies
Increased breast milk supply
Increased confidence in ability to care for their babies
Increased confidence that their babies are well cared for
Increased sense of control

All of these benefits have been proven time and time again by research. In fact, in countries without as many medical resources, this is often the only option for many premature babies to be kept warm. While preemie parents are often unable to have baby placed upon them immediately after birth, you can usually start K-care very soon after your baby is born. There are some instances when baby is too ill to be taken out of their incubator. These instances are much less than some NICU's would have us know but if this is truly the case, you can lay your hand firmly, but gently on your baby's body so that they can experience your touch at the very least. If mom isn't available right away, dad can and should do skin on skin with baby as soon as possible!
For more resources on K-care, see the end of this article. (Note: If you're having a difficult time getting your NICU to allow K-care, these resources are research based and supported. Bring them to the NICU and fight for your and your baby's rights!)

2. Notice baby's state of quiet alertness.
Dr. Sears says: "Within minutes after birth, the newborn enters a state of quiet alertness, the state in which, researchers have discovered, a baby is most able to interact with her environment. it's almost as if she is so enthralled by what she sees, hears, and feels that she doesn't want to waste any energy squirming. During this alert stage, the baby looks directly at the mother's eyes and snuggles at the mother's breasts....The quiet, alert phase lasts only an hour or so, and then the baby contentedly drifts into a deep sleep. You'll see this state again in the days to come, but for shorter periods of time."

At first, preemies spend only very brief periods of time with their eyes open, and do not focus on anything. Assuming your preemie does not have any eyesight issues like ROP, your preemie will only have a few periods a day, for possibly only a few seconds, when they are in a quiet alert state (The Essential Guide for Parents of Premature Infants). When your preemie is in this quiet alert stage, bring her about 8 inches away from your face, and interact with her. Smile, talk softly, change your expression often and allow her to enjoy this time with you. Do not let anything that isn't vitally important inturrupt these moments. If a procedure or medication needs to be done but it can be held off for a few minutes, do so and use your preemie's quiet alert time to interact with her. If for some reason you are unable to hold your preemie, get close to the incubator and put your face level with hers. Open the door to the incubator, place your hand on her and talk softly.

*NOTE: Even if your baby has eyesight issues, you should obviously still do these kinds of things with your baby! :)

3. Touch your baby.
Dr. Sears says: "Gently stroke your baby, touching her whole body. Besides feeling good, stroking has medical benefits. The skin is the largest organ of the human body, and it is very rich in nerve endings. At a crucial transition time in a baby's entry into the world, when breathing patterns are often very irregular, stroking stimulates the newly born baby to breath more rhythmically."

This is one of the things that almost ALL preemie parents can do with their preemies. There may be times when your preemie is too delicate or too sick to hold, but you can almost always touch them. Depending on their gestational age and health, there are different types of touch that should be utilized.
Still Touch is exactly what it sounds like. You lay a hand gently, but firmly on your preemie and do not move it around. Some preemies are very sensitive to being stroked and with the very earliest preemies, stroking their skin can cause damage. It is important to pay attention to your preemie and notice their reactions as you're touching them. It's also important to talk to your nurse about the condition of their skin and what is and isn't safe. If you feel your NICU nurse is not receptive to your needs and wants as a parent, ask to speak to the charge nurse.
Containment provides your preemie with a secure and nurturing human-boundary. Use your hands to provide containment by holding baby's arms and legs in a flexed position. This method of providing stability and predictability enables parents to gain confidence, especially during the early days in the NICU. Containment is useful for preemies who are medically unstable, fretful, or recovering from surgery. It can also be used during procedures where your prem needs support and comfort.
Movement: If you have an older preemie or as your preemie gets older and can tolerate movement, try a firm stroking on the bottoms of their feet or palm of their hands. If they are tolerating that well, you can try other movements. You can also try patting their butts. Keep a very close eye on them to see how they tolerate the movement. If they don't like it, stop and try again later.

4. Gaze at your baby.
Dr. Sears says: "Your newborn can see best at a distance of about ten inches, which, incidentally, is the approximate distance from a mother's nipple to her eyes. During the first hour after birth, a baby's eyes are wide open, as if wanting to relate to his new world."

Once they start getting quiet alert times, gaze at them often. Direct eye contact with them so they can see you and learn your face. Even if they're asleep, which preemies sleep far more than regular newborns, it is comforting for mother and father/partner to gaze at their newborn. As soon as you can get up to the NICU after your baby is born, spend time just looking at them. It can be difficult to see past all of the monitors and wires hooked up to your baby so look at their face. Absorb their tiny eyes and nose, see their ears, their sweet baby cheeks. Breathe deeply and just gaze at your baby.

5. Talk to your newborn.
Dr. Sears says: "Studies have shown that newborns can distinguish their mother's voice from that of everytong else very early in life. Baby can also recognize Dad's voice, as well as siblings'. Mother's voice comforts her baby and helps baby feel at home in the world."

Your baby has heard your voice from the time their ears were developed in utereo. They know your voice, as well as their fathers voice. Talk to your preemie all the time. Read to them. Sing them songs. Tell them about your day. Tell them what their big sister or brother is doing. Tell them how much you love them and how proud you are of them for being so strong and brave. They will be comforted by your voice.

6. Delay routine procedures.
Dr. Sears says: "Often times the attending nurse takes care of routines first, such as measuring the baby, cleaning him up, giving him vitamin K and putting ointment on his eyes...Ask the nurse ahead of time to delay these procedures for an hour or so, until you and your new baby have enjoyed the initial bonding period."

Procedures that are done on preemies right after they are born can almost never be delayed. Many times they are life saving things such as providing oxygen etc. However, you can ask that the blanket or towel they use to clean your baby off be given to you. The smells from the womb will help stimulate the mother's milk production. Also, speak to the nurses and doctors ahead of time and impress upon them how vital it is for you as a new mother to be able to at least briefly touch and look at your baby after they are born. Depending on how well they are breathing on their own, you may be able to spend time gazing into their face. Of course, this may not be an option but let your medical team know how important it is to you if it IS possible.

7. Breastfeed your baby in the first hour after delivery.
Dr. Sears says: "The baby's sucking and licking of the nipple releases the hormone Oxytocin into the mother's bloodstream. Oxytocin causes the uterus to contract and lessens postpartum bleeding. It also produces feelings of affection. Your baby's first sucking experience should take place at the breast. Newborns need to breastfeed early and often in order to learn correct sucking based on the sucking instincts they are born with."

Most preemies cannot be brought to breast right away. If they can, great! But in almost all instances, this simply isn't possible. What you can do however is start pumping as soon as possible. If you know ahead of time that you're going to deliver, have a pump brought in your room. If not, have a nurse bring you a hospital grade breast pump right away. You should start pumping as soon as you can, preferably within 3 hours after your baby's birth. Even if you get nothing at first, keep pumping to stimulate your breasts. It is imperative that you pump often, at least 8-10 times in a 24 hour period. If you're not responding well to the breast pump, try hand expression. Many moms respond to hand expression far better than they do to a breast pump. In fact, there is very new research that demonstrated that mothers who followed each electric pumping session with hands-on compressions of the breast extracted more milk and boosted their long-term milk production.

Human milk is far easier on a premature baby's digestive system. It contains lipase, a hormone that helps with fat digestion, which allows babies to be able to use more of the calories available in the milk. In fact, studies have shown that the milk of mothers who deliver a premature infant is higher in protein, fat, and other nutrients for catch-up growth. (Dr. Sears)

By 32-34 weeks gestation, most preemies can start attempting to breastfeed. That doesn't mean they'll catch on and start breastfeeding immediately (although some may!!), it just means that their suck/swallow/breathe reflex is usually mature enough to start trying to breastfeed. They may just nuzzle or fall asleep but keep trying! And I STRONGLY recommend not giving preemies any bottle feedings until breastfeeding is established. If the NICU insists on mouth feedings, you can try alternate feeding methods.

8. Ask for privacy.
Dr. Sears says: "This first hour after birth should be a quiet one in which Mother and Father/Partner focus on their new baby. Ask that you be left alone as much as possible during this time, so that your attention is not diverted from your baby by the hustle and bustle of nurses and other hospital personnel."

Again, this is something that you probably will not be able to have with your preemie. Most preemies have to go to the NICU right away, even if it's just for observation. However, once you can get to your preemie, unless your baby is having procedures done, there is no reason why you cannot have privacy. Even if you're in a NICU where there are multiple beds in one room, there are usually curtains or room separators that are offered for your baby and you can ask for privacy. Spend time with your preemie and try to focus on them as opposed to the machines and wires. It can be difficult to celebrate the birth of a baby if they are premature and sick but remember, you just had your baby and try to enjoy and celebrate the birth of your baby.

Kangaroo Care Resources and Articles
Midwifery Today: Kangaroo Care
Kangaroo Care Benefits
U of Michigan: Kangaroo Care

Pumping Resources
Pumping for your Preemie
More Nutritious Breastmilk for Preemies
Breastmilk for Preemies

Other Preemie Resources
Bonding with your Preemie
"The Premature Baby Book" by Dr. Sears
Ella's Halo

Works Cited:
http://preemiehelp.com/for-preemie-parents-and-carers/parenting-in-the-nicu/bonding-with-preemie-in-the-nicu/positive-touch-and-your-preemie
http://scopeblog.stanford.edu/2012/01/more-nutritious-breast-milk-for-preemies/
http://www.medicalnewstoday.com/releases/157955.php
http://www.exclusivelypumping.com/2007/11/30/pumping-for-your-preemie/
"PREEMIES: The Essential Guide for Parents with Premature Babies" By Dana Wechsler Linden, Mia Wechsler Doron, Emma Trenti Paroli

Guest Blog: Jessica's Story

My name is Jessica and I have the most beautiful daughter. The last 8 months have been a roller coaster and I wanted to share it with you and your readers:

When I woke up on November 16, the last thing I thought I would do was have a baby. I was 32 weeks pregnant, and my water broke. All I could do at the hospital was cry. I wasn't ready, the baby wasn't ready, my boobs weren't ready. Well, Elizabeth was ready!

She was born a mere 5 hours later. I got to see her for a few short seconds before she was rushed off to the NICU. She needed oxygen at first, then intubation and a vent along with two doses of surfactant to help her lungs inflate/deflate properly.

I started pumping that evening, and continued for about a week or so until I could start trying to nurse.

She didn't take her first feeding until Saturday, November 20th. I remember the exact date because that was a HUGE day for us. That was the first time we got to hold her. We couldn't even touch her before then. A few days later, we were given the go ahead to try to nurse.

At first, Lizzie would open wide, take the while nipple into her mouth, I would get my hopes up....and then she would quickly fall asleep. So, the nurses started letting her latch while gavaging her feeding. That way she would start to realize that mamma's nipple meant full tummy. At that point she was battling jaundice. She was under lights for a total of 10 days. During those 10 days, I could only take her out to attempt to nurse once a day, and she could only be out of the isolette for 45 minutes, maximum. This meant that usually, we would spend most of the 45 minutes struggling her sleepiness to get her to nurse, and my poor husband would only get to snuggle her for 10 minutes or so after I finally gave up and let them gavage a few milliliters.

Slowly, but surely, Lizzie started to get the hang of it. As she grew stronger and more stable, she got moved around to different spots in the NICU. I found out later that a couple of the nurses advocated for us to have the best spots in the corner because she was a good nurser and deserved the good spot - with more privacy.

We spent 29 days in that NICU, and by the end of it, Elizabeth was breastfeeding full feeds at least three times a day, and taking the others from a bottle. Thanks to my diligent pumping right from the beginning, she has only ever had breast milk.

We came home on December 15th, and the transition to full time breastfeeding was hard - on both of us. She had to work harder more often, and I had to spend virtually 24 hours a day with a 5lb baby attached to my breast.

Just when we were getting into a groove and both my husband and I were getting more than 2 hours of sleep at a time, BAM! I needed my gallbladder out - the day before Christmas Eve.

I was told that I needed to pump and dump for at least 24 hours after my surgery, and 24 hours after my last pain pill. I had a nice freezer stash, but not that nice. I only took the prescribed pain pills for one day so I could go back to nursing as soon as possible. I was more determined than ever to not give my daughter any formula. Hey, we made it through a whole month of being separated, I wasn't about to let one little bitty surgery get in my way now! Thankfully, an amazing friend offered to donate some of her frozen milk to bridge any shortage I may have had.

Once I recovered from surgery, we were back to smooth sailing. The amount of time she needed to complete a whole feeding had gone down to about 20 minutes or so, I was actually getting a little sleep, things were great!

Then I went back to work part time.

I was (and am) able to pump once (sometimes twice) during my work day, which is about 7 hours long, including drive time. I did everything to keep my supply up and keep enough milk in the fridge for her. I even pumped while driving. Slowly my supply started to dwindle and my pumping output went way down. *Enter amazing, beautiful, milk donating friend* She not only donated MORE milk to help us out, but gave me tips and encouragement to help get my supply back up. I have to admit, during that time, the sample cans of formula were looking kinda nice.

After trying fenugreek, oatmeal, sports drinks, and tons of water, my supply finally came back.

Now, Elizabeth is eight (8!!!) months old and nursing like a champ. We actually just had a day when she was ALL about the boob and wanted nothing to do with my husband or anyone else. He jokingly said, "Remember when it was a struggle to get her to eat? Geez, where'd that kid go?" Hmph.

She is starting to become more and more mobile, and more and more busy, so lately nursing has been the only break time we get. I love sitting down to feed my amazing daughter and looking into her eyes. We have such a special bond.

I am so very proud of her for being so strong so early. She has shown me a strength I have in myself that I never knew was there. I couldn't have done any of this without the help of my cheerleaders, including my amazing, supportive husband.

It was all so worth it.

Guest Blog: Kirsty's Story

Sophia's first feed

Sophia had a tongue tie when she was born which caused some problems latching. For the first two days we expressed colostrum with a syringe and syringe fed her. When my milk came in I used a pump and finger fed her with a feeding tube taped to my finger.

When she was three days old, we took her to the doctor to get the tongue tie cut. After that I called the lactation consultant to come and help with getting her latched correctly. I was able to feed (uncomfortably, and with difficulty) while she was there, but when she was gone I couldn’t do it properly. The same thing happened when my midwife helped me, and even my aunty. Whenever someone was there to help, I was sort of able to do it, but when I tried on my own, it just didn’t work. Sophia woke up at 3am, so I tried putting her to the breast again to feed her. She wouldn’t latch: I was full, leaking, and stressed; she was hungry and stressed. I called the midwife (yes, at 3am) in tears, with Sophia screaming in the background, and told her, “I can’t do it, she won’t latch”.

Sophia being finger fed EBM

“You need to both calm down, have a shower” (she knows Sophia loves the shower).

“Can you still express?”

“Yes”

“OK then, just express, and finger feed her.” I was so intent on being able to breastfeed, that I had totally ignored the breast pump.

I pumped, fed her, then we all slept happily.

After speaking to my midwife, and Plunket, seeing lactation consultants, and discussing it with my husband, I decided to just ‘give up’ on breastfeeding. Obviously it isn’t going to work for us, so there is not point stressing us both out trying. I went and purchased my own pump (until then I had been using one borrowed from my midwife).

Sophia having a bottle of my EBM

I was still finger feeding Sophia, so at about three weeks old we tried Tommee Tippee Closer to Nature bottles. She didn’t like them, so we went back to finger feeding. When she was six weeks old, we finally found a teat she liked, so were able to transition her to a bottle.

I managed to build up a good supply of milk in the fridge, so that when we went out for dinner on our anniversary I had a drink (two standard drinks). The next two pumpings I had to throw out because of the alcohol in my milk, and after that I noticed my volume had decreased.

For a while my supply struggled to keep up with demand, so I kept trying her at the breast to stimulate production. I also while cluster pumped for a day, and soon my supply was back.

I enjoy pumping, as it is a nice chance for a wee time-out – I usually use the time to read. If I have to, I am able to pump while feeding Sophia, or giving her a cuddle. It gets easier to do other things while pumping once you’re used to it.

In the first few weeks I felt like a terrible mother because I couldn’t breastfeed. I don’t have any photos of Sophia being finger fed, because I didn’t want there to be evidence of it in later years. Looking back on it now, it was crazy thinking. I have come to realise that I am the opposite of a bad mother. My baby is better off on expressed breast milk than she would be on formula, and full time pumping takes a good dose of love and commitment on my part.

I had many people offering to help me get my baby breastfeeding, but after two months I got to the point where I knew it wasn’t going to happen, no point stressing about it.

Sometimes when I am giving Sophia a bottle in public I feel like I have to justify myself to strangers and explain that it is EBM, not formula in the bottle.

Sophia - 7 Months

Because my pump is battery operated, I am able to pump when I’m out and about. I always take my power cord with me just in case, so I have been able to plug myself into the Mall Parents’ room, University Parents room, and at friends’ homes. I have pumped in a park, in a cafe, in the car on a long trip, on an intercity bus in broad daylight, and even on a full intercity bus at night time (they guy next to me didn’t say anything about it :s)

My greatest fear is that I’ll go on holiday out of town, and leave my pump, or part of it behind. I am thankful to say that never happened, although I did leave essential parts behind on two occasions when I went to Uni.

Sophia on her 1st Birthday

My supply started decreasing when Sophia was ten months old, and a couple of weeks before her first birthday it got so low I thought I wouldn’t be able to make it until her birthday. It made me sad, and I felt like a failure again. I started pumping just morning and night (12 hours apart), but I was getting a lot more milk, so was able to keep pumping for another couple of weeks. When I was only getting 50mls, I started pumping just in the mornings, which lasted about a another week. I was pleased I made it pumping exclusively until Sophia’s first birthday, and continued for a couple of weeks after. Because I got a few more weeks than I was expecting, when I stopped, there weren’t any sad feelings.

I am really proud of myself for pumping so long, and I’m quite surprised my supply managed to hold up for a year without a baby’s mouth to keep it going.

I am due with a little brother for Sophia in November and I am filling myself with as much information as possible and surrounding myself with supportive people in real life and online so I can feed him at the breast instead of from a bottle.

I made the most of my pumping experience, but it was hard. I would much rather be able to feed my baby whenever, wherever than need to have a bottle and somewhere to warm it, and have to remember to take my pump with me everywhere I go. Come November I hope to become a total NIPing pro!

I know with a little bit of help, support, and perseverance I CAN breastfeed. I have learnt from my past and will make sure I succeed at this. I keep telling myself “I WILL BREASTFEED”, and I really do mean it.

I’m taking the lazy way out this time and breastfeeding. No bottles or pumps for me (except for pumping milk to donate via HM4HB NZ).

Kirsty's story originally was posted on Anything Baby minus the exciting update! Good luck to you Kirsty and please keep us posted!

Guest Blog: Why Exclusively Pump?

While the answer seemed obvious to me I quickly learned that this was a question that surfaced to many people’s minds when they learned that I exclusively pumped for my daughter Camille. First the insurance company initially refused to cover my hospital grade pump because when they asked why I pumped I gave the wrong answer. Inability to latch and low supply are not insurance worthy reasons to pump. We don’t have a lot of extra money so we thought it was worth trying harder to get coverage. Insurance companies used to cover pumps more liberally but lately they have become much more discriminating as to who truly needs to pump and who doesn’t. My insurance company covers the pump for infants with medical problems such as cleft lip or prematurity. Of course these infants need that extra help to get the breast milk they deserve BUT…Who chooses to pump for the pure enjoyment of it? The vast majority of EPers (exclusive pumpers) do so b/c they have to. Some full term babies don’t latch for whatever reason and some mothers have to go to work. Why are these reasons somehow less valid than cleft lip and prematurity? Bottom line is that all of these babies need their mother to pump in order to get breast milk. Well, I was pretty determined and I don’t know how I EVER found the time or energy to do this going on basically no sleep but with a lot of calls to different people I finally did get the insurance to cover my wonderful hospital grade pump.

Another source of questioning came from my in-laws, specifically my mother-in-law. Now I’m not knocking mother-in-laws and many are wonderful additions to the family but my mother-in-law hates me. No kidding, she has made it pretty clear that she doesn’t like me but I’m still married to her son so she’s going to have to deal. Anyway, she hated that I exclusively pumped and was constantly recommending that I switch to formula. I told her how important it was to me that Camille get breast milk and all the reasons why I pumped but if anything that made her more set against it. I’m not sure exactly why it bugged her so much, maybe she thought I was showing her up b/c she gave her son formula even though she didn’t have any latching or supply problems at all, but it just unnerved her that I was pumping. She enlisted the help from the women in her family and her hairdresser to try to get me to switch to formula. When my husband and I visited that first Thanksgiving with our brand new daughter they all tried to persuade me to switch to formula. They undermined the benefits Camille was getting and gave me absolutely no credit for all the hard work I put into making sure Camille got the best food. One of them actually said “weird” when I explained what I had to do. The hairdresser, also a NURSE, told me that the benefits of breast milk were only in the first couple of days. Does she think I’m stupid? Also, how mean! That was the short period of time Camille was actually on formula due to my low supply. Now I’m not sure if the hairdresser knew this but how hurtful to say all my work was for nothing b/c the one time Camille needed it I couldn’t give it to her. Of course I know better and I was shocked a nurse would give me mis-information just to undermine me. The question “why are you pumping” quickly morphed into the demand “you should just switch to formula b/c pumping is worthless.”

Why pump? Even the most superficial research over breast milk will give you many reasons why breast milk is the perfect food for babies. (Research also shows that this benefit is amplified with premature babies. Babies that are, as a group, probably less frequently breastfed than term babies due to latching problems actually benefit more from breast milk.) I was determined that my daughter, Camille, get these benefits. She was a very high strung little baby and refused to latch. She hated nursing and would scream continuously every time I tried to nurse her. Even if she did latch I think pumping would have been more practical in the beginning b/c she ate such small amounts at a time. For many months she would eat every hour or more and then usually not more than an ounce. The most she would eat at a time was at night and it was usually 2 ounces. We suspected acid reflux was at the root. It was actually easier to pump larger amounts fewer times a day than to breast feed her for little spurts 20 times a day! My little girl was not premature but there were in-utero problems. I had preeclampsia and there was an unknown length of time (probably several weeks) where she was not getting nutrition from the placenta. She had stopped growing and was small for her gestational age. I was heartbroken. After she was born people frequently commented on how small she was and said she looked like a preemie. One woman walking by at the store said “look at that baby! It doesn’t even look real. It looks like a toy.” It cut me to the quick to hear that. If I could give this tiny person a special gift that would last her a lifetime and for which there could be no substitute I would. And I did.

I’m proud to say that with the exception of several bottles of formula the first few weeks, my daughter ate exclusively breast milk the first five months of life and after that breast milk with a slowly increasing amount of solids. For the first 7 months I pumped 8 times a day, then I tapered down to 6. At 11 months I was down to four. After 12 months I pump a few times in the evening after my husband’s home and Camille’s in bed. At 12 months I introduced cow’s milk but she still gets breast milk. Although now, at 16 1/2 months, she’s down to two ounces of milk a day. Even though it took a lot of pumping to establish a supply in the beginning (my body had turned off due to the preeclampsia) I eventually produced more than she was eating. I would adjust my pumping to keep more in line with her appetite. I wouldn’t pump less frequently b/c I tried to mimic her eating frequency as much as was practical. (Nursing/pumping duration, spacing, and frequency modulate fat levels in breast milk) Instead I pumped one breast instead of two and lessened the amount of pumping at night. I didn’t store milk other than saving extra milk in the fridge for up to a week. There were several reasons why I decided not to freeze my milk. One reason is I believe strongly in the La Leche League mantra that supply will keep up with demand. I was never worried about losing my supply again b/c all I had to do was pump extra if Camille began to eat more. Within a couple of days my supply went up to meet her needs. A lactation consultant also gave me this very valuable piece of advice: milk production increases the most between 1 and 5 am. If I pumped an extra time in that window it had a bigger impact on my supply than if I pumped several extra times during the day. If Camille was especially fussy and high maintenance one day and I just couldn’t find many chances to pump, I’d have my week’s worth of stores in the fridge. Another reason is that freezing destroys some of the beneficial components of breast milk. So it wasn’t necessary and it was not as good of milk (although still very good to all those who do freeze their milk). It just wasn’t worth the extra hassle. If I had a bit more time and a bit more sleep (i.e., if Camille was an easier baby) I would have frozen my milk to donate to milk banks—definitely keeping this in mind for next time.

There is no question that exclusively pumping is a pain in the butt! You don’t get any of the bonding pleasure associated with nursing—I mean you’re hooked up to a machine. My daughter was colicky and chronically over-tired (some days she got as little as 9 hours of sleep in a 24 hour period—not including the few 10 minute naps she’d sneak in). Do what I could, I couldn’t make her sleep. But I could control what she ate so while her sleep problems made things more difficult they motivated me even more to pump. With her fussiness and sleep issues it was difficult to find good times to pump during the day when my husband was at work. We have no family in the area so I ended up hiring a low cost nanny to watch Camille a few hours during the day. For the first six months she would come for three hours two-three days during the week. Those were my easy pump days! I would pump once before my husband left for work, once when the nanny first arrive, once just before she left, possibly one more time before hubbie came home from work, once as soon as he arrived from work, one or two more times before bed, and once in the middle of the night. When Camille and I were alone together and there was no one else there to watch her, I would put her in her bouncy seat while I pumped. We’d play with toys, sing songs, or just chit-chat. If she got fussy I’d turn on a vacuum I placed near-by and that magically soothed her. Sometimes she’d even go to sleep while the vacuum was on. In order to get the hind-milk I would always pump both breasts for 15 minutes. Often there would be two let-downs during one session.

I’m proud of what I’ve done for my daughter and when she’s older I’ll be happy to let her know she was breastfed. Of course, many mothers would have opted to use formula and that decision does not make you a bad mother! Everyone’s family situation is different. Perhaps some women would think that the stress of pumping and time spent doing it would impair their ability to enjoy and engage with their baby. I can definitely understand this but for my situation, pumping was the best for both me and my daughter. All of the support I received made it possible for me to keep my sanity while I pumped. I know a few other mothers who exclusively pump(ed) and I’m advising a long distance friend on the matter. Her daughter is 5 months now and she’s still an EPer! Other moms have praised my pumping so I knew there were people out their who appreciated what I was doing. Every little compliment or word of acknowledgment helped me to feel good about what I was doing. There is also a wonderful yahoo community of EPers that a fellow EPer introduced me to. Knowing other EPers and visiting this online community let me know that I wasn’t alone and that my way of doing things was not “weird” at all. For my baby shower my aunt gave me The La Leche League’s Womanly Art of Breastfeeding. Whenever I was tempted to give up pumping I just read this book’s section on the benefits of breastfeeding. Almost all of these benefits (and it is a long list) apply to expressed milk as well as nursing. Most important of all was my husband’s support. He was always hugely supportive of my decision and bragged on the good quality food Camille was getting. He also told me that if I decided to go to formula instead that would be okay too. He was behind me 100% and he let me know that he was aware of the benefits of EPing AND its difficulties. Without all this support, especially from my husband, I couldn’t have done it. Several mothers I met at ECFE (I think there were about three) also had latching/supply problems. They said they tried to EP in the beginning but their husbands persuaded them to stop b/c it took too much time or for some other reason. I think lack of support was the ultimate factor behind these women’s decisions to switch to formula. So if it’s something you want to do tell people how important it is to you and get as much support as you can. Remember, the benefits of breast milk last a lifetime. You can never undo that.

Guest Blog: Exclusively Pumping: Take 2

My name is Jamie, mom to two beautiful girls, Lydia and Eliana. Lydia is my first born and came into this world on September 12, 2008 weighing just 6 lbs 13 oz. Prior to giving birth, I had decided that I was going to breastfeed and pump so that my husband could feed her. No one in my family had every nursed, so this was a totally foreign concept to me, although very important. When Lydia was born, I made sure to get her latched on as quickly as possible, and as far as I knew, things were going well. She seemed to be doing great, and I was so much in love with her that I ignored the pain. I worked with the lactation consultant at the hospital while we were there, but could never really get her latch just right. By the time we came home, just two days later, I was bleeding and in so much pain that I was crying through each and every feeding. For anyone that knows me, you would know that I don’t cry. I’ve actually been told I’m a robot because it takes A LOT for me to cry. I knew something was wrong and didn’t know where to go for help. We had a home nurse come visit us and she was able to help get her latched on properly, but by the time she left we were back to square one. At the same time, Lydia continued to lose weight and it was starting to get me worried. I continued to nurse her and fought through the pain, but after 10 days I knew that something needed to be done. I had been holding out on pumping because I wanted to wait 3 weeks before introducing a bottle.

I called the hospital and scheduled an appointment with the lactation consultant. We went in that day, and she tried to help as much as she could, but when she tested Lydia’s suck on her finger she confirmed my suspicions that Lydia was biting me with EVERY. SINGLE. SUCK. Ouch! She basically told me that some babies are biters and I could deal with it, pump exclusively or give her formula. She even patted herself on the back and said that one of her kids was a biter and she just suffered through it for an entire year. No thanks, crying at every single feeding for a year?! That didn’t sound healthy for anyone. I decided right then and there that I was going to go home and pump and feed her that way.

When we got home we hooked up the pump and Lydia took the bottle right away. I felt and immediate relief knowing exactly how much she was getting at each feeding, and knowing that her weight would start to go up since she was indeed getting enough milk each day. I Googled “exclusively pumping” and found a slew of resources and was relieved to know that I wasn’t alone in making this decision. The best website for me was a message board on ivillage. Although I never posted there, I found myself there daily getting tips on how to succeed. I learned that the first 12 weeks are the most important, as this is when your body is building up the supply. It’s crucial to pump every 2-3 hours around the clock to mimic the feedings of a newborn. Pumping 8 times a day wasn’t easy. There were times where I would pump for 20 minutes, clean all the parts, get a bottle ready, feed Lydia and then find myself starting the whole process all over again. The hardest time to pump was in the middle of the night, which coincidently, is also the most important since that is when your body produces the most milk. The message boards told me not to drop the middle of the night pump until at least 12 weeks. But I was lazy, and I found myself dropping it very early. Luckily for me, I was able to

very quickly build up a very large supply. I was making more than Lydia could eat each day and built up a good freezer supply. I was happy, my husband was happy and most importantly – Lydia was happy and healthy. Mommy wasn’t crying and making her anxious with each feeding.

Perhaps the best thing I learned the message boards was that I didn’t need to wash and sterilize my pump parts with each feeing – that was taking up a lot of my time! I just had to rinse them after each use and put them in the fridge throughout the day. I tried to micro-steam sterilize the parts each night before bed as well. I continued to pump and feed Lydia throughout the course of the first year of her life. Because I didn’t know any better, I pumped 5-6 times a day for the entire year. Honestly, once I got used to it, it really wasn’t that big of a deal or hassle. We even went on a road trip when she was 9-months old, and I pumped throughout the trip and kept the milk in a cooler on ice. When she was 11.5 months old I gradually started mixing whole milk in with her breast milk bottles and after about 2 weeks she was weaned completely from breast milk. For those two weeks, I was dropping a pumping session every couple days until I was finally able to stop pumping completely without any engorgement or pain.

Three days after I quit pumping, I found out I was pregnant with baby #2. So much for a break! J Throughout this pregnancy people would ask me if I was going to pump again or if I was going to breastfeed. I knew that I wanted to try and nurse, but given my success with pumping, I was open to the possibility of pumping as well. One important thing to note is that I work part time as the Sales and Marketing Manager for a local catering company. This job requires nights and weekends, and I was back to work meeting with clients about 3 weeks after Lydia was born. One way or the other, I would be pumping and bottle feeding at least part of the time as #2 was due in the middle of our busiest time of the year!

Fast forward to May 26, 2010 when my daughter Eliana Clara was born weighing a whopping 8 lbs 9 oz. She latched on like a pro at the hospital and I thought for sure it was going to be smooth sailing from there on out. Not so much. Just like her big sister, Eliana had lost enough weight in the hospital to put her right on the edge of having to supplement with formula. Because of this, the pediatrician wanted us to take her in to our clinic over the weekend for a weight check. We went in on Saturday morning and found out that Eliana had continued to lose weight. I know this is common for breastfed babies, but it’s still not very comforting for a new mommy. While we were there, I mentioned to the doctor that I had noticed a white spot on the pupil of Eliana’s eye. The doctor took a good look at it, and basically told me that it was definitely not supposed to be like that, she didn’t know what it was, and that I needed to see an ophthalmologist right away. This was Saturday morning of Memorial Day weekend and everything was closed until Tuesday. I was a nervous wreck from the vague response the doctor gave me and Eliana was fussy and hungry so I decided to nurse her while the doctor went to get the contact information for the ophthalmologist. I didn’t have my Boppy with me and I wasn’t very skilled at nursing, but I knew it needed to be done. The second she latched on, the familiar pain from my experience with Lydia came back with a vengeance and when I looked down I saw blood. NOT AGAIN. I was an emotional wreck about her

eye and her weight, and right then and there my husband and I agreed that we were going to break out the pump as soon as we got home since my milk had already come in.

The second we got home, I pumped 2 oz. and Eliana gulped it down immediately. My friend, Medela, and I were reunited once again. I worked really hard to build up my supply at the beginning by pumping 8 times a day, including overnight. Within a week I was pumping over 50 oz a day! This was obviously too much for my small little baby, but I was able to build up a nice freezer supply for future needs. Could I have tried harder to get her to latch on properly? Probably. Do I regret not trying harder? Not at all. I was actually relieved to start pumping again because I knew it was something that I could control when there were so many other variables with Eli’s sight that I couldn’t control. I gave myself a quick refresher on pumping by reading up on the ivillage message board, but ultimately went with my gut instinct and time available to pump. Chasing a hyper not quite two year old around is hard enough, pair that with pumping around the clock and a new baby and that makes for a very busy mommy! I started dropping pumps pretty rapidly, and stabilized a 5 pumps a day for a quite a while. Today, Eliana is almost 6 months old and I pump an average of 30 oz. each day and I only pump 3 times a day. I usually pump in the morning, sometime in the afternoon (between 2:00-4:00) and right before bed. Eli is a really big eater, and there are days when I have to dip into my freezer supply, but as of right now I’ve still got 30 oz. in my fridge at any given time. For those readers wondering about her eye, she was diagnosed with a pupillary membrane on her left eye. Basically it’s a cloudy membrane that restricts her vision unless her eye is dilated. Long story short, we have to dilate her eye twice a day with drops, patch her “good” eye for two hours a day to strengthen the other eye, and she wears glasses whenever she’s awake. With all of this treatment, we’re hoping to salvage as much of her sight as possible. Regardless of the outcome, she still has one eye that works great and she’ll be able to lead an otherwise normal life (i.e. she’ll be able to drive a car).

Pumping has worked great for us, I can leave the girls when I have to go to work, and it’s really come in handy at the multitude of doctor’s appointments that we’ve had for Eliana’s eye. I’ve found that the doctor is able to get the best views of her eye while I’m feeding her a bottle. It’s also especially handy because I only have to do it 3 times a day, which leaves me the rest of the day to chase Lydia around. J I intend to continue pumping until she reaches a year, just like her sister. I have come to terms with the fact that my supply might diminish because I pump so infrequently. But I am a firm believer that everyone has to do what works for their family and what they feel is in the best interest of their child. Pumping has been such a wonderful experience for me. Do I enjoy being hooked up to a machine? Not really, but I find it to be pretty relaxing. I CAN’T do anything else other than watch TV or play on my phone, so it’s a nice break from the rest of my crazy days. Most importantly, both of my girls are happy and healthy and God has blessed me with a good enough supply to feed them exclusively with breastmilk for the first year of their lives.

Being an Exclusive Pumper (part 1)

The hospital grade Medela pump I'm using

I will be writing many a blog post about exclusive pumping. This first one, I thought I'd just talk about how I slipped into being an EPer (EP=Exclusive Pumping) with my first and briefly touch upon EPing with my second daughter. I touched upon exclusive pumping in my first blog post, and some of this will seem repetitive but it's a bit more detailed about my EPing journey!

My first daughter was born at 34 weeks due to severe preeclampsia. I tried really hard to breastfeed her but every time I'd bring her to my breast, she'd fall asleep. The few times she kind of latched on (and it was never a proper latch), she would doze off before she could start suckling and never got even close to causing a let down. The lactation consultant (LC) at the hospital where I gave birth was pretty useless and didn't help AT ALL. Luckily, when my daughter was in the NICU, the nurses brought me a breast pump and had me start pumping immediately. If they hadn't, I honestly don't think it would have ever occurred to me to pump full time and I'm guessing I would have taken the formula route. I continued for several weeks to try and get Olivia to breastfeed but each time, we would fail and I would end up a sobbing, pumping mess while my husband bottle fed her. After several weeks, I gave up and just decided I would pump. I had NO idea what I was doing or how often I should pump. I called a lactation consultant and she said to pump every 3-4 hours. I pumped every 3-4 hours and for a while, I woke up at night but the LC told me I didn't need to do that because my sleep was just as important. NOTE: Yes, sleep is EXTREMELY important while your breastfeeding but if you go 7-8 hours without pumping, it drastically decreases your milk supply!! I also wasn't using the right size breast shield (which is the part that actually touches your breasts) so my pumping wasn't as effective as it should have been.

I tried to find support and help but I didn't know the term "exclusive pumper". I felt like I was the only person in the world who pumped their milk for their baby. I also had no idea that you could actually do this successfully because the advice I had received from the LC was incorrect and my supply was decreasing drastically. I started looking into what I could do to increase my supply. I tried the typical things, drank tons of water, ate oatmeal everyday, Fenugreek, and Mothers Milk tea. The Fenugreek and Mothers Milk Tea did actually work a little bit. I believe it increased my supply by about .5 ounce each pumping, sometimes as much as an ounce. Olivia was eating way more then I was producing though and it was getting to the point where she was getting more then half her feedings in formula. I found some information about marathon pumping sessions and I tried this a few times, but that didn't help me very much because by the time I tried, my milk supply was so low it just didn't make a difference. By the time Olivia was 5.5 months old, she was getting one bottle of breastmilk a day and the rest was formula. I was beside myself and knew that it wouldn't be long before I wouldn't be able to give her any breastmilk at all. Luckily, I was able to get her to latch on and successfully breastfed her until 16 months, but that's a story for another day!

My second daughter, Ella, was born at 29 weeks gestation and with her, I started pumping within hours of her birth. I know so much more now then I did with Olivia and my supply is out of this world. I'm hoping that this continues, and I'm working hard to ensure that my supply stays up until she's strong enough to start breastfeeding which probably won't be for several more weeks. The LC program at this hospital far, far surpasses the one at my original hospital and they are used to dealing with moms with preemies so I have high hopes that we'll be able to successfully breast feed! I'll talk more about why I'm so much more successful with EPing in my next EPing post.

I'm the youngest of the group and I claim the hardest nursing experience medal! :)

Kangaroo care with Olivia after trying to nurse. 2 days old

My name is Christa and I'm the youngest of the bunch (by 5 months ha-ha). I have no fun nicknames so Christa will do just fine. I have a 23 month old named Olivia and my husbands name is Shane. Olivia will be 2 in October.

Prior to my daughter being born, I figured I'd breastfeed for about 6 months. I don't know how I came up with this number, or why on earth I thought it sounded like a good plan but that was what I thought. Once she was born, that completely changed. I should start by introduction by giving you a brief history of how Olivia came about. It wasn't as simple as a roll in the hay and a positive pregnancy test. We tried for a year, and had to go through infertility treatment to conceive her because I had polycystic ovarian syndrome (PCOS). I finally got pregnant in March of 2008 and was due in December 2008. I had a pretty high risk pregnancy, with low progesterone, gestational diabetes, PSD (pelvic symphisis dysfunction) and then at the end, severe pre-eclampsia. I was diagnosed and hospitalized with pre-eclampsia on October 20, 2008. Exactly one week later, at 33 weeks and 5 days, my blood pressure had risen and sustained to 260/180 and they induced me. I had always intended on having a totally natural delivery but after about 25 hours of labor, I asked for an epidural. After about 48 hours of labor, I ended up with a c-section. Olivia was born on October 29 and weighed 4 lbs 9 ounces. I saw her for about 10 seconds before she was rushed to the NICU and then didn't get to see or hold her again until she was about 7 hours old.

I realize that is a lot of background information but it's important to lead me up to my breastfeeding journey! When I finally got to see and hold Olivia, she wasn't able to feed because of a medication I had been on while in the hospital called magnesium sulfate. She had to wait 24 hours before any food could be given to her. Before she could even eat, the nurses had brought me a breastpump and had me hooked up to it, pumping colostrum, which was stored in small syringes for her when she finally could eat. By the time Olivia was cleared to eat, I was eager to breastfeed her. I was in the NICU holding her and brought her to my breast with a lactation consultant present and we got her on my breast...and she fell asleep. She was barely able to latch on. I was absolutely crushed. Aren't babies supposed to latch on and eat right away?? We tried constantly. I would get up every 3 hours and try to make it to the NICU to get her to latch on but even if we could get her to latch, which was never a proper latch, Olivia would fall asleep right away. She was just too weak to latch on. After a few days, they asked if we wanted to do bottles. I said ABSOLUTELY NOT!! I wasn't going to give her bottles! I was going to breastfeed. But it came down to this--if she couldn't eat, she couldn't go home. So several hours later, and many many tears, I decided to give in to the bottles. I still tried breastfeeding her every time I was in the NICU but it just didn't work. So I continued pumping and she would get my milk from a bottle. We brought Olivia home when she was 7 days old.

For about 6 weeks, I continued trying to bring her to my breast, in hopes she would latch on. We had a few half hearted nursing sessions with a nipple shield but my milk was so fast flowing that it would get overfilled with milk and always falls off. Everytime she would refuse my breast, I would hand her over to Shane or my mom and they would bottle feed her while I sobbed with my breastpump attached to me. Eventually I stopped offering her my breast and just decided to continue pumping. We did have to supplement because the pump just didn't provide the supply and demand nor the latch that a baby did and try as I might, I couldn't get my breasts to give me what my tiny baby needed. I didn't have any education on what I was doing and I was totally flying by the seat of my pants. There is a lot I know now that I didn't know then, but hindsight is 20/20 I suppose!

By the time Olivia was about 5 months old, I'd suffered pretty bad depression about failing to get her to latch, several nipple infections and my supply was so completely low that she was getting about 1 bottle of breastmilk a day. I contacted La Leche League (LLL) and the lactation consultants (LCs) and asked if babies were able to latch on after having spent so much time at the bottle. They said it was worth a try but it probably wouldn't work. I knew that if I didn't get her to start breastfeeding, it would only be a very short time before she had to be completely on formula. On April 16, 2008, when she was 5.5 months old, I came home from work and sat on the couch cross legged. I took down my shirt and brought my almost 6 month old up to my breast.

Like she'd been doing it the entire time, Olivia latched on like a little pro!!!!!!!!!!! She breastfed for exactly 7 minutes before detaching herself and SCREAMING her head off. I had my mom prepared with a bottle, so we finished her feeding with a bottle. A few hours later, before Olivia was super hungry, we climbed into bed and I brought her to my breast again. This time she latched on again with no issues and had her entire feeding from JUST breastfeeding. I was still nervous she wouldn't continue so for quite some time we always had a bottle ready but she never had an issue after that. At almost 6 months old, my 34 weeker latched on and breastfed like a little professional piggie!! I can't even express to anyone how this felt. It was probably my number one biggest achievement of my entire life. Within weeks, my milk supply increased to the point where our freezer was full of breastmilk and I even looked into donating milk. We loved nursing and since we co-slept, Olivia fast learned how to pop the boobie out of my sleep bra and latch on while we were both sleeping.

A breastfed baby is a happy baby.
Olivia, a few days after she latched on.

I nursed Olivia up until February of 2010, when she was 16 months old. I'd wanted to nurse her longer (so much for 6 months right?!) but we wanted to have another baby and the medications I had to take were not safe for breastfeeding babies. So in February of 2010, I weaned her (much to my sadness and her complete lack of caring it seemed ha-ha) and then lo and behold, 2 weeks later....I was pregnant with baby number two...with NO fertility drugs!

Now I'm 26w2d pregnant with our second girl and actually on strict bedrest for pregnancy induced hypertension. We're preparing for the possibility of another preemie and I have my Medela pump and style ready to go. If we have another preemie with latch issues, you bet I'll go through it all again but this time, I am more eduacted and I definitely will not stop trying to get her to latch on.