Exclusive Pumping in the Neonatal ICU with Rachel Wells

Rachel, a journalist based in Nashville, was 24 weeks pregnant when she and her husband discovered their son Abel had severe intrauterine growth restriction. Against all odds, he was delivered by C-section a month later at 29 weeks, weighing just 1lb 7oz. Rachel shares her experience of spending nearly three months in the neonatal ICU and, in particular, her experience of exclusive pumping. For many of us who decide to exclusively pump, the (seemingly never-ending) process can be quite traumatic. As always, we at Nyssa aim to share the full spectrum of the postpartum experience. For those who have pumped or are currently exclusively pumping, we hope Rachel’s honest and raw account can provide some solace. 

You exclusively pumped for 4 months while your newborn son, Abel, was in the NICU. Please can you share a little about what lead to you needing to pump for him? 

Yes, I exclusively pumped for four months, nearly three of which Abel was in the Neonatal ICU. At 20 weeks we found out the baby had severe intrauterine growth restriction (SIUGR) and reverse end-diastolic flow, meaning deoxygenated blood that should've exited his body through the umbilical cord was reversing back into him. We were told he'd pass in a few days. We made funeral arrangements and I prepared to deliver a stillborn amidst hospitals not allowing visitors and potentially partners. Somehow four weeks later he was still alive, and at 24 weeks we were told I should be admitted for 3x/day monitoring. After a week of monitoring, he was delivered via c-section. He was born weighing 1 lb 7 oz and was too fragile to hold let alone breastfeed. 
Can you describe a bit about you had been planning to approach feeding? If your plan had been to feed from the breast, did you struggle with reconciling that plan with the reality of your situation? What, if anything, made that acceptance easier? 
My desire was to breastfeed for as long as I could. It felt like such an obvious and natural decision. Later I learned a lot about how none of that is true. Culture really permeates us more than we think.
At first, I was so devastated by grieving him and then by not being able to touch him for days after his delivery to remember I'd even wanted to breastfeed. My husband and I planned to take a baby prep course at the beginning of our third trimester, but our pregnancy didn't get that far. I learned how to self-express and pump during a five-minute lesson from a stranger in the hospital. I was proud I could give him colostrum and breastmilk in the beginning. As weeks wore on in the NICU, I was told he'd probably learn to feed faster through bottle feeding, but I kept my foot down around breastfeeding. 
When he was finally strong enough to try, I attempted to latch him, fighting to see his tiny face from behind the CPAP breathing tubes and over my medical mask. It was a guessing game and I was furious about the multiple complications. Still, he latched and did his best to feed even though he was really still too weak to pull anything out. We kept trying. Sometimes he'd scream bloody murder and the nurse would come in to suggest we switch to his feeding tube. Other times he'd quickly latch and feed well.
Eventually, feeding was the only thing keeping him in the hospital and I felt guilty for continuing to try breastfeeding, but it felt like the only thing I had left after losing so much. We never really had the chance to exclusively breastfeed anyway because he required nutrition fortified milk to support his development. Although we didn't have the journey I so deeply wanted, I had a few glimmers of success and that's what's kept me going. Even now, I look back and know I did my best and that'll just have to be enough. But I will say, even though that sounds nice, I still struggle with a lot of grief and anger over the situation. 
Could you describe the logistics of pumping exclusively to someone who hasn’t been through it? What was your rhythm during those months?  
It's hell, to be honest. In order to keep your supply up, it's important to pump every two to three hours -- day and night. I'd meticulously plan the day and night's schedule in advance and after every pump, I'd record the time I started and the duration. After a few pumps, we'd wash the parts to make sure everything was clean and dry for the next few sessions. If we were leaving the house, I'd make sure we packed the pump, parts, clean bottles, a pumping bra, and a cooler to store pumped milk. The pumping process took up every minute of the day. If I wasn't pumping, I was cleaning parts. If I wasn't cleaning parts, I was pumping. And through all of this, I had to accept my baby wasn't even living under our roof.
What was the most difficult moment for you during that time?
In the NICU I often had to stop holding him and put him back in his isolette so I could pump. It was heartbreaking every time. Because I was recovering from a c-section, which is a major surgery no one warns you about, I couldn't visit the hospital as often as I'd of liked because I couldn't walk. When I did go, all I wanted to do was hold him for the hour I was allowed, but in order to provide milk, I had to let go.
What, if anything, helped make it easier? (Equipment, logistics, emotional support etc.)
I wouldn't have been able to exclusively pump if it weren't for the support of my husband. He cleaned the pump parts a majority of the time. He listened as I cried about wanting to quit. He encouraged me by saying how amazing it was that I could provide any milk at all provided how stressful our situation was. 
How was your partner able to help you? Looking back, would you ask for your support system to do anything differently? 
If you count the hospital as part of my support system, I'd have them remove all the breast is best posters from the hallways and doors. Doctors and nurses talk about how painful a preterm delivery or a NICU stay can be, but I don't see anyone proactively thinking about how triggering the signs plastered all around the labor and delivery unit are. When I learned how a person's body alters breastmilk based on a baby's needs, I understood breastmilk's unique power, but I didn't and don't understand why the impacts of the emotional toll of breastfeeding or exclusive pumping weren't equally weighed into the equation. We know emotions alter our physiology, so why aren't we advising new parents to that end?
In what ways do you think pumping exclusively impacted you most, emotionally and physically?
The emotional toll of knowing I was trying to care for my son while being physically separated from him was the worst. Our bond just wasn't there. I knew he was my child, but it felt like he could be anyones. I knew I was his mother, but I felt like an animal being used only for what it could produce. In fact, the pump was the reason I quit. The sound of the machine, the monotony, the relentless rhythm brought back flashbacks from the NICU and I couldn't get over it. It got to a point where if I heard the noise I sobbed.
How did you feel when you finally ‘broke up’ with your pump?
I felt like a failure like the pump was there to facilitate something good and I couldn't see it as anything other than bad. The thought of feeding Abel formula felt like I'd be purposely poisoning him. No one ever told me formula was bad, but I somehow knew it in my bones. It took me weeks to wrap my head around breaking up with the pump and switching to formula. When some friends told me about how they quit pumping and made the switch everything clicked. When I finally stopped, I felt like a human again.
What tips and advice might you have for someone who is pumping exclusively for their newborn? 
I'm not proud to suggest this, but run the dishwasher half empty. If it saves you time or energy, do it. Make up for wasting water by increasing other environmentally friendly approaches -- like boiling water rather than buying distilled bottles. I'd also suggest finding the right flange size and buying enough parts for every pump so you don't have to clean them throughout the day. I didn't learn the last tip until the end of my pumping career and it would've saved me from a lot of back pain and tears hunched over the sink.  Truthfully, I don't think you can exclusively pump without sobbing at least 50% of the time. I don't think it's actually physically possible. So, if you're pumping and crying, you're doing it right. And finally, if you're looking for permission to stop pumping, I'm giving it to you.