At around 3am on 6/3/16 (Alec was born around 24 hours earlier), I woke up in a hospital ward in Addenbrooke’s and called the midwife to ask them to phone through to the NICU to see how my newborn teeny tiny baby was doing. Instead of phoning through, a health care assistant took me in a wheelchair to see him. Here I met Felicity who was looking after Alec – she turned out to be one of our favourite nurses. We chatted generally, and she asked, “Had you hoped to breastfeed?” I had really hoped to breastfeed, but with these circumstances, it hadn’t even crossed my mind that that would be an option, or that he would be needing milk, or that I would be able to produce any at all! “You need to start expressing,” she explained – by hand initially, then onto the hospital grade double pumps a couple of days later. This was something amazing that I could do for Alec – to play a part in feeding him! All my hopes of breastfeeding this time (it hadn’t worked out with Evan) I now held very loosely, but I was totally determined to give this my absolute best shot and do all I could.
Why pump milk for a premature baby?
“Breast is best” – a phrase that gets used a lot. In this instance, breast milk was the only food that Alec could tolerate, and he was able to start on dribbles of milk feeds at just a day old. Breast milk for premature babies can help to prevent both chronic lung disease and NEC, along with generally building up immune system and antibodies. Babies that small can’t tolerate handling and so actual breastfeeding isn’t an option, but having mum’s milk is almost considered part of their medical care.
Round the clock pumping
I quickly established a bit of a routine with pumping milk: “Got the pumping going today – working out a routine for managing 8-10 times a day.” (7/3/16) It was reinforced by all nurses and lactation specialists that expressing once between midnight and 6am was absolutely vital (to do with hormones and milk production), and that to really establish a supply I needed to pump 8-10 times in a 24 hour period. I did that initially, expressing every 2-3 hours in the day, and setting my alarm for 3:30am. That was a killer. You can dress it up as, “Oh, it’s getting me used to the night feeds,” but as far as I’m concerned, night feeds involve a cuddle with your baby, settling them, caring for them etc, not sterilising equipment, attaching yourself to a noisy machine and washing up whilst a nurse cares for your baby upstairs! But, I kept going. The expressing broke the day up a bit and it was something beneficial to do for Alec, especially as I couldn’t cuddle and soothe him etc. I dropped the middle of the night pumping when he was about 2 months old and enjoyed full nights of sleeping (until he came home)!
In competition with myself
These pictures were taken when I was proud of the volume I’d produced – the middle photo was when I had “graduated” to the larger sized purple tray! I was encouraged to keep a log on a provided chart of details such as how much milk I was producing, what times of day I was expressing, etc. I don’t think I really needed to keep it updated past the first couple of weeks once I had got the milk supply going. However, I quite liked seeing the supply gradually increase and establish, and I always wanted to get more than the day before, so I recorded everything I expressed until 3rd August. Alec was tiny and his daily intake amount (calculated from his weight) was less than I could produce in a day; also he didn’t get up to full feeds because of the stoma. Incidentally, my most productive day was 22nd April when I produced 551ml.
Each day I’d drop my milk off in a fridge in the “milking parlour” as I called it; actually it was the expressing room. This consisted of three cubicles with chairs and pumps, a big fridge, washing up facilities and a microwave for sterilising equipment. During the 4 ½ ish months we spent in Addenbrooke’s this was jazzed up a little with some floral wall stickers and a radio! The window looked out onto the helipad so sometimes you could see the emergency helicopter landing or taking off – I always wondered if it was Prince William. Sometimes I went to the milking parlour to express, other times I did it by Alec’s cotside.
Milking parlour friendships
The milking parlour was a strange place in that everyone was there for the same reason – they had a poorly baby and they were expressing milk for him/her, which was possibly the only thing they could really do. Awkwardly there was quite a bit of standing around, waiting for microwaves, washing up and cubicles. I dislike awkward silences more than the difficulty of talking to strangers, so I always preferred to try and chat. Some of the conversations that I had in that room led to what I hope will be really long term friendships. Sometimes it was a tearful chat about how our babies were, other times it was helping each other out with what to do/where to leave the milk/how to sterilise equipment correctly. I found it to be a place of mutual support – in the early days I would say about what was going on with Alec and there would be ladies who had been through similar and were coming to the other end. On the other hand, with Alec’s crazy medical history, quite often when other ladies spoke about what was going on with their babies, I had already had some experience of it – in some ways I found that a bit hard, as I didn’t want to come across as “been there, done that”. I do like a good chat, and I often would disappear off to express and be gone a good while!
The nursery nurses ran the milk kitchen like a military operation. Each day I dropped my milk off and it was collected. All milk had to be labelled with date and time expressed, my name, Alec’s name and date of birth, along with another label with address and hospital number. The nursery nurses made up the feeds for every baby on the unit each day, including adding medicines and vitamins. Anything that couldn’t be used that day (i.e. I produced more than Alec’s daily amount) was frozen. “Saw a milk kitchen lady and checked they were using the older frozen milk – she went and checked and I had 10 big trays in freezer – around 50 bottles in each!” (21/4/16) Serious stock rotation was going on in that milk kitchen!
I didn’t produce huge amounts in comparison to some of the other ladies – however, as mentioned, I produced much, much more than Alec required. I’m very proud to have been able to donate some of my milk to the unit on two occasions: “A lady from the milk kitchen came to meet me and ask me about donating my milk – I went to look in the milk kitchen; there was loads! As it only can be frozen for 3 months, there’s a chance Alec won’t get to use it so they asked for a health and lifestyle profile and I have to consent and have a blood test.” (27/5/16) Sometimes women aren’t able to produce enough milk for their baby, and donor milk, particularly for premature babies, is seen as preferable to formula where possible. My mum called me Daisy for a while!
And all worthwhile…
I would have been happy if I’d just pumped and pumped until my supply went down, or until I just couldn’t keep up with Alec any more, and bottle fed him my milk. In this situation, I was holding breastfeeding very lightly; I was just so thrilled that he was able to have my milk that I was quite relaxed about breastfeeding or not. However, Alec has turned out to be very good at feeding! He’s now exclusively breastfed, with the occasional bottle of my milk (there’s still loads frozen and we’re on July milk!) – this wouldn’t have been possible without pumping for 5 months, as it meant I had the supply to meet his demand by the time he was ready to try feeding. Almost unbelievably, my 23 weeker is “normal” in his feeding habits! I don’t really ever express any more but it was certainly worth it.