"You have to do the best you can
under the circumstances
and realize there's no point in getting upset.
You'll run into difficulties,
and if you can change or improve the situation, change it.
If you can't,
don't fret about it."
-Bob Bole
Many emotions and feelings surround the breastfeeding struggle that premature moms face. Part One of this guide will discuss how the mother's emotions are affected by accepting pumping, the logistics surrounding pumping, suggestions from others. the spouse's role, and problems with milk production.
First Impressions and Expressions
At first, until the mother finds out she is indeed able to participate in breastfeeding, she may feel
very upset and grieve her loss of a very important part of mothering her baby. She may feel angry and sad that nursing was "taken" away from her. Even if she was previously uncertain as to whether or not she would breastfeed her baby, she can be mad that the decision was made without her - she had no input.
However, when the news is shared about pumping breastmilk for her preemie, a mother's outlook is likely to change. If she chooses to try pumping, she may start to feel excited and joyous. She can actually DO SOMETHING for her baby! She can be an active participant in mothering, even if she can't yet hold or care for her baby. This is very reassuring to the mother - she is still very important to her baby. Mixed in with her joy, though may be other emotions - fear, worry,
embarrassment, disappointment, disgust.
Fear and Worry
The mother is likely to fear that she will be unable to produce any or enough milk for her baby. The feelings can be similar to performance anxiety. With many nurses and lactation consultants
watching and "waiting for the milk to appear", she may start to doubt her abilities when the milk
takes the normal few days to "come in". She may even want to give up now. This waiting can make the mother upset and feel like a failure. It is important for the mother to recieve lots of
reassurance and support during this time - from everyone. It is also important to educate her on
the normal process of beginning breastfeeding - the wait for milk, colostrum, typical amounts that are produced at the start, and why. It also is important to make sure her pumping techniques
are correct. (Too often a mother is issued a breastpump and not instructed in how to operate it. Or her techiniques are not reviewed and perfected by a nurse or lactation consultant._
Once the milk begins to flow, she may still have fear that she will not produce a suitable amount or that it will unexpectedly stop at any given time. Here again, education and support are vital for the mother. It is not likely that the milk will disappear when a good pumping routine is established., so that fear can be eliminated with education. Also, it should be stressed over and over that producing any amount of breastmilk is a great accomplishment, whether or not that amount is able to be the sole source of feeding or only a portion. A mother should understand that any
amount of breastmilk she can produce for any amount of time is worthwhile and great for the
baby.
Embarrassment, Disappointment and Disgust
Because expressing breastmilk is not the usual route to breastfeeding a newborn, a mother can be
embarrassed at what she is trying to do. She may be embarrassed that she cannot feed her baby
like other mothers do. She may feel embarrassed to have to learn to pump while in the hospital.
(A closed door and a door monitor can help with this!) She may feel that others see her as a
failure as a mom because she cannot do it the way as other moms do.
She is likely to feel disappointed that the cozy bond of nursing has been replaced with attaching her breasts to a mechanical pump. She may even feel disgusted at the technique and feel that she is
milking herself like a cow.
It can be hard to view pumping as worthwhile and important when these feelings enter her mind. It can help to praise the mother's fortitude for "sticking it out" and trying to "do what's best for
the baby". It can be especially reassuring when she sees her baby receiving her milk, via tube or
bottle feedings. It can help to reinforce that feeding in this style does not mean it is permanent, usually it is temporary until the baby learns to nurse.
Supporting the Mother's Choice
to Express Milk
Many times, friends and family members, even spouses will encourage the mother to give up the struggle of pumping milk. While their intentions are good, the mother needs encouragement and support to persevere and hang in there until she chooses to stop expressing. Often instead of hearing compassion, the mother hears doubt about her abilities and discouragement hidden in these well-intended suggestions. She may wonder if others understand how intensely she feels about breastfeeding. She may not be able to explain why she feels this way. She may be ashamed to admit that breastfeeding and pumping is the only way she feels successful as a mom and it is "making up" for her failure in pregnancy, childbirth, or delivering a healthy baby. She may not be able to express how pumping makes her feel connected to her baby, how often it is the only bond she feels with motherhood at this time.
If she were to admit these things, many friends would try to persuade her that she is not a "failure" adn that she can be bonded with her baby in other ways. This increases the lack of connectedness she feels with friends. It may also leave her feeling as if her feelings have no value and they are not normal. She may refrain from discussing the matter any further because she doesn't feel safe to share her true feelings. It helps if friends can understand all that expressing milk offers to the premature mother. It is suggested that friends and family unconditionally support the decision to pump and breastfeed as long as the mother sees fit.
The Logistics
Pumping breastmilk is not anywhere near as convenient as nursing. The logistics that are
involved can bring up more feelings in the mom.
Finding a Pump
It can be frustrating, scary and worrisome to locate a pump. The mom is under pressure to pump
routinely, but between traveling, sleeping, and visiting baby, finding a routine is all but easy. It
can be frustrating to have to time travel and visits around a pumping schedule. It can be worrisome, especially when leaving the hospital the first time, that she won't be able to easily find a pump to rent at home. Worry also crops up when a pump is not readily and easily available near the NICU. This happens often when there are not enough pumps available, or too many hospital employees are allowed to use it. The mother attempts to regularly schedule pumping sessions, but cannot do so because of the inaccessibility of pumps. She may need to resort to bringing her own pump if the NICU cannot work this problem out.
There are other worries, too. Not only does the mother have to worry about finding the pumping
room, physically getting to it (especially when recovering from C-section), but she concerns
herself with getting to it in time as well. Make sure the mother knows the location of all pumps, has help in getting to the rooms (wheelchair if necessary) and someone to help her schedule pumping accordingly. Since parents often get wrapped up in what is happening in the NICU, perhaps a nurse can be asked to remind her of when she should leave to pump.
Finally, many times there are misunderstandings about the what to do with breastmilk. Freeze it?
Refridgerate it? How much should be brought to the NICU and when? It is important to fully explain milk storage procedures to a mother. Even if she fully understand them at the time, the procedures should also be written down for her to review if a question arises. Too often a mother spends hours pumping milk, to find out she stored the milk improperly and it must be dumped. How disheartening this is to the mother! Make sure she comprehends what amount of milk is to be kept “fresh” for immediate use. Too often a mother is not told just how small an amount of milk is taken by the baby at first and she is disappointed to find out her baby may only take a few cc’s. Prevention through education can nip disappointment, discouragement and upset in the bud..
Got Milk, but what about everything else?
A mother often worries that she may forget her supplies for pumping. This can cause her to feel
pressured which in turn makes pumping more difficult. She may get to the pumping room, get
undressed and ready to pump, and realize she forgot one part of her pump. It is not uncommon
fro a mom to go to the trouble of pumping, only to find out she forgot empty bottles or a cooler for the milk. Help her make a check-list to carry on trips to the NICU. Double check that she has all supplies in the NICU and at home. Know who she can contact in a pumping emergency.
The Role of the Spouse
While physical limitations will keep the husband from pumping (although there has been a mention or two in history of men lactating!), they can play a vital role in it. The spouse should help encourage and support the mother as long as she chooses to express breastmilk and attempt to nurse.
Many times the spouse may encourage his wife to give up expressing and nursing before she is wants to stop. He often does this out of concern and caring - he wants his wife’s life to be a little less stressful and upsetting for her.
He may view pumping as an inconvenience not only to his wife, but to himself, as well. It takes lots of time (as much as nursing a baby!) to successfully attempt expressing milk for many days, weeks or months. It can put a damper on schedules, and tie down the mother in terms of what she can do and where and when she can go places. It is normal for both the mother and father to resent this "inconveniece". However, it is best to acknowledge it as such, and move on to finding ways to positively support and encourage the mother as long as she chooses to pump for her baby.
In addition, the dad may feel discontinuing pumping could ease some stress he feels. He may feel more secure in the knowledge that his baby is getting a determinable amount of milk at each feed and may doubt less about weight gain.
One the other hand, he may encourage her to continue expressing when she is otherwise ready to stop. Again, while she should consider his opinion when making her choice, she should ultimately be the decision maker, for it is her body and mind that is bearing the stress. The husband needs to support her choice totally, either way it goes. If she chooses to continue, he needs to not
undermine her courage, perserverence and determination with his own doubt and worries.
They husband can do much to relieve the stress of pumping and help make expressing milk easier for the mother. He can turn pumping times into a relaxing event in several ways. He can help prepare the supplies for pumping - empty bottles, a timer, pump parts, as well as set up a
comfortable “pumping station”, stocked with pillows, a blanket, the remote control and a
cordless phone. He can turn on some relaxing music, a movie or television show. Or he can
provide some magazines or a book to read. The husband can prepare a warm drink or a glass of
water to sip before and during pumping. If possible, it helps for him or another helper to stay close in case sheneeds assistance. The support of a spouse can be very reassuring to a mom during this time.
Whoa - is THAT your milk???
Because pumping breastmilk (versus nursing at the breast) gives the mother a visual result of her
efforts, it can stimulate many, mixed reactions. Obviously, the visual result offers a few advantages. It can be reassuring and encouraging for the mom to see that she can take an active
part in mothering her baby. It can add to her feeling like a “real mom”. It can make her feel
special and important - for she is the only one who can provide this special milk. The problems with this visual “report card” seem to arise when the mother’s production is either on the high or low end.
A large amount of Breastmilk
For the mom who produces a large amount of milk, it can feel wonderful. She may feel a sense of control return to her and sense of accomplishment. However, this mom can also be embarrassed and upset at her body’s large production. This is especially true if nurses and lactation consultants call attention as an abnormal function (“You need how many bottles??!”, “Oh she makes so much milk, she could feed the whole NICU!”). It can make her view her body’s response as inappropriate or abnormal, especially if the baby cannot take any or very little milkfeeds. She may feel like the milk she is producing is a waste. This mom may often be embarrassed to ask for bottles to store the extra milk and instead throw it away.
A Small amount of Breastmilk
At the other extreme is the mom who produces too little milk. She is also likely to be upset. At a time when she already feels like a failure in the pregnancy department, a lack of success in
pumping can be a final blow to this mom’s esteem. She may be ashamed to take the half-filled bottles to the NICU. She may decrease the time she pumps, since it appears to be so unproductive anyway. This only adds to the problem - the less she pumps, the more the supply dwindles. Or she begins spending more and more time pumping during the day and waking herself up multiple times in the night. As she becomes more fatigued and stressed, her supply drops even lower. When she shares her struggle with friends and family, they may encourage her to give up pumping in an effort to reduce stress, fatigue and depression. This leaves her feeling even more alienated and misunderstood.
If she accidently spills or wastes any milk, she can become extrememly upset. Don’t be surprised to find her obsessively sopping up spilled milk in an effort to save it and hysterically crying. She may even become so stressed that she becomes forgetful with her pumping procedures. She may accidentally forget to store her milk when she finishes pumping or she may forget to take her pump parts to the NICU. It is normal for this mother to start asking for help and searching for remedies to her problem. If the proferred remedies do not offer a solution to her low supply, she gets even more upset and can become compulsive. She can get into a vicious cycle of seeking out many new remedies, anxiously trying them, then becoming even more upset and disappointed when they don’t work. Or she may stop asking for any help at all, even if she has not tried all suggestions, for fear that nothing will ever work. It is a shame that at a time when a success with breastfeeding could help resolve feelings the of failure as a mother that surround preterm birth, it is only adding to her feelings of failure.
In both instances, the mothers feel abnormal and ashamed. They both can feel anger at the loss of control over their bodies and their babies. They both can feel depressed at not being able to nurse her baby. They may start to see nursing as the ultimate or only goal and lose perspective of all else. Their esteem may suffer under the pressure of pumping.
What to do?
For the overproducer...
Help them see the long-term benefits of pumping for the baby. Reassure her that the efforts of her pumping do have a goal - actually nursing her baby - and are not in vain. If she is in need of an immediate reward, and it will be awhile before the baby is to begin feeds with the milk, suggest possibly donating some of her milk to a milk bank. Have a nurse and lactation consultant work out the bottle supply and storage logistics with her. She should always have an ample supply of storage bottles for the milk. Talk with the doctors about the schedule for introducing and upping feeds - it helps to have a plan of action for using all the milk that is building up. Reinforce how proud she should be of her success. Help develop a sort of “advent” calendar to help her look forward to the goal of breastmilk feedings and nursing with mom.
For the underproducer...
Help the mom feel pride in her efforts to produce milk, regardless of the amount. It is difficult work, tiring, and added stress for the mother. Let her know that her efforts are acknowledged, for a worthy cause and not in vain.
Make the nurses aware of her struggle. They can be more careful with their words. Let them know NOT to comment at all on her production amounts (comments such as “don’t waste that milk - we don’t have much!” or “don’t you have any more?” can really hurt). Help the mother focus on other aspects of mothering she can participate in and not just breastfeeding. Ask nurses to teach her ways to touch or massage the baby, if allowed. Help her pick out some special children’s books to read when she visits. Help her decorate the nursery or shop for some preemie clothes if she chooses. If she is kangaroo-ing, include many times for just cuddling without the pressure of trying to nurse. Assist her with pumping (wash parts, store and label milk, keep her company or provide and entertainment while she pumps). Encourage her to set up a meeting with the lactation consultant to review her pumping techniques and discuss possible suggestions.
For both moms...
Reinforce the normalcy of their emotions. Help them connect with other preemie mothers
experiencing a similar problem, through a support group at the hospital or perhaps the internet. Help them keep their focus on the baby’s progress as a whole, not just the feeding aspect. Do not encourage or insist that the mother should stop pumping in either instance. Often, she feels this is her only link to the baby, her only way to compensate for her “failure” in the mother department. If the mother brings this up, help her weigh her choices objectively, without adding your personal opinion. Help her find a lactation consultant to help her with any and all difficulties.
Go to next topic Breastfeeding, Part2
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