Here are a few lessons I (eventually) learned after my preemies both spent their first weeks of life exclusively fed expressed milk.
1. Get the correct equipment. With preemie-man #1, I pumped for eight months using the wrong size nipple shield. Eight. Months. Let me just tell you, that was hell on a number of levels. The shield was too small and caused chaffing which was painful (a-duh) and consequently inhibited my let-down. Ultimately, my production suffered too because I couldn't empty my breasts completely. Cue the long sad nights of releasing more tears than milk. Pure hell.
Also, get your hands on a hospital grade pump (Medela or Ameda), you can find rental sites online or by talking to a local lactation consultant (LC). I believe you can usually rent from the hospital (not ours though!). Then keep your receipts and submit that sh*t to your insurance company for reimbursement (pump, supplies, consultant visits, all of it---worst case? They say no)
Might I also recommend a hands free nursing bra? I made one myself by snipping 2 holes in a Bella band when I had little guy #1 but broke down and bought one for #2. It was worth every penny, I can even snooze during pumps at night now, if I get the pillows set up just right! The LC recommended one called PumpEase (Fabulous 50s) by Snugabell because of it's adjustability and solid design. I am thinking of marrying mine.
2. Be an exhibitionist (at least once, anyways). Sit and pump with an LC early in the game (first week, if possible). She obviously is into boobs, since she's a lactation consultant (shall we assume they're all female?? Actually sounds like a good gig for a straight guy...) and won't mind one bit. Also, she can identify things like: do we have the right size shield? Or, are you smashing the whole apparatus against your fun-bags, thus inhibiting blood flow and let-down, (guilty!!)??
IMPORTANT NOTE: Pumping should not be painful!
3. Massage the girls. Give yourself a nice little '4-quadrant' rub down before your pumping session. Focus on any lumpy parts and if they feel like they're not emptying as you pump, add some gentle pressure to those areas to help get things moving.
4. DRINK DAMMIT!
A) Drink water. Loads of water. I am inevitably thirsty every time I sit to pump, so a glass if water is essential with every pump-party. Water is big time important for milk-making.
B) Drink beer. But maybe not loads of beer bc it'll kill your production and weasel it's way into the milk (duh). And no one likes a drunk baby. Those crazy kids just can't hold their liquor. Luckily, some genius invented alcohol strips to double check alcohol content of expressed milk. You can get them at my favorite place in the world: Target. Another good reason to imbibe with caution is that we can assume you've been abstaining for at least a few months (unless you're one of those crazy broads from that show that blows my mind every episode: 'I Didn't Know I Was Pregnant') and are also exhausted by your pumping ultra-marathon. I mean, no one wants to be the chick passed out on the bar after two drinks (been there, done that...ok, it's my M.O.). Still, they say Brewer's yeast helps boost production, so a beer here and there may kick up the volume and also helps makes life seem worth living again.
5. Find a way to entertain yourself. Any nursing mom with a mobile data plan will tell you that their smart phone is their best friend and it rarely misses a pump/nursing session. Whether you're catching up on The Walking Dead or 'pinning' brilliant workout plans to kick that baby weight (and maybe some high calorie deserts to cancel out that workout in one sitting) suddenly you feel more connected to outside world...which is easy to lose touch with when your world is consumed by your tiny little miracle.
**NOTE: every so often during your pumps, sneak a few good peaks at some photos of the little one. It's like porn for your milk glands (bad analogy?)
6. Stay off those damn message boards. When you're looking for a late night distraction, just do yourself a favor and stay off those damn message boards. Trust me, you have enough to worry about already. Research is fine in moderation, just stick with credible sources instead of relying on 'BigSexy' who thinks you burn 500 calories an hour when breast feeding, 'unless your feeding twins'. I don't know what's more atrocious, her gross misunderstanding of energy needs or her blatant misuse of the word 'your'. I can't account for the 'sexy' part, but I will say she's probably pretty damn 'big' if she thought she needed 12,000 extra calories a day to sustain her milk production.
7. Hot compress or shower when necessary. If you're getting 'backed up' or feel like you're not emptying completely (lumpy lady lumps), try a hot compress or shower then massage a few minutes each before pumping. Try putting pressure on the lumpy areas during pumping. You may do the shower with massage again afterwards just to polish things off if things are bad. If the lumps don't resolve in a day or so, get some help (OB or LC)!! You don't want to push your luck with mastitis. A friend of mine had it eight times before learning her son had a tongue tie that was the culprit (talk about a nursing trooper!! Can we give her the Dedicated Mommy Award please??)
8. Know the expectations, but set realistic goals: Possibly the only advantage I can think of for exclusive pumping during the preemie weeks/months is that you can keep track of every ml you produce. There is zero guesswork as to whether you're making enough milk. The goal is to achieve at least 750 ml (25 oz) a day by day 10. Pump 8-10 times a day, round the clock for 15-20 minutes at a time (stop 2 minutes after you quit getting milk). More than 20 minute sessions should not be necessary (I was having to pump 30-40 with #1, should have been a big red flag!). Get help if you're worried about production or let-down, it's time to hit up the LC (or your OB) again.
Also, keep in mind that being separated from your baby is miles from the ideal new-mom scenario. Duh. Our bodies prefer to make milk for babies not plastic funnels attached to whirring, sucking machines. So, don't be shocked if your girls don't go above and beyond in the production department. Yes, you should seek some help if things aren't moving at the ideal speed because it very well could mean there's a problem! (See items 1,2,4, and 7). Sure, breast is totally best, for preemies especially. Can you believe your body knows the baby is early so it produces a special version of milk?? But, it's more important that mommy is not a basket case. If you give it the good ol' college try and it still doesn't pan out, you have not failed. You are not a bad mom. Don't let those LC bitches convince you otherwise.
9. Collect as many pumping kits as possible and keep one at the NICU. I have three kits at home, plus one at the hospital. It gets me through the night without having to do the dishes after each pump. If you badger the nurses or LCs, they will pass that sh*t out like candy ;)
10. Remember, LCs are all crazy bitches on some level. So don't let them get under your skin. It's their job to convince you to stick with something that requires your life to be interrupted every 2-3 hours. It also puts some pretty solid pressure on mommy to be the sole source of food for at least the first 4-6 months of life, and NICU mommies are already generally crumbling under the weight of stress and anxiety. See item 8 for a pep talk if one of those nutty women has made you feel bad about yourself. Plus, realize they're not all created equal. The two I have at the hospital have proven to be kinda sh*tty in my case, but I did some looking and found one I love.
11. Pump on the go. Seriously. I do it in the car. I don't actually know if it's legal, so if you decide to try it and it's not, don't point any fingers my way. Part of me kinda wants to get pulled over just to see the look on the cops face. It does require the purchase of a car AC adapter because those battery packs aren't worth sh*t. I have one called a 'PowerCup' and it's amazing (looks like a coffee cup and sits in the cup holder).
12. Accept help. Let's fact it, you cannot do it all (shocking, right?). Let your husband/partner do the dishes and make you a meal every once in a while! Stress can be a big buzz kill for milk glands, so let yourself be taken care of a little bit, it's good for the baby ;)
I'm sure there's more wisdom out there I have missed. It helps to connect with other moms in the same boat if you can (there are some great groups on Facebook and all over the Internet...just be wary of #6!)
Happy pumping, my friends.