Being Electric Ermintrude
When you have a premature baby well-meaning folk bombard you with stories about early babies that are now six feet six and running international merchant banks, robbing post offices or whatever. This is reassuring the first time, tiresome by the twentieth. When your baby is born premature you just assume it is going to be OK unless something is obviously wrong, in which case you don't want to hear about babies who turned out OK.
What few mention is the hard slog of waiting for your boiled-squirrel-in-an-eggbox baby to become a take-away baby. And they definitely don't know about the hours and hours on a breast pump that are ahead - no-one talks about it.
Mechanical breast pumps are one of those items of medical equipment for assisting unmentionable bodily functions; the mere mention causes a snigger, saying you use one has people wincing with embarrassment whilst wondering what they are. The Ameda electric double-pump was certainly designed by someone with three hands and no breasts. Its dysfunctional design and counter-intuitive controls are accompanied by the wildly optimistic claim that its action imitates that of a suckling baby. Puh! No baby I know feeds like that, let alone goes beep-beep like a reversing toy dust cart. That said, an electric breast pump is your only realistic option to keep your milk supply flowing until your baby is able to feed itself - you couldn't do it with a hand one, you'd be there forever and develop biceps larger than Pop-Eye. For all its faults, it does the job.
Those of us breastfeeding our once premature babies are not as commonplace as we should be. Many women find their milk dries up before their babies become able to feed . Why this is I am not qualified to say; all I can do is relay how I and a couple of others whose babies were born in the summer of 1999 did it.
I had some warning that Lucian was going to be born early as my waters broke 10 days before he was born at 28 weeks gestation, so we had time to do some research. We pulled pages from a web site offering advice to parents of premature babies and Bliss, the charity for premature babies, sent me a photocopy of a tremendously useful article published in a midwifery magazine.
The information I found contradicted the advice given by the hospital staff. To be fair, neonatal nurses are trained to look after tiny babies, not their mothers, and most are young and have not had children. I was told to use the breast pump for no longer than 20 minutes. As they had only seen single pumps this meant ten minutes per breast.
However, to back-track for a moment, at the hospital where I had Lucian I had to make most of the running to get as far as being given this (duff) advice. Some hospitals have breast pumps lined up like supermarket trolleys and loan them out, but where I was they were few and hard to find not already in use, pretty cronky when you managed to lay your hands on one and there was no loan scheme. The breast feeding counsellor (who was rarely seen in the SCBU) gave me the numbers of the companies that sell and hire them. Lucian was 12 weeks early so, as I could buy a home model for two months rental of the industrial version I got my own.
When you are going to be doing this for weeks or months, there is no point in having just a single pump that does one breast at a time - it will take ages. A double pump encourages you to produce more milk in total and milk of slightly higher quality. What they don't tell you is how awkward it is using the damn thing. You need to hold a funnel to each breast, so if you want to drink something at the same time (one gets terribly thirsty) you have to devise a way of freeing a hand by holding funnel against boob with a raised a knee. You get quite good at doing this, to the point where you become over-confident and think, "Perhaps I'll put my feet on a stool, use both knees and read a book." Then one knee slips, you can't catch anything and everything ends up on the floor. Be realistic - choose a radio station you can tolerate for long stretches and face up to the fact that you are going to get well acquainted with their programme schedule.
Nomatter how careful you are it is a drippy business. I wore a nursing bra to hold a tea towel in place under my boobs to catch the dribbles. Rather than try to hold up a T-shirt or similar (it falls down and you can't see what you are doing), wear something that unbuttons down the front.
All the books tell you how one produces breast milk in order to meet the demand. The article Bliss sent me covered a hospital study of how best to keep mothers' milk supply going whilst their babies were in special care. The study found the keys to success included, first and foremost, always draining both breasts at each session. If you don't express all you have you send a signal to your body to make less next time, creating a downward trend - so the "20 minutes and no more" rule was ridiculous. Also, the let-down reflex comes in waves so a breast appears to dry up but then, as the pump keeps running, it will start up again. This could explain why later, when feeding your baby, it will get cross with a breast until you swap sides, but be quite happy to go back to it five minutes later when the other one temporarily runs dry. A lot of people also find their baby seems to prefer one breast to the other. When using the pump day in, day out, I and others would find that one breast produced more than the other, then the situation would reverse.
This is all very well, but it assumes you can get your milk flowing in the first place. It happens spontaneously with a screaming baby on your knee, less so when you have a pale blue plastic machine on a table next to your chair. It can take quite a while at first. One reads about taking a hot shower which does help, but you can't be doing it half a dozen times a day. Placing flannels - as hot as you can bear - on your boobs for about ten minutes (whilst the pump tackle is cooking in the steriliser) has the same effect and makes for interestingly day-glo pink boobs! Massaging your boobs with a soapy hand also helps, stroking lightly towards the nipple. But still don't be surprised if it takes much longer for the let-down reflex to kick in than when feeding a baby.
How long it then takes to drain the breasts varies from individual to individual and how long since you last did it. I kept reading about how you should express 6-8 times a day, but it took me so long at each session (up to an hour and a half in the mornings) that there wouldn't have been any time between, let alone a couple of hours in the afternoon to go to the special care unit to see my baby. I managed 4-5 sessions a day, starting the first at 8am and finishing the last at midnight. I couldn't face getting up in the night to do it, though you are supposed to and others I know did. They also managed to drain both breasts in half an hour, leaving me slaving away.
You never produce as much as you do in the first few days when you have breasts like medicine balls. Your supply eventually stabilises at more or less the same amount per day, with the quantity at each session varying throughout the day (usually most in the morning). This would also happen if you had a full term baby and were breastfeeding it. I read about how a baby sucking on an empty breast stimulates you to produce more milk in the future, so would leave the pump running for a couple of minutes after there was not a drop left to try and imitate an increasingly demanding baby. My supply didn't radically increase but it didn't go down either.
Although I never needed to take anything to stimulate my supply I consulted a homeopath just in case. She recommended drinking fennel tea and a remedy called Pulsatilla. If you get into a state where your milk dwindles no matter what you do, you can get a prescription for a short course of prolactin. This works whilst you are taking it but not necessarily forever, and you should not have more than two courses.
Having got the milk flowing you have to keep it flowing. Visualisation, thinking about your baby and looking at a picture of him or her definitely help. Things are easier if you can be in a peaceful, private room on your own. If you are concentrating on something completely different the milk flows much slower, so holding a conversation with someone is best avoided. This is probably why babies hate you talking on the telephone whilst also feeding them - it's not that they want your undivided attention for selfish reasons, they just want to be fed!
The great thing about breastfeeding a baby is you can do it anywhere. Using a breast pump really ties you down. You can sit in the corner of a café feeding your baby with a coffee on the table in front of you for half an hour, but you can't very well take your pump into a café, ask for a nice seat near to an electric socket, take out both breasts and sit there clasping a plastic funnel to each. Anyway, you wouldn't have a hand free for the coffee cup.
At the time it feels like you will be forever producing milk into little bottles to put in the freezer so it can be defrosted later and fed to your baby via naso-gastric tube. Eventually your baby gets strong enough to have a go, though they are still so small compared to any part of you it's like balancing a pea on a barrel. The ability to co-ordinate sucking, swallowing and breathing comes together at about 34 weeks gestation, but it's hard work for them. Lucian would manage two or three sucks and be totally exhausted for the rest of the day. Gradually they manage more and you go into a period when they breast feed for a few minutes once or twice a day and have the rest via naso-gastric tube. This builds up to being breast fed during the day and having a rest, being tube fed, at night. As Lucian got stronger still the night staff would further encourage his abilities by cup feeding. This involves holding a shallow dish brim full of milk up to his lips so the upper lip comes over the edge. He would them half slurp, half lap the milk. It was messy and slow but some milk went down. The purpose was to avoid confusing him with a bottle, which requires a sucking technique different from breast feeding. However, once he was very sure about how to feed from me we tried giving him my milk from a bottle and he took it without a murmur. I became one of those lucky mums whose babies will take a bottle from anyone.
Let no-one tell you otherwise, this is not easy - it's a hard grind. I spent up to 6 hours a day or more on that breast pump for almost two months. There were days when I sat for hours wailing uncontrollable tears of misery, the pump beeping as Radio Four played yet another chance to hear something I didn't think much of the first time it was broadcast. But I am glad I did it and that I didn't give up. So, if it happens to you, get that pump, grab a tea towel, set the radio, grit your teeth and get on with it.
Amy Silverston
37 Laurier Road
London NW5 1SH
020 7485 7625
Spring 2000
Amy.Silverston@virgin.net
Other misc information once you both get home
Sickiness. Premature babies are more prone to reflux - at the end of a feed it all comes back up. This is terribly dispiriting for you but they just want to feed again. Reflux is something they grow out of during the first year. They suddenly start keeping their feed down one day. Various medicines help a bit but their effect tends to wear off. Of the things we tried I found infant Gaviscon helpful but every baby is different.
The reflux worried the health visitor because Lucian was barely gaining weight. She pressured me to start giving him baby rice on the grounds that it would be heavier and more likely to stay down. He was 3-4 weeks past his due date and weighed just under 6lbs. I had read that one does not start premature babies on solids until at least 4 months past their due dates so refused to comply. I then noticed a lump in his scrotum. Knowing other boys in the baby unit had had hernias I went to the hospital asking if this was the problem (the doctor didn't know). We were in Great Ormond Street the next day where it was a short minor operation to close up the hole through which the testicles had descended into the scrotum - it has usually closed by the time a full term baby is born.
I mentioned the reflux problem to the consultant who said that it was probably linked to the hernia. This proved to be the case. Once the blockage it had caused was solved his digestion was much easier - much less by way of colicky type problems and a dramatic reduction in the reflux. I told the consultant about the health visitor urging me to feed Lucian solid food and he was horrified. "It's much too soon and he's car too small."
The lesson is to follow your instincts. Health visitors are in the front line. If a baby appears not to be thriving they want to get food into it - hence their readiness to recommend bottles of formula and baby rice at the drop of a hat (or a drop on the scales).
Catching up. It may be received wisdom amongst people like teachers that they catch up by the age of two but whilst this may be likely when a child was a few weeks early it is not necessarily the case when there are 3 months to make up. Lucian was born at the end of August, which puts him into the school year before he should have been. I have challenged nursery schools which want to enter him on the basis of his birthday and then hold him back if he struggles. I found out that they can exercise discretion but almost none have the confidence to do so. I won my case after finding two professors of paediatrics who had done long term follow-up studies of premature babies who agreed with me and wrote letters to that effect. One said he can still pick out in tests the children who were premature as late as 11yrs old.
Clothes. Everything for newborns is far too big! There is a limit to how far up one can roll the sleeves and feet. There are companies that make teeny clothes. They had leaflets in the baby unit. We also have a knitting pattern for small cardigans that I can pass on if you have a knitting granny.