It’s 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 needed for frequent and prolonged milk expression. These
pumps automatically cycle suction with release of suction–very much like 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.

There are many good
mini-electric, battery-operated and hand (manual) breast pumps on the market. But
these pumps were not designed for frequent and long-term use. These pumps were
designed to get 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 don’t cycle suction automatically, which often leads to complaints of breast
soreness or tenderness. The motors of mini-electric pumps can burn out with frequent
use. Frequent changes of batteries are needed when battery-operated pumps are used
frequently. And these pumps become sluggish and less effective at milk removal as
batteries wear down.

Most maternity units and newborn
intensive care units (NICU) have electric breast pumps available, so you can start
pumping right away. 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 your baby in the NICU,
so
you won’t have to miss any pumping sessions.

To find breast pump rental
stations in your area, look online. Or ask the NICU staff, a lactation consultant
(IBCLC–International Board of Certified Lactation Consultants), or a breastfeeding
support leader. Many healthcare benefit plans, including Medicaid, cover the cost
of
breast pump rental and collection kit purchase. But you may need to include a letter
from a neonatologist or a lactation consultant with the request for reimbursement.
This letter should explain your baby’s need for milk expression. 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
find out if they have certain requirements for reimbursement or pump rental station
referral. If health insurance won’t cover the cost, remember that the equipment
needed to maintain milk production still costs less than the infant formula you’ll
have to buy if you don’t pump. (A high-risk baby is more likely to be given a more
expensive, special formula for a longer time, too.)

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.

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’s 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.  

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 needed if you’re pumping milk for twins,
triplets, or more.

At first you may find frequent
pumping produces more milk than your high-risk baby needs. But extra milk can be
frozen for later use. It’s 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 needed for several days
or weeks if you want to increase production to meet your baby’s growing appetite.

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. But 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
about 1 minute before stopping. 

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). Then they 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. 

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. But don’t be concerned if there is some variation
in
the schedule from day to day.

It’s easy for time to slip away
and for pumping sessions to get a late start. It’s helpful to set an oven timer, a
digital watch, or cell phone to remind you when the next session is to start. If a
session is delayed, pump a little earlier next time.

Keep track of when you pump, how
long you pump, and how much milk you get 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.

You are more likely to continue
a routine if you pump in a comfortable, yet convenient, spot. Have a snack and a
drink in reach. Listening to relaxing music has been shown to increase breastmilk
production. Or you could distract yourself by talking with someone over a
speakerphone or watching TV. You can also use the hands-free pumping equipment and
do
other activities at the same time as you are pumping. 

Follow the same routine for most
or all of your pumping sessions. Your ritual might include:

• Pumping in a certain
  place

• Putting warm compresses on
  your breasts and doing breast massage before pumping

• Dimming lights

• 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

You might want to look at a
picture 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 audio of their babies’ cries when they begin to
pump. Others simply think of their baby while pumping. Skin-to-skin contact with your
baby (called kangaroo care) in the NICU has been found to increase milk
production.

Nighttime pumping sessions will
seem less annoying if the pump and collection kit are set up and ready to go when
it’s 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 chilled
correctly until morning.

It’s easy to get 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 trouble producing milk.
There may be moments when you’d like to throw the breast pump out the window. Know
that such feelings are normal. But don’t throw that pump away. It’s an expensive
machine, and it’s 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 they come home from the
hospital.