preemie baby and pumping - when can/should i cut back?

[Peace+Hope]

hi, and thanks in advance for advice!

i've been home with my little charlie since march 31st. he was born at 37+1 with asymetrical IUGR (belly measuring two or three weeks behind that). after a week in the NICU getting breastfeeding established, we came home.

now he's eating a LOT, some extra long periods of hourly cluster feeding, or eating every two hours. even at two hours, i don't like to pump out, because then when he's ready to latch he isn't at a full breast and ineffectually sucks for over an hour, off and on.

my LLL leader i snot being very direct on the phone, and the hospital lactation consultants are booked through wednesday.

my concern is cutting out too much pumping and drying up. the LCs drummed into me that he's not big enough to maintain my supply, and pumping is necessary for that reason.

now i'm engorged, having to pump before i can feed the little guy each time. but i worry that a fall-off of production will follow the engorgement if i don't pump, or that pumping will extend engorgement. argh!

any advice????

[pbjmama]

How are his wet and poppy diapers?

You mention he is ineffective at sucking and you think that is because of the breast not being full. Does he have any tongue or palate problems? Or perhaps you are referring to comfort sucking?

He is so young and your first, right? I would keep up the pumping. I know it is hard now, more than double the work of just pumping or just breastfeeding! He is so young that your supply isn't even fully established yet - so it isn't all maintenance. I think hanging in there is important for now to establish supply, you will have to pump alot more if you don't get the correct supply.

If you feel you need help sooner than Wens I would get your records and see another area LC, it doesn't have to be the one from the hospital.

[sahmmie]

Congratulations on your little guy!!

Perhaps you can pump after each, or most feedings; probably not when he's nursing every hour, but during other parts of the day. When I was nursing and pumping I noticed that there was almost always milk within an hour of pumping.

[CallMeMommy]

You should post this in the preemie/NICU forum, too. Lots of BTDT advice.

For me, I had a 31-weeker with no other problems, and they suggested I keep pumping after I brought him home, too. That lasted, oh, a couple days before I quit. He was transferring milk efficiently and wasn't being supplemented at all, so I saw no need. If you're having to supplement with bottles on a regular basis, I'd keep doing what you're doing until you can get in to see the hospital LC. If he's taking feeds solely by breast with no supplements, you could try gradually cutting back the number of pumping sessions and see how he does. You can always add them back in if you need.

[lalemma]

I had a 33 weeker, and when I had a similar freak-out (when was I supposed to pump so he wouldn't wake up to a mostly-empty boob, when he seemed to be on the boob ALL THE TIME?) our LC suggested several approaches: nurse on one side, pump on the other (either during or after the feeding), pump both sides right after feeding, or pump about an hour before you suspect he'll want to eat again.

Pumping both sides right after feeding worked best for me. I felt like it was most successful at telling my body to make more milk without taking milk away from my baby.

Like the above poster, I quit pumping pretty soon after he came home - as soon as he was taking all of his feedings from the boob (he came home from the NICU on bottles of expressed milk) I pretty much knocked off the pumping. It took about two weeks to transition to just boob, I think.

Good luck! I know it's really draining (no pun intended) the first few weeks, but it will get so much better.

[MaryMarg]

Congrats on your new baby boy! As the mom of a 33wk DD who spent a month in the NICU, I can relate! Lactation hounded me to pump and I couldn't stop! Didn't know when to stop is probably more like it! Found it best to pump right after a feeding and sometimes skipped one or two pumps a day to give myself a break. I continued pumping, however, until DD was about six or seven months old, although I gradually decreased to about two times daily. I also had frequent engorgement and know the pumping put me in that cycle. However, I was glad to have the frozen milk when I unexpectedly had to return to work for a few months and then to use later as DD began the sippy cup. As your baby becomes more and more efficient and seems content, consider decreasing the pumping. It was, however, a great way to ensure a strong milk supply and have extra left over for the future. It's a challenge (washing all those supplies--yuck!!) but extended pumping was worth it for me! Best wishes!

[Peace+Hope]

thank you ladies!

i just couldn't pump with him eating every 2 hrs or more (that's time from first latch too) and get any rest at all.

so, i took the plunge and quit pumping altogether. it seemed like even pumping off an ounce or two at the beginning of feedings was just stimulating more over production.

it took time to get over the LC's advice ingrained in me that i would have to pump til he was 7 lbs...

now the engorgement has gone away and i feel letdown every hour or so, and he's getting plenty. still not asking for the second breast, but a couple times a day i offer it if i think he's anywhere near having emptied the breast he's just nursed on.

i hope other moms will find this thread helpful in searches. i just couldn't figure out when i was going to stop pumping, but my little guy decided for me! yay babies!