Your High-Risk Baby and Expressing Milk
How to get ready to make enough milk if you are expecting a high-risk baby
Breastfeeding has important health benefits for almost all babies. And, it helps you
and your baby bond. But the benefits are even higher for babies who are born high-risk.
Babies in the NICU need a mother's breast milk to help support their immune systems,
improve their digestion, and decrease the risk of a serious condition called NEC (necrotizing
enterocolitis). If you are expecting a high-risk baby, providing your child with breast
milk is something only you can do. Below are some suggestions for how you can get
ready to make enough milk for your high-risk baby:
If possible, start pumping within 60 minutes of delivering your high-risk infant.
Evidence shows that this can help make more milk than if you start later.
Use breast massage and warm your breasts before you pump.
Start expressing milk by hand, then use a pump as needed, to get your milk started.
Listen to relaxing music as you pump. Evidence has shown that this can help women
to make more milk, possibly by reducing stress.
Techniques for expressing milk
You will have to depend on milk expression to establish and then maintain milk production
until your high-risk baby is ready to breastfeed. Most mothers find they get more
milk in less time when using a hospital-grade, electric breast pump with a double
collection kit when providing milk for high-risk newborns.
Developing a milk expression routine
You will want to pump at least 8 times in 24 hours. Even if using a good electric
pump, it is helpful to learn hand expression in case you are ever without some of
the equipment pieces for the electric pump when it is time to express milk. Sometimes
in the early days of milk expression, mothers find they get more colostrum through
hand expression than they do with the breast pump.
Do not put off or stretch the time between pumping sessions during the first 3 to
5 days after giving birth. You may not see any milk during the first several pumping
sessions, and you may only get a couple of drops for several sessions after that.
Keep expressing. The milk produced before day 3 to 5 after birth is called colostrum,
and it is normally produced in small amounts. However, colostrum is especially rich
in the anti-infective properties that can help your high-risk baby. If you are able
to pump or hand express even one drop, it may be beneficial to your baby. Drops can
be drawn up, and stored, in syringes specially labeled as "colostrum."
It is important to use the right kind of pump when long-term milk expression is necessary,
and not all breast pumps are created equal. Most mothers with high-risk infants find
that a hospital-grade, electric breast pump is necessary for frequent and prolonged
milk expression. These pumps automatically cycle suction with release of suction--similar
to a baby's sucking action. Studies find mothers who must pump for several weeks,
or even months, produce a larger amount of milk when using this type of pump.
Although there are many good mini-electric, battery-operated and hand (manual) breast
pumps on the market, these pumps were not designed for frequent and long-term use.
These pumps were designed to obtain milk for an occasional "relief" feeding. Most
of these smaller pumps require a mother to invest more time and effort to obtain an
adequate amount of milk. Many do not cycle suction automatically, which often lead
to complaints of breast soreness or tenderness. The motors of mini-electric pumps
can burn out with frequent use. Frequent changes of batteries are necessary when battery-operated
pumps are used frequently, and these pumps become sluggish and less effective at milk
removal as batteries wear down.
Getting a pump
Most maternity units and newborn intensive care units (NICU) have electric breast
pumps available, so you can begin pumping immediately. They will also provide a double
collection kit, which you should take with you when you leave the hospital. The collection
kit is then used with the hospital-grade, electric breast pump you will rent for use
at home. You can also bring your collection kit with you when spending time with the
baby in the NICU, so you will not have to miss any pumping sessions.
The NICU staff, a lactation consultant (IBCLC--International Board of Certified Lactation
Consultants), or a breastfeeding support leader will know of breast pump rental stations
in your area. Many healthcare benefit plans, including Medicaid, cover the cost of
breast pump rental and collection kit purchase when a letter from a neonatologist
or a lactation consultant explaining the baby's need for milk expression is sent with
the request for reimbursement. Because of the many benefits of a mother's own milk,
health insurance companies know they ultimately save money if you pump your milk for
your baby. Contact your health insurance company to learn if they have specific requirements
for reimbursement or pump rental station referral. Should health insurance not cover
the cost, remember that the equipment needed to maintain milk production still costs
less than the infant formula you will have to buy if you do not pump. (A high-risk
baby is more likely to be given a more expensive, special formula for a longer period,
Breast pump collection kit
A breast pump collection kit includes tubing, breast flanges, and collection bottles.
The tubing attaches to the pump itself and transfers suction to the breast flange,
which may also be referred to as the "breast shield" or "milk funnel." The flange
is the piece that is in direct contact with the breast. It is centered over the nipple
and areola of the breast. A hard plastic bottle connects to the breast flange piece
and collects milk flow. Clean collection bottles should be used for each pumping session.
Double collection kit
A double collection kit allows you to pump both breasts at once. Studies have shown
that mothers tend to produce more milk in less time when they use this type of collection
kit with a hospital-grade, electric breast pump. This may be because mothers find
it is easier to pump often enough when using this combination of breast pump equipment.
Many mothers also like to use a hands-free bra or hook. This allows you to have the
flanges held for you so that you can do other activities with your hands.
How often and how long?
A full-term, healthy newborn typically breastfeeds for the first time within an hour
or two of birth and will want to eat about 8 to 12 times in 24 hours for the next
several weeks or months. A milk expression routine should closely imitate this pattern,
so you will want to begin pumping as soon after your baby's birth as possible:
8 times a day. Pump at least 8 times, or for a total of at least 100 minutes in every 24-hour period.
The more pumping sessions, the better. More frequent sessions may be necessary if
pumping milk for twins, triplets, or more.
Freeze any extra milk. Initially, you may find frequent pumping produces more milk than your high-risk baby
needs, but excess milk can be frozen for later use. It is better to stay ahead of
your baby's current intake. If you pump less than 8 times a day, you may find milk
production begins to drop after several weeks. Then, 10 to 12 daily pumping sessions
may be necessary for several days or weeks if you want to increase production to meet
your baby's growing appetite.
A typical cycle. Most mothers pump for about 15 to 20 minutes, every 2 to 3 hours during the day,
with one, 4- to 5-hour stretch of uninterrupted sleep at night. You could pump for
about 15 minutes without interruption. However, you may find it helps to take a "massage"
break when milk flow slows after 5 to 10 minutes. Stop, massage your breasts, and
then reapply the pump until a minute passes without any milk flow. Some women pump
longer than 15 to 20 minutes and wait until there has been no milk flowing from the
breasts for approximately 1 minute before stopping.
Single vs. double. Some mothers prefer single pumping of each breast separately, especially when first
learning to use the breast pump. These mothers pump one breast for 5 minutes (or until
milk flow slows), then pump the second breast for 5 minutes (or until milk flow slows),
and repeat the whole process but continue to pump until a minute passes without any
milk flow for either breast. Single pumping lets a mother massage each breast as she
pumps, which can increase milk flow. If a mother wants to massage both breasts at
the same time, she can use a hands-free bra or hook to hold the flange to the breast
while she massages the breast tissue.
How much milk?
After 7 to 10 days of frequent pumping sessions--at least 8 times a day and for a
daily total of 100 minutes or more--expect to produce between 16 to 32 ounces (about
500 to 1,000 ml or cc) of breast milk a day. This may be more milk than your high-risk
baby needs just now, but you will be glad to have extra milk in the freezer if milk
production drops at some point, which is not unusual after several weeks. Then any
stored milk can be used.
Do not be surprised if you obtain more milk at some pumping sessions than others.
Many mothers find they obtain more milk earlier in the day. Also, expect some variation
in the total amount pumped from day to day, but talk to a certified lactation consultant,
your baby's doctor, or a breastfeeding support leader if you find the daily total
keeps dropping for several days in a row.
Mothers of high-risk newborns have found some or all of the following suggestions
helped them develop and stick to a routine when expressing their milk for days, weeks
Stick to a schedule. Many mothers find their milk lets down more quickly and they soon get larger amounts
of milk when they pump at about the same times every day. Do not be concerned if there
is some variation in the schedule from day to day, however.
Set a timer. It is easy for time to slip away and for pumping sessions to get a late start unless
you set an oven timer or digital watch to remind you when the next session is to start.
If a session is delayed, pump a little earlier next time.
Chart pumping sessions. Keep track of when you pump, how long you pump, and how much milk is obtained by using
a simple checklist chart to note pumping sessions. A written record will help you
pick up early any drop in number of sessions, time spent pumping, or volume of milk
obtained, so you can make changes before a real problem develops.
Get comfortable. You are more likely to continue a routine if you pump in a comfortable, yet convenient,
spot. Have a snack and a beverage within reach. Listening to relaxing music has been
shown to increase breast milk production. Or, you could distract yourself by talking
with someone over a speakerphone or watching television. You can also use the hands-free
pumping apparatus and do other activities at the same time as you are pumping.
Create a ritual. Follow the same routine for most or all of your pumping sessions. Your ritual might
Pumping in a specific location
Applying warm compresses to the breasts and doing breast massage before pumping
Turning on soft music
Using relaxation techniques, such as slowing your breathing and imagining a beautiful
waterfall that turns to milk after a minute or two of pumping
Include your baby in the ritual. You might want to look at a photograph of your baby or breathe in the scent of a blanket
or cap he or she has worn as you pump. Some mothers listen to an audiotape of their
babies' cries when they begin to pump, and others simply think of the baby while pumping.
Skin-to-skin contact with your baby, which is sometimes called Kangaroo Care, during
visits to the NICU has been found to increase milk production.
Plan ahead for night sessions. Nighttime pumping sessions will seem less bothersome if the pump and collection kit
are set up and ready to go when it is time to wake up to pump. Some mothers save steps
at night by placing bottles in an insulated cooler with an appropriately sized freezer
pack to keep milk properly chilled until morning.
Be positive. It is easy to become discouraged, bored, or frustrated when pumping at least 8 times,
or more than 100 minutes, in 24 hours for day after day--especially if you are having
any difficulty producing milk. There may be moments when you would like to throw the
breast pump out the window. Accept such feelings as normal, but do not throw that
pump away. Not only is it an expensive machine, it is allowing you to provide the
most valuable food your baby can get. Remember, by providing your high-risk baby with
this exceptional milk, you are a vital member of your baby's healthcare team. It also
maintains your milk supply so that you can bond with your baby through nursing when
he or she comes home from the hospital.