Breastfeeding in the NICU -- Guest Post

I was never good at pumping. Breastfeeding, sure, I had that down, after three years of nursing my firstborn. I think at its largest, my freezer stash had topped out at 8 oz, hand-expressed on the rare occasion Captain wasn't physically attached to me. But when my second pregnancy got complicated, when I was anticipating NICU time, that meant pumping for real. From years of hanging out in breastfeeding-friendly spaces online, I knew the basics. Put yourself on a schedule. Stay hydrated. Look at photos of your baby. Make sure your flanges are the right size and replace your tubing and membranes regularly. Oatmeal, brewer's yeast, flax seeds, blah blah blah. But none of that really prepared me for the reality of trying to provide milk for my tiny baby, as well as getting him to latch and feed effectively straight from the breast.

Miles Adrian was growth restricted, born at 37 weeks via successful induction. (I actually delivered him directly onto the bed while the nurse was out of the room, with my husband calling for help in the doorway. It was an exciting night.) He was 3 lbs 10.9 oz, only 16.5 inches long, and absolutely perfect. Due to his size, he was whisked away to the NICU. My room was up a floor and one (connected) building over. For the two days I was admitted, I had to walk down multiple long hallways and ride down an elevator to visit him. When Captain was born, he roomed-in for our entire stay, so it was particularly weird to have had the baby but not have the baby with me at all times.

One of the nurses showed me how to hook up to the hospital grade pump, wrote the number for Lactation on the board, and that was about it. I had a supply of 1mL, 5mL, and 10mL syringes, labels with my name and medical records number, and a sample-sized bottle of Dawn for washing pump parts. The ice machine was just outside my door, so I could keep those tiny syringes cold between trips to the NICU. The sink in my room was lined with paper towels and drying flanges. I aimed for every three hours, which was nearly impossible between rounds, meals, bathing, trying to rest, and, of course, the hours I spent with the baby. Twice a day, there were new PCAs and a new nurse, some of whom I only ever knew by their names written on the whiteboard.

He was so tiny. He had an IV in his arm (later removed and replaced with a port in his foot) and sticky leads monitoring his heart rate, blood pressure, and oxygen saturation levels. Because he was in an Isolette, a nurse had to get him out and put him back in for me. It was the beginning of cold and flu season, so we had to scrub every time we came in, and visitors were extremely limited. My older son didn't see his new brother in person until he came home from the hospital. Only two visitors were allowed bedside at once, so mostly it was me and either my husband, my mom, or my mother-in-law keeping me company. I was friendly with the nurses, most of whom were really great, and our NICU neighbors, who had a set of quadruplets.

Everything in the NICU is numbers. Two minutes scrubbing in. Three hours between each feeding. Milliliters of breastmilk in each bottle, minutes spent nursing on each side. Wet and dirty diapers, each one meticulously weighed. Body temperature within the Isolette. Grams lost meant more time before graduating to an open crib; bradycardia spells could push a release date back.

We were incredibly lucky. Miles was considered full-term, and even though he was the size of a 32-weeker, he had full-term lungs. He came out breathing on his own and stayed on room air. His suck-swallow-breathe reflex had developed just fine, so he never needed a g-tube. But his mouth was tiny, and he was sleepy, and we constantly had to maneuver his various wires and cords. For the first few days, I was pretty much always terrified I was going to rip his IV out, and I don't think my husband even held him at all until the IV was removed. I spent hours at a time just holding him, letting him try to latch, switching sides when he got frustrated. The nurses would ask how long he'd fed, and I never really knew. Five minutes one side, ten on the other? He had milk on his face and a wet diaper, and he was sleeping on me, exactly like he should have been doing at home.

Being released from the hospital and leaving the baby behind was surreal. My husband had to uninstall the infant seat and shove it in the trunk to make room for my mother-in-law, who'd been watching our big kid. I unpacked my bag, got a load of laundry in, and set up my brand new breast pump. I had a pretty good routine going from the hospital: Two sets of flanges, so I could use one while the others were being washed, carefully pouring milk into the NICU-supplied bottles (milk now measured in ounces instead of mere milliliters), time & date on each label. Still, there were differences between the machines. The hospital grade Medela had a lovely gentle preemie setting, and a preset that switched between regular and letdown modes, and automatically turned off after 15 minutes. My personal double electric was much noisier: the Symphony sang, "Milk for Miles, milk for Miles;" the Pump In Style shouted, "Rock on, rock on, rock on!"

Both sets of grandparents are nearby; they had all taken turns watching Captain during my induction and subsequent hospital stay so my husband could be with me. He had three weeks off, and basically took over being the primary care-giver for Captain so I could focus all of my time and energy on the baby. I couldn't have done it without their help.

The next morning, I was back at the hospital, up the elevator this time, carrying bottles of milk in an insulated bag. I acquired a reputation as a "hardcore breastfeeder." Twice, Miles was accidentally given formula when someone didn't check the fridge for milk. I cried. After the first time, his nurse made a big note on his chart; the second time earned him a laminated sign taped to the Isolette.

Those were my days, celebrating each tiny success: IV gone, back to birthweight, incubator temperature turned down. I learned which rocking chairs were the most comfortable, how to change preemie diapers without yanking on leads, which nurses were willing to sit around and chat. I read books on my phone, took a bunch of breastfeeding selfies, confided in wonderful women via a private Facebook group. I hated having to leave him, especially when he was awake. If I could have stayed at the hospital full-time, I would have.

At home, my fridge filled up with milk, which I dutifully transported to the hospital each day. I was terrible at keeping to my schedule. Even after spending the whole day nursing the baby, I felt engorged and would pump ridiculous quantities as soon as I walked in the door. I always meant to pump twice at night but never got around to setting an alarm, and regularly slept until my boobs hurt enough to wake me up. Basically, I did everything wrong and it's sheer dumb luck I didn't get plugged ducts. I pumped while eating, while browsing on my phone, and with visitors sitting across from me, since I refused to banish myself to the bedroom. At the one week mark, I started keeping some back to freeze, as I knew there was no way Miles was drinking it all.

On the ninth day, Miles was discharged. He was only 1790 grams, still just under four pounds, but he'd been fine overnight in an open crib. As one nurse put it, they were fine moving him from the incubator a little early because he was out with me all the time anyway. He passed his hearing test and car seat test, got his first vaccine, and the hospital photographer took newborn photos. And along with the diapers and other supplies, we were sent home with a cooler full of milk- about half a gallon all together.

I stopped pumping in favor of breastfeeding full time as soon as Miles came home. I probably should have pumped for comfort for a couple of days instead of going cold turkey, but I was awfully sick of that machine. I honestly don't know how exclusive pumpers do it: I never did figure out how to fit in all of those extra steps while caring for the baby. We don't know for sure what caused Miles' growth restriction (it was likely some sort of placental issue), but he's growing just fine now.

My NICU milk took up room in the freezer for three months, at which point I donated 45 ounces to a local mama in need. I can't stand to dump the rest, but I don't really want to use it, either. And today, I nursed.

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Emma Wade is a get-out-of-the-house! mom, adventuring around Columbus, Ohio. She is a feminist, nerd, internet junkie, breastfeeding advocate, and doesn't like writing author bios. Emma blogs inconsistently at TodayINursed.tumblr.com.