The shock and stress of having a baby born prematurely is difficult in and of itself to deal with. The frequent trips to the hospital are exhausting. And the worry you feel about the health of your son or daughter can be overwhelming. If you had hoped to breastfeed your baby, you will no doubt want to use a breast pump to initiate and maintain your supply until your baby is strong enough and developed enough to start short attempts at breastfeeding and hopefully eventually transition to exclusive breastfeeding, but until this point, a breast pump will be a necessity. The requirements of expressing breast milk in the early days and weeks post-partum can add additional stress to what is already a difficult time, but having good information on how to best establish your milk supply will assist you to build a strong milk supply and provide the best nutrition possible for a pre-term baby: mother's milk.

The benefits of breast milk for preemies have been well researched. Not only can breast milk decrease the risk of necrotizing enterocolitis (a serious intestinal infection which is a very serious complication for any baby), but the breast milk from mothers of preemies is uniquely suited to the needs of these tiny infants. Breast milk contains an high level of antibodies which can decrease serious infections and illness in preemies. Breast milk also has growth factors which are very important for premature babies who are often very small and may have difficulty gaining weight. Mothers of premature babies also produce milk that is higher in nitrogen, protein, lipids, fatty acids, vitamins, calcium, and other vital elements important to the development of preemies.

It is important to begin using a breast pump to provide stimulation as soon as possible after the birth of your baby. It is best to use a hospital-grade double electric breast pump at least until your supply is well established. Your baby's neo-natal intensive care unit (NICU) should be able to help you locate a place you can rent a hospital-grade breast pump. When starting to use a breast pump following delivery you will want to follow, as closely as possible, the feeding patterns of a full-term baby in order to establish a strong milk supply. This means that it is important to use a breast pump 8 to 10 times within a 24 hour period for at least the first couple of weeks. Frequent stimulation is crucial to establishing a good supply; just as a full-term newborn would nurse on demand frequently, but likely for short periods, you must provide frequent stimulation to your nipples, breasts, and areolas. It is important to pump around the clock: both day and night. Although at night you can go for slightly longer periods between sessions. When beginning to pump soon after delivery, you do not need to pump for lengthy sessions. Ten to twelve minutes per pumping session is enough. Initially, you many not express too much in the way of colostrum or milk, but it will increase over the next several days with dedicated pumping.

At first, the milk you express is colostrum: a thick, yellow milk that has a very high concentration of antibodies and fat. While there is not a large volume of colostrum, it is worth its weight in gold! It can sometimes be difficult to express colostrum with a breast pump because it is thick and somewhat sticky. If you are finding it difficult, try hand expressing to see if you can express more. Use a syringe to collect as much of the colostrum as you can.

Your baby's NICU will give you instructions on storing and transporting your breast milk. Since preemies are more susceptible to bacteria, viruses, and other illness, it is important to carefully follow the guidelines the NICU gives you. Always use sterile collection bottles and sterilize your pump kit regularly. Fresh breast milk is almost always best, so try to deliver your expressed breast milk to the hospital as often as possible.

Usually within the first week or two, you should see your milk supply start to increase. You may find that you become engorged frequently. Frequent pumping is the best way to combat this. It will subside as your body starts to regulate its milk production. When your daily volumes start to increase, you will need to increase the length of your pumping sessions to ensure you are emptying your breasts as fully as possible. A general guideline is to pump for 120 minutes per day divided by the number of sessions you are pumping. Therefore, if you are pumping 8 times a day, you would pump for approximately 15 minutes per session. This is just a general guideline though and you may need to pump longer. The breast pump you are using can also vary the length of time you need to pump since not all pumps are as efficient in removing milk.

Initially, lactation is hormonally controlled, but this endrocrine control switches to an autocrine control- supply and demand- over the first several weeks post-partum. Prolactin, the primary hormone involved in lactation, dramatically decreases within the first couple days post-partum (one reason why frequent pumping is vital starting as soon as possible after delivery) and then slowly continues to decrease over the next 6 to 12 weeks. Many women who have not pumped frequently during the first few weeks after the birth of their baby find that their supply starts to decrease around the time that their prolactin levels would naturally be decreasing. It is best to make use of the prolactin you have in your system in order to establish a strong supply early on and then maintain that supply by maintaining the demand through efficiently and completely removing the milk in your breasts on a regular basis.

Generally, it is important to continue pumping frequently- at least 6 to 8 times per day- for the first couple of months post-partum or until you are able to transition to breastfeeding. If you find your supply is becoming extremely large- 45 to 50 oz. per day or more- it is better to decrease the length of your pumping sessions by a minute or two than to decrease the number of sessions you are pumping per day. The frequent stimulation is still very important. It is also better to establish as strong a supply as you can as opposed to only reaching the amount that your baby currently needs or is projected to need upon discharge from the hospital. While your baby's intake is low, your milk production needs to continue on as though your baby was born full-term. Trying to increase your supply later on once your baby's intake increases can be difficult with a breast pump since it will require you to start pumping more frequently than you already are. It is much easier to decrease your production once your baby starts breastfeeding. It is also important to continue to pump at least once during the night at least for the first couple of months post-partum (or until your baby starts to breastfeed exclusively): until a full-term baby would start sleeping through the night. However, some women choose to continue pumping at night as a way of reducing the sessions through the day and some women find that by eliminating the night session their supply declines.

Mothers of premature babies can sometimes have more difficulty establishing their milk supply. This may simply be a result of the premature birth since the mother's hormone levels may not be optimum for lactation. This is particularly true for mothers of extremely early preemies and micro preemies. Difficulties can also sometimes be a result of the medical interventions necessary with a premature delivery: IVs, cesarean sections, pain medication, pitocin, etc. Usually,given time,mothers of preemies are able to establish a good milk supply. Sometimes though, it may take longer for your milk supply to increase. If however, even with diligent pumping habits, you are unable to establish a sufficient supply, there are medical interventions that can sometimes be effective. Domperidone and Reglan are the most common prescription medications used to increase milk supply. Before turning to the use of these drugs though, it is best to exhaust all other means of increasing milk supply. www.kellymom.com is a valuable evidence-based website and has extensive information on increasing milk supply.

The frequent pumping that is required to initiate your milk supply with a breast pump can be very overwhelming, especially when you are already trying to cope with the issues surrounding the premature birth of your baby. But remember how important breast milk is to babies and even more important to babies that are born premature. Often it can feel very isolating in the NICU and you may feel as though there is little you can do for your child, but you can provide breast milk for your baby. You can provide your child with something that only you can give; something that is made especially for your baby and something that meets your baby's very particular needs.

Stephanie Casemore, the author of Exclusively Pumping Breast Milk: A Guide to Providing Expressed Breast Milk for Your Baby, is the mother of a "former" preemie who was born at 31 weeks gestation. She experienced all the emotions and challenges involved with having a preemie, hoping to breastfeed, using a breast pump to initiate and maintain her supply, and ultimately the disappointment of not experiencing the breastfeeding relationship with her son that she had hoped for. Casemore exclusively pumped breast milk for her son for one year. Her website,ExclusivelyPumping.com, is a unique resource site dedicated solely to the needs of women who are exclusively pumping breast milk for their babies.