Pumping in the NICU: Liquid Gold or Liquid Guilt?


Two hours after my son was born, a lactation consultant knocked on my hospital room door. She peeked her head in and asked “Are you going to breastfeed?”

I stared at her, trying to process the question. I had just delivered my baby four months before his due date and my tiny one-pound son was rushed to the Neonatal Intensive Care Unit (NICU) before I could even see him. I was in shock.

“Well,” I stumbled, wondering how a baby that small would even be able to eat. “I’m not sure yet.”


She pushed the door wide open and stood with her hands on her hips. “You do know that giving breast milk is the only thing you can do for your baby now, right?” she said, “It’s liquid GOLD!”

Whoa – that’s a lot of pressure! I started pumping as soon as she wheeled the hospital-grade breast pump into my room. It felt weird. Nothing happened. Nurses told me it could take a few days for my milk to come in.

I tried pumping next to my preemie’s isolette in the NICU. He stopped breathing and turned blue. Nurses rushed to get his heart rate and oxygen levels back up. Tears ran down my face as I stumbled out of the way trying to cover myself so my boobs weren’t hanging out for all to see. I spilled what little milk I had pumped in the process. That was the last time I pumped bedside.

The hospital had a pumping room with a curtain and two old chairs. The clock ticked so loud, I could hear it over the “chugga-chugga” of the breast pump. There was one ugly painting on the wall, dingy from years of neglect. I left my baby’s bedside every two hours to stare at that painting because I had started to get milk.

When my son was two days old, they gave him the first of my breast milk through his feeding tube. As soon as I saw that my pumping efforts were going to pay off, it made the ugly pumping room look a little prettier – I was doing something for my preemie.

I usually produced 1/2 ounce of milk at a time. On good days, I would get almost a whole ounce. I thought that was pretty good until I saw the other moms leaving the pumping room with huge bottles full of 5 or 6 ounces.

Uh oh.

I started taking herbal supplements touted to increase milk supply. They helped, but not enough.

I took a prescription medication with a side effect of increased breast milk production. Other side effects included uncontrolled muscle spasms, inability to keep still, and Parkinson’s-like symptoms. OK – that didn’t work.

My son ate so little at first, I started gathering a stockpile of milk in the freezer. I was so proud! Until he started eating an ounce at a time and then two ounces. My freezer supply dwindled.

But damn it! I was going to get my son his liquid gold!

I kept thinking about what the lactation consultant said that first day “It’s the only thing you can do for your baby.” I was failing him. Again. First, I couldn’t keep him in; then I couldn’t feed him. Guilt is a bitch.

I was miserable. I spent at least 5 hours a day hooked up to a machine. I did “power pumping” where I pumped for 10 minutes every 20 minutes for 2 hours. I read every book and research article that I could find about increasing milk supply. I spent hours with the lactation consultants trying new techniques. I said I wanted to quit….they said, hang in there, you can do it!

But, I couldn’t.

My body would not cooperate. I was stressed out and in pain. (I’m sure that did not help.) I was so guilty. All of the posters in the hospital told me day in and day out that “Breast Milk Is Best!” But, there were no posters that said “Pumping Milk for a Preemie Might Not Work – It’s Not Your Fault!”

My son quickly out-ate my supply. The only option left was formula. Thankfully, my preemie did well with the transition from breast milk to formula.

Even though pumping breast milk was one of the most difficult things I’ve ever done, I’m glad that I stuck with it for as long as I did. I was able to give my son breast milk, even if it was only a tiny bit. I appreciate the lactation consultants who were there to keep me motivated when I wanted to quit. But I wish there was more support for those of us who are physically unable to continue breastfeeding or pumping.

I’m not encouraging anyone to stop pumping. If you are, and it’s working, please keep going! You are doing an amazing thing for your baby. But, if you’re like me and pumping is becoming a source of pain and stress and it’s just not working even though you’ve tried everything…it’s ok to stop. We can let go of the guilt together.

Maybe I’ll make a new poster for the walls: “Breast milk is liquid gold, but formula is golden, too.”

More from Andrea Mullenmeister

Pumping in the NICU: Liquid Gold or Liquid Guilt?

Two hours after my son was born, a lactation consultant knocked on...
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  • Thank you. I can relate to this post so strongly. My oldest was born at 29 weeks and that first week after his birth was horrendous. Having the nurse come to teach me how to hand express those first few drops of colostrum, squeezing them out expertly but painfully herself. Me, earnestly trying to do the same every few hours but not even able to fill the smallest syringe with milk. I remember one of the NICU nurses coming to my room on day 2 to ask me why I hadn’t brought any breastmilk in to them. She may have thought her firm words would be encouraging but to an already sore and guilt laden mama they were crushing. I persisted and I’m thankful I was eventually able to pump. When we left NICU 5 weeks later it was will freezer bags full of leftovers. I think in the NICU situation the nurses need to have so much more sensitivity to the whole picture when approaching new mums. Well done for nourishing your baby with breastmilk and well done for nourishing with formula too when it was best. I’m glad you’ve been able to put the guilt down!

  • Thank you for your story. I am a nursing student, currently working in a NICU, and my long-term goal is to become a lactation consultant. Your experience is an excellent corrective to the heavy-handed approach that many medical professionals take in our effort to provide education and support. Looking through these comments, I can see that you are not alone.

    I hope that someone told you, along the way, that your son’s early delivery meant your breasts had less time to develop and prepare for breastfeeding (neither one of you were quite ready for his birth!). Yes, the stress and emotional nature of your journey may have played a role, but there are biological reasons for what you experienced.

    All of your self-sacrifice, pumping, research, and every drop of the milk you provided for your son is amazing. Also, your ability to adjust your expectations, adapt and introduce formula shows flexibility, which is key to parenting, no matter how old our children are (mine are 10, 13, and 16). Great job surviving the regimen for that long and thanks, again, for your honesty.

  • I so could have written this article myself. I pumped for 10 months to the point I would get an ounce over the course of an entire day. Second preemie luckily I didn’t go to that extreme but of course even knowing what I knew it’s hard to stop even when it’s obvious that the effort isn’t worth it anymore. What I finally settled on was…if I’m spending hours pumping is that time well spent or would it be better spent enjoying my child and then enjoying me? If will and effort were the determing factor in who makes the most milk I should have been pumping gallons but I wasn’t.

  • Thank you so much for writing this. My son was delivered two weeks early via emergency C-Section, and I learned the hard way I’m allergic to morphine. The first three days were hazy, but I remember the LC coming in to give the speech about Breast is best, and why I wasn’t pumping. It took her awhile – she kept having to repeat herself as I was violently throwing up every few minutes and missed what she said. She recommended pumping since I couldn’t stop throwing up for a week.
    After we went home, I pumped so I could do a mix of breast milk and formula, but something wasn’t right. i had severe PPD with panic attacks. I’d have them after pumping like clockwork. Turns out those “feel good” bonding hormones released during breastfeeding can be “suicidal depression” hormones instead for some lucky people like myself! “Keep going, it’ll make you feel better! It’s just guilt, keep going!” Normally great advice, but in my case it was the exact opposite of what I needed.
    I’m so thankful I had a pediatrician who, before our visits would give me a questionnaire to fill out for myself as well as our baby. Ultimately they were the ones who figured it out and prevented me from suffering any more. I’ll always have the guilt for not breastfeeding, but it’s greatly outweighed by my relief to feel human again.

  • Pumping is HARD! When my third child was in the NICU and I was recovering from my emergency c-section I had a two hour window to visit the NICU and try to bottle feed him, get back up to my hospital room, pump, and get back down to the NICU. Every two hours. I’d exclusively nursed my older two, so I knew that if I could get through that awful cycle it would be worth it. But if I hadn’t already breastfed? I don’t think I’d have done it, especially after they started adding formula to the breastmilk over my objections.

    Some of those moms who are coming in with full bottles? It may be because they’ve already nursed. When my fourth was born, I’d only weaned his brother a few months earlier. By the time he was ready to come home, I’m pretty sure I was producing enough milk for the who NICU and dumping half of it down the sink because that was easier than finding extra bottles.

    I think moms who pump long term deserve trophies. As pro-breastfeeding as I am, I doubt I could’ve made it for more than a couple of months if we hadn’t been able to successfully transition from bottle to breast.

  • This is the most supportive message I’ve been able to find regarding the decision to stop pumping. My son was born at 28 weeks weighing 1lb 12oz. I started pumping in the recovering room after my c section before seeing my son for the first time. We just brought him home from the hospital a little over a week ago after being there for 92 days. I pumped every 2 hours during the day and every 3 at night for the first 2 months and every 3 hours the last month. I pumped through pain that felt like there were needles going into my nipples and after creams and medicines finally found out that I have vasospams. I finally found medication that helped a little but I’m still in pain. I’ve had a low supply the entire time but was able to provide enough to feed my son through his NICU experience and have some frozen. Pumping felt like something I could do for my son when I felt as though my body failed me in carrying him to term. Now that he is home I feel even more stress when I need to pump and my supply dropped even lower if that was possible. When I want to just enjoy my son I need to get him situated so that I can pump. I know that I provided him milk when his tiny tummy needed it most but I need to make sure I’m ok so I can be a good mom. My husband and I made the decision together that it it best that I stop so that I can take care of him and myself. I’ve been scaling back the amount times I pump a day and have a sick feeling in my stomach for when I’m finally finished. The guilt takes over. This posting gave me the final push to say that it is ok for me to stop. Thank you for helping me take care of myself and my family.

  • My first was born 6 weeks early and as soon as she was born I was asked if I was going to breastfeed I said yes, as I was told Brest is best. I was pumping every 3 hours and at first was getting a good amount of milk but by the time she came home I wasn’t getting much. So we started to mix feed the hole time I was doing everything in my power to increase my supply but it wasn’t working, I was stressed out and not enjoying my baby and by the time she was 16 weeks my husband said to me it is ok to stop breastfeeding you have done the best you can but I think you would be better off if you stopped. So we stopped, I think I just needed to hear from someone that it is ok to not breastfeed.
    I have now had baby number 2 and I tried breastfeeding again and it was going great until I went back to work and my supply is dropping off, but this time we are 8 months in and I know that if I have to stop it is ok.

  • I am in a premmie group, and was tagged asking me to read your story.
    My son was born at 31 weeks, and I haven’t had a good milk supply. I pump every 2 hours around the clock. I’m lucky if I get an ounce out of both breasts. I have a notification on my phone that goes off telling me it’s time to pump, and each time it goes off I nearly break down.
    I have a huge amount of guilt. My body couldn’t keep him in, and safe…and now I can’t even make the milk he needs.
    God forbid anyone asks how a pump session went….
    I have 3 older kiddos at home too, so trying to juggle them, their school work, house work, hours at the nicu, and pumping…omg.
    I’m not ready to quit yet…but I am so glad that I’m not alone, because it definitely felt like I was.
    Thanks again.

  • I’m sorry to all the moms I had such a bad experience when I came to pumping mock my daughter was born at 23 weeks Wayne only 1 pound 6.6 ounces it is chill right after birthday tell you to start pumping and I wish some of the moms that I read comments from were told that when you first start pumping the first couple days you’re only going to get drops after that your milk finally starts coming in and since you’re pumping and not breast-feeding you never going to get the same amount of milk my daughter was in the NICU for four months and it wasn’t easy at all but I did have the support from a wonderful lactation specialist at Kaiser in Downey I did a lot of kangaroo care because skin to skin contact with your baby will help and they let me start trying to breast-feed her even though she couldn’t get a true latch because of the feeding tube down her throat but that kept me going I kept pumping every four hours because like a few people have said that’s all I was able to do for her the most I ever produced was probably about 4 ounces combined from both breasts I knew a lot of Mother’s that would fill up 8 ounce bottles I also knew Mother’s That couldn’t pump at all because their milk never came in but instead of feeling guilty they looked for other sources for breast milk Don’t feel guilty because at least you tried feel guilty if you don’t try or make excuses for the reasons why you don’t

    • Thanks for sharing your story, Karla. I’m so glad you were able to provide milk for your preemie! Kangaroo Care is so important in the NICU. Donor milk is a great option for many babies. But in my case, when my milk dried up, my son was too big to receive donor milk, so the only option for us was formula. I’m so thankful that formula was an option for him – FED and LOVED is best, don’t you think?

  • My son was also full term but I also relate. I live in China though and had no LC to help me, rather the opposite I had Drs and nurses pushing me to start formula from day 1. I wanted to breastfeed so badly bc of the hype that breast milk is best and the pressure I put on myself, that I pushed back really hard on their efforts for me to give formula. I pushed back to the point that I my son was hungry all the time because I wasn’t getting enough milk, but I didn’t realize that to be the problem because I thought I was doing what was best for him and I had no Dr/LC willing or able to give me solid help/advice. Finally at 1 month we found out he was still below his birthweight that I was forced to give in and supplement with formula. Shortly thereafter my milk supply dwindled to the point that LO refused the breast and I crushed at my inability to provide for him became depressed and resentful. It’s been a difficult road and my heart goes out to all the mothers who have also felt similar guilt.

    • Thank you for sharing your story, Anna. ((((hugs to you)))) That sounds so difficult. I’m sorry you’re experiencing this guilt. It’s a process to work through – my son is 4 and I’m still struggling with the guilt, although it’s not as bad as it was when he was small. Be nice to yourself – you did everything you could.

  • I went through the same thing except I had twins in the NICU! The nurse said “you have clinically low milk supply” as I’m trying to take care of two teeny babies, balance caring for my 4 year old at home (an hour away) and heal from a C-section. I pumped my way into the emergency room w a brutal case of mastitis. Thank goodness my doctor and my pediatrician gave me permission to stop…my desire to help them and my guilt was literally making me sick. Thanks for writing this!

  • I needed this article. Our daughter was born a little over a week early via c-section, she latched wonderfully right away and I EFB’d for the first three days of her life but unbeknownst to me my supply had not come in and it never really would – we only learned this because as we were getting her ready to go home, she started to have tremors, we asked the nurse to have her evaluated – turns out her blood sugar level was way below normal, she had basically been starving for three days.. they whisked her away to the NICU where she would stay for an additional 3 days .Once I pumped we learned that I was only producing approx 1/2 oz combined after 20 mins of pumping.. no wonder she was failing! Worst-day-of-my-life, we went from being excited to go home as a family to camping out in a parent lounge while our little one was in an incubator hooked up to all sorts of machines all because I wasn’t able to produce enough to feed her. Thankfully she recuperated quickly but I can not stop thinking about how it could have been prevented if the hospital was more open to “whatever works for mom & baby”. If they weren’t so focused on breast being best they might have thought to have me pump when we reported to them that even though she was nursing, her output was on the decline. We constantly tracked her input/output with the nurses and yet they never tried to suggest formula, not even after two days with out a bowel movement… breast isn’t always best.. nutrition is. To this day my supply is barely there, I nurse as much as I can but I’ll feed here whatever necessary to keep her healthy

  • I can relate to the low supply. I bleed sometimes trying to supply for my little girl and it didn’t help that my husband’s mother kept calling me a bad mother for not being able to supply enough milk and I am not joking she actually said those words to me many times. I am hoping with my next kid it will be better

  • I pumped non-stop because I felt it was the only thing I could do. When I had absolutely no control over the circumstances, pumping gave me a sense of purpose. I pumped for the three months in the NICU and then for nine months that followed. I was stubborn and never let up… I am grateful to have had support from family, friends, nurses and specialists, so that I could do it for as long as I did. However, I recognize now that the best thing I did for my kids was stay by their side and believe in their strength and courage.
    To those who can’t or who don’t want to, know that breast isn’t best. Love is. Sing to them. Touch them. Hold them if you can.

  • I breastfed with virtually no issues and I still wanted to give up some days. You are amazing and the love you have for your son is going to do more for him than any breastmilk could. I want to slap anyone who treats a new mom with anything but compassion.

  • My experience was a little different. My first son was born at 41 wks and 10 lb 5 oz, they said that because he was so big that I would never make enough milk for him. All the nurses and even the hospital pediatrician told me that. I was heartbroken.

    • That is total BS unless you had actual issues with undersupply (as it’s obvious many do). It’s absolutely possible to breastfeed a big baby and produce enough milk for them. Some of us, me included, have oversupply issues; I could have easily fed two or three babies with the amount of milk I was making when my milk first came in. My sons have both been over 8 lbs at birth and I’ve never had issues with producing enough milk for them. Normally the body makes enough milk to fulfill the demand your baby creates by nursing. No doctor should ever tell you that because you have a big baby you “would never make enough milk” for him or her. That’s horrible advice! I’m so sorry you were told that! I hope you were able to nurse despite what you were told.

  • I didn’t have a premie but can relate to so much of this experience. I think it’s ridiculous how much pressure is put on moms to breastfeed. It CAN be best, but doesn’t mean it is for a LOT of people. My daughter also quickly out-ate my supply, even though I was able to breastfeed on demand for months. No supplement or anything I tried ever increased my supply for more than a few hours or a day. I always felt like I was failing because she was not gaining weight well. As soon as we switched to formula completely (I supplemented at 7 months on, and should have way sooner), she FINALLY slept through the night. I think my milk was not very rich and she was always hungry.

  • The pro-breastfeeding movement really needs to be reined in. My wife got a similar line (our daughter was born full term), and there was an inordinate amount of unrealistic pressure placed on her to get the breast milk production going full swing. It simply was not happening, our child was hungry all the time, and the staff only relented and brought in formula when I insisted on it.

    ‘Breast is best’ is nonsense. ‘Breast is ideal, but not the only acceptable alternative’ is closer to the mark.

  • This brought tears to my eyes because I’ve had the same experience. And like you, I felt like once again I had failed my daughter (born at 31 weeks) for not being able to produce enough milk and guilt for even considering an end to the endless pumping where a quarter of an ounce was a good session. It wasn’t until a Neonatologist realized the stress and agony I was in and eventually told me she was “medically advising me to end it” based on the top it was taking. Thanks to her and a LC who was also very supportive I was finally able to let go. But I still felt very much alone and would have benefitted from hearing stories of other moms who have shared a similar experience. Thankfully I have two healthy daughters, both preemies, who have thrived on formula. It is liquid gold in our world.

  • Thank you for your sharing your story! My triplets were born at 29 weeks. I did all my research and I was prepared to breastfeed. I started pumping as soon as possible. I was so proud of that first few drops 2 days after they were born! I was lucky that I was able to pump and be successful with producing breast milk. My problem came when, at a few weeks old, one of my little guys was ready to actually breastfeed. Except that he never got the hang of the latch. Neither did baby number 2 when it was his turn. Baby 3 never really got the breathe-suck-swallow thing and ended up with a feeding tube. So I had lots of milk but was tied to that damn pump 4 to 5 times a day. No one seemed to appreciate that sometimes it is just too much. Once 2 of my guys were home I finally gave up pumping and switched to formula for them. What I had stockpiled in the freezer went to Baby 3 who was still in hospital and struggling with a multitude of health issues. You know what? My guys did just fine with formula as have countless other babies. The guilt and pressure placed on women to breastfeed is enormous and there is very little support when you are unable to do so for whatever reason. People should be supported in making decisions that will work for them. Breastfeeding IS ideal and we all know that. But we don’t live in an ideal world…

    • Yvonne, that was a great idea saving your milk for your baby who was still hospitalized. He definitely benefited from that! It’s so true – we don’t live in an ideal world…and we’re all just doing the best we can. Congratulations on your triplets! How old are they now?

  • Both my babies were full term, but I still relate. I remember tears rolling down my face while nursing my shrieking son in a recessed doorway of the clinic hallway the week after he was born, willing my body to produce anything that would sustain him. And there’s nothing like having a LC hand nurse you. Thanks for sharing your story!

  • I can totally relate. I was committed to pumping when my daughter was born at 29w. But when the LC came in when I had tears streaming down my face because I was afraid my child would die, and gave me her canned speech about “breast is best” and never commented on my emotional state, it did not feel good.

    • I’m so sorry that happened to you. It felt “canned” to me, too, like the LC was just going through the motions and saying what she was “supposed to” say. She didn’t take into account any of the trauma I had just experienced. LCs, especially those working with preemie moms, need to look at the big picture and provide positive support, not guilt trips!

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