Parenting: Breastfeed

No matter how well you plan, life sometimes throws you a curve ball. Throughout her pregnancy, Stephanie Casemore of Ontario, Canada, planned to breastfeed her son. When he was born nine weeks premature, Casemore faced challenges she never imagined. Like many preemies, her son couldn't directly breastfeed at first.

Casemore, now the author of Exclusively Pumping Breast Milk (Gray Lion Publishing, 2004), found herself stuck in an endless cycle of breastfeeding, bottle-feeding expressed milk to "top off" her son and pumping. By the time she was done with one round, it was time to start over again. "I have heard many mothers say that this cycle took over their world and wore them down to the point that a change had to be made in order to manage other aspects of life requiring their attention," she says.

Casemore's situation isn't unusual for mothers of preemies, as well as some full-term babies who have feeding difficulties at birth. While many of these mothers are able to transition to fully breastfeeding, for others like Casemore, the circumstances are so overwhelming that mothers choose to bottle-feed in order to save their sanity. Casemore didn't want to feed her son formula, so she chose to exclusively pump.

Giving breast milk in a bottle long-term is indeed possible, according to Judy Crouthamel, an international board-certified lactation consultant (IBCLC) with the Breastfeeding Alliance, Inc. Often, a mom just won't have the time to work with a baby on transitioning to the breast. "This may not be the only child a mom has," she says. "It may be easier to take 20 minutes to pump and feed the baby than spend up to an hour trying to get the baby to latch and then have to pump anyway."

Challenges of Exclusive Pumping
For women with a strong belief in the importance of breast milk, exclusive pumping can be preferable to using formula. Yet, by no means is it an ideal feeding arrangement. Casemore believes it's important that women not have illusions of pumping being easy. "The fact that it is time consuming and exhausting – especially early on – cannot be overlooked," she says. "This can lead a woman to not pumping enough or to dropping pumping sessions too early, which in turn can lead to a drop in supply."

In addition, depending on where you give birth, you may encounter a lack of support for exclusive pumping. The staff may not have heard of it being done successfully and may not view it as a realistic option. "Some doctors will suggest a switch to formula without mentioning the option of pumping," Casemore says. "They may even suggest that pumping is not a realistic option if a mother broaches the subject."

Making It Work
How can you make it work? The first thing is to have the right pump. "Hospital-grade breast pumps such as Ameda and Medela are the only pumps that a mom should use when her baby is a preemie and not latching," Crouthamel says. If you plan to continue pumping long-term, you can switch to another pump later, but it's important to understand that hospital-grade pumps are built to establish your milk supply, while store-bought pumps such as the popular Medela Pump-in-Style aim to maintain an existing supply.

The second step is to follow a regular pumping schedule. "The most important element to building and maintaining a strong milk supply is to establish and maintain excellent pumping habits," Casemore says. This means that in the beginning, you should pump every time you bottle-feed your baby, even in the middle of the night. It's a good idea to pump every two to three hours and at least once between 1 a.m. and 5 a.m., making a grand total of at least eight to 10 pumping sessions every 24 hours.

Troubleshooting
Maintaining a milk supply is probably the biggest challenge moms face when exclusively pumping. Some are unable to continue more than a few months. Although any breast milk is better than none, as Crouthamel points out, there are some things mothers can do if they notice a supply dip while pumping. "If a woman detects a dip in supply, it is important to find the cause if there is something specific," Casemore says. "If nothing specific can be determined, the best way to boost supply is to start pumping more frequently, mimicking a baby's growth spurt."

Here are some additional tips Casemore offers for troubleshooting a supply dip:

• Check for a problem such as a blocked duct or mastitis.
• Inspect your pump. Sometimes there may be a hole in the tubing or a blockage someplace.
• Get adequate nutrition and rest. You need to eat enough in order to produce enough milk, and stress from sleeplessness can also impact your supply. (Although with a baby around, getting sleep can be easier said than done.)
• Drink at least eight to 10 glasses of water each day. Your body will have an easier time producing milk if you're adequately hydrated.
• Eat oatmeal. "Many women give anecdotal support to the value of oatmeal in increasing milk supply," Casemore says.
• Try fenugreek or Mother's Milk Tea, which help some women. Watch for gassiness or stomach irritability in your baby or yourself.
• Wait to start any hormonal contraception until your milk supply is established, and then opt for the progestin-only pill (also called the mini-pill). Estrogen-containing contraception can negatively impact your supply.
• Don't ignore your pain. If pumping hurts, check for thrush or reduce the suction level in your pump. Lanolin can also help with sore nipples.
• Connect with other women in your situation for support and advice. There are online support groups for women exclusively pumping, as well as breastfeeding advice forums, where you'll find women with a wealth of knowledge who can offer additional tips.

In the End
Exclusive pumping is obviously not for everyone, but it's the second best option after breastfeeding, according to the World Health Organization. Casemore's book can be added to the resources that help and support women in offering their babies the nutritional benefits of breast milk while relieving the overwhelming stress they face in the beginning.

"Know that it is possible to exclusively pump long-term if breastfeeding does not work out," she says. "While it might not be the breastfeeding relationship you expected, it still is a wonderful feeling knowing that you are nourishing your baby and giving them a gift that will last a lifetime."