The Road to Milk

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Establishing a milk supply after the birth of my 26 week micro preemie was not an easy task. I was unprepared for this level of difficulty.  But, I tackled it with my all… I’m the mama who embraces crunchy… who knows that today’s evidence based medicine was the hair brained idea of someone 20 years ago… who knows that not everyone fits into a textbook… who understands there is a time and place for modern medicine but also feels that we overuse it…

Day 1… I was sick… all day.  I didn’t look at my phone or turn the tv on in my hospital room.  I was in too much pain and just felt out of it.  At 7:23 pm, my beautiful miracle girl, Elizabeth Joy was delivered via emergency classical cesarean section. I lost a little extra blood… I had an infection… and just had major surgery.  As soon as I was back in my room, I started pumping.  The hospital provided a Symphony with the preemie+ card and a pumping kit.  I pumped every three hours around the clock for 20-30 minutes. I wasn’t getting anything… a tiny drop of colostrum here and there.  With my last preemie (34 weeks), I would get at least a couple mls of colostrum that first day. Feeling defeated, I would use a sterile swab to wipe up any little drips of colostrum I could and then take it to the NICU to rub inside Elizabeth’s mouth. She would have her gut primed on donor milk. I am so grateful for donor milk and that our NICU is strict about providing it… but it’s a sad feeling to know your body has failed your baby… they’ve entered the world much too soon… and now, I can’t even feed her the tiny amount she needs.

I was discharged on day four… Friday.  By Saturday night, I had a fever of 103F while on ibuprofen and pain medicine containing acetaminophen.  My kidney infection was back.  I had to start on antibiotics that weren’t safe for a micro preemie (although they would have been fine for a full term baby). I continued to pump, but now, she couldn’t have the little bits I was producing and had to have full donor milk until the medicine was out of my system.  By the end of two weeks, I was getting 15-20 mls each time I pumped. My right side would always produce exactly double what my left would.  This was enough milk to feed her because her needs were very low at that time. They began fortifying my milk with Prolact+H2MF (fortifier made 100% from human milk)- this is an amazing product that kept her off bovine fortifiers which reduces the risk of NEC greatly.

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Each syringe represents one full pump session at a week post birth. I was getting 6-7ml combined.

Around week two, I ended up in the ER with a uterine infection. Enter another round of antibiotics that were not safe for a micro preemie. I had a horrific allergic reaction to them and then was put on another antibiotic which was okay for her to get in my milk. By one month in, I was getting a combined 30-45ml every time I pumped.  I was so discouraged!  With my 34 weeker, I was quickly getting 8-10oz every time I pumped and had to “down regulate” my supply once she got to breast. I didn’t understand why it wouldn’t be the same this time (from an emotional stand point, my brain did understand that my body wasn’t ready to deliver, I had a traumatic delivery, I was ill before and after birth, and the stress of NICU life is no joke).

I talked with the NICU IBCLCs daily… I tried going up and down flange sizes… I tried fenugreek & blessed thistle.  I stopped blessed thistle because it made my hay fever go nuts!  Eventually I stopped fenugreek as well because my supply had not increased even a ml since I started it and I wondered if I was one of those women it hurt rather than helped. I ordered Moringa (ended up not using it).  I started sunflower lecithin in the hopes I could empty faster. I increased my pump times to 40, 50, 60 minutes each session. I stopped using the Preemie+ setting and increased suction. I drank more. I ate more (hello weight gain!). I power pumped. I massaged and used heat. I alternated heat and ice. I cluster pumped and started sleeping one 4-5 hour stretch at night.  Finally, by 10 weeks, I had a decent supply!  I was up above 20 ounces per day.  I stopped using the PISA at home and brought home another Symphony so I was using it round the clock.  My supply continued to increase until I hit my daily max of 36-40 ounces (the average breastfeed infant consumes 24-30 opd, so this meant I had a slight over supply). I felt confident that I could bring my baby home and be able to feed her once she was at a full volume.

When I stopped pumping overnight (slowly increased my sleep time break from 4 hours to 5, 6, 7 hours), I had to pump 90-100 minutes in the morning to get fully empty. This would result in my largest pump of the day, 11-15 ounces. The rest of the day I would get 3-6 ounces in about 60 minutes depending on how long I went in between pumping sessions. On average, I spent six hours a day hooked to a breast pump and another 60-90 minutes storing milk and washing parts. This journey is not for the faint of heart.

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One month into the journey… 30ml combined from both breasts at each pump session. A great session might see 45ml.

 

Elizabeth has always stayed on a low volume- we aren’t sure why.  I speculate that either my milk is extra calorie rich or she has a lower metabolism.  Either way, shes a chunky little monkey and gets 16-18oz each day through her g-tube. Because of her lower volume needs,  I was able to get quite the freezer stash.  I knew that I wanted to donate my milk to Prolacta because there product ensured my tiny baby stayed off bovine products which may have saved her life! When Elizabeth was five months old, I sent off our first 1800 ounces to Prolacta. To date, we’ve donated more than 2500 ounces to Prolacta and another 1000 ounces to local babies. I’ve had a few freak out moments when my freezer is near empty and I think “what if?”. So far, we’ve been blessed that I’ve managed to maintain a supply (about 32 ounces a day now that I’ve dropped pumps). And that Elizabeth’s needs haven’t increased much.

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Today, our miracle girl is just over SEVEN months old.  I have switched back to a full time Symphony pump (I began using a Lactina and tried PISA and Spectra when she left the hospital).  Recently, I added the Medela Sonata pump to our family… I feel like I have managed to decrease the overall amount of pump time since making the switch to Symphony/Sonata by at least 25%. I still spend a lot of time pumping.  My life still revolves around my boobs (as does a lot of my conversation…). But, all the work is absolutely worth it to know I have managed to feed my tiny girl, 100% mamas milk despite her having a feeding tube.

There have been days I wanted to quit.  There have been days I have cried.  There have been cracked nipples, clogs, swollen and painful breasts, nipples so sensitive that even being touched by water hurts… I have washed pump parts until my eyes glaze over… I have stood up after 90 minutes attached to a pump to not be able to walk fully upright from being in one position too long.

Conventional advice didn’t work for me. Here’s what did:

  • longer pump times 45-60 minutes
  • massage massage and more massage
  • heat
  • more calories from nutrient dense foods
  • double what I pump in water each time with an 8 oz minimum- (so if I pumped 2oz, I drank 8oz water… pump 5oz, drink 10oz water.)
  • sleep with cluster pumping before and long session after
  • hospital grade pump full time
  • stopping supplements (except sunflower lecithin if I felt a clog coming on)