First of all - I never did it, so I have never "walked in their moccasins".

Second, my experience is very limited:  four (very small sample) moms who
did it for over a year (2 very sick babies who never went to the breast and
2  babies with cleft palate/cleft lip) and a few moms who did it for
extended periods of time (6 weeks to 3 months) until their babies could be
breastfed (usually due to very large nipples and tiny babies).  These were
not moms with babies in NICU - they had their babies at home.

Here is a summary of what I observed worked for them:

They all learned to start pumping BEFORE the baby got hungry.  In the
beginning, this meant pumping every hour.  

A few good-natured babies would give "hunger cues" and then patiently wait
- never crying as long as they heard the pump going - knowing that the milk
would be coming once the sound stopped.  BUT if mom took too long after
turning off the pump, they'd start crying!

Most moms found they needed to pump on a schedule to keep ahead of her
baby's needs:
- every hour the first week, with one longer sleeping (for mom) period even
though the baby was being fed (all were bottle fed) every 2-3 hours.  Dad
usually took over the night feeds so mom could pump while baby was being
fed, making the process a little shorter.
- every 2 hours with some longer sleeps the second to third weeks
- every 3 hours after the fourth week, but at times their milk supply would
go down and they would have to increase to every hour for a few days.  
- some had to take fennugreek or Reglan (we did not have access to
domperidone) after    4 - 5 months.  They took them when they saw their
supply not keeping up with baby's needs.  They never "weaned" from
Fennugreek or Reglan - they would take them until their milk supply
increased, then stop.



Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA

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