Pump up the music: Improving breast milk production in the NICU

The breast pump is a fabulous invention. It is what gives modern moms the option to pursue a career and breastfeed. And for moms of babies born prematurely, it is everything. Their babies get a great start with breast milk, and moms can establish milk supply even if they are separated by prolonged stays in the NICU.

Source: Wikimedia Commons

In a study published in Advances in Neonatal Care last week, Douglas Keith and colleagues reported on their attempt to increase production in moms pumping milk for their preemie babies [2]. 162 moms of preemie (average 32 weeks) or critically ill newborns admitted to the NICU were given a hospital-grade breast pump and encouraged to pump 8 times per day. They were randomly assigned to one of 4 groups. A control group received standard support for breastfeeding, and the remaining 3 groups were given a recording to listen to during pumping. The second group received a recording with a spoken guided relaxation. The third received the same guided relaxation, but it was accompanied by soothing guitar lullabies. The fourth received the relaxation/guitar recording, plus a video player with images of their own babies. Milk production and milk fat content were measured over 14 days.

What effect did a little music and pictures have on milk production? The results were actually quite striking. All 3 of the “listening intervention” groups produced more milk during the study, and not just a little more – 2-3x more! Milk production on day 14 is shown below.

Listening to the guided relaxation increased milk production, and this effect was most striking when it was accompanied by music and baby pictures. In addition, milk fat content was higher in the verbal+music+pictures group, as well as for the first week in the verbal only group. Importantly, there was no difference in pumping frequency between the 4 groups of moms.

I think these results are remarkable. Presumably, the audio recordings and baby photos help mom to relax and improves milk letdown, though this study didn’t investigate specific mechanisms. Still, providing music and baby images is an easy and inexpensive intervention, and the data show that it can significantly improve milk production during the first few weeks of life in babies that likely need it most.

The authors speculate that perhaps the “listening interventions” relaxed mom and increased oxytocin release. Oxytocin is a favorite hormone of all mamas. Sometimes called the “love hormone” or “cuddle chemical,” oxytocin plays a critical role in the birth process, milk letdown during breastfeeding, pair bonding, and maybe even sexual pleasure. (This story on oxytocin and male sexual function caught my eye a couple of days ago. Plus, there’s this one and this one, too. The cuddle chemical makes for catchy science stories in the media.) Music therapy has been shown to reduce stress in other situations, but the effect of music on oxytocin is unexplored.

It is interesting to note that the moms in the verbal+music group didn’t seem to benefit as much as those listening to the spoken relaxation alone or those in the verbal+music+pictures group. The authors point out that music might have been more effective if moms were allowed to choose their own favorite tunes. Maybe the guitar lullabies were of the annoying variety, particularly for a mom listening on repeat for 8 pumping sessions per day. For that matter, I would imagine that any guided relaxation recording could suffer from the same problem. Since the study didn’t tease out the specific effects of music vs. spoken words, I think that moms wishing to apply this idea in their own lives should assume that any relaxing recording might do.

This paper suffered from some kooky stats and figures. For example, I honestly don’t know how the authors managed to publish this without error bars shown on their figures. Usually that’s a red flag that the study and/or the journal has some real problems (usually both). In this case, though, I thought the data were rather remarkable and worth sharing.

If you’re pumping – especially for a preemie – taking the time to get your warm fuzzies going is definitely worth a shot. Turn on some relaxing music and turn your gaze on your little one. Put your feet up, take some deep breaths, and know that in this case, kicking back might just be the best thing you can do for your baby.

Did you pump while your baby was in the NICU? Or to help establish your milk supply? Do you have any tips on pumping to help make it more enjoyable for other moms?

REFERENCES

1.  Hill, P.D., J.C. Aldag, R.T. Chatterton, and M. Zinaman. Comparison of milk output between mothers of preterm and term infants: the first 6 weeks after birth. J Hum Lact. 21(1): p. 22-30. 2005.

2.  Keith, D.R., B.S. Weaver, and R.L. Vogel. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 12(2): p. 112-9. 2012.

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42 thoughts on “Pump up the music: Improving breast milk production in the NICU

  1. Pingback: Pump up the music: Improving breast milk production in the NICU … | Baby Images

  2. Thank you for this article! I had been looking at pictures of my son while I would pump (my some spend 136 days in the NICU) but since he is home, I have been ‘too busy’ and have gotten away from it. Thank you for the reminder. If this helps, there is an app for the iPhone called Express Yourself Pumping Assistant. It is free and you can add pictures of your child in a slide show, record and play audio clips of your child cooing, feeding, crying and laughing, there is a reminder to alarm every 4 hours to pump and a journal to keep track of your volumes pumped. I love this app and hopefully other mamas will too.

  3. I pumped while my daughter was in the NICU. She was born at 27 weeks so I was pumping from the get-go. I tried photos, music, pumping in front of her incubator… every trick the NICU staff and lactation consultant told me. Unfortunately after two weeks of pumping my guts out I still wasn’t producing milk (just a few drops per session). To save my sanity (and my sore deflated breasts) I stopped and signed off on donor milk. In the long run, this was the best decision ever, because instead of being hooked up to a machine for hours on end and getting no sleep or milk to show for it, I could actually do things like kangaroo for hours, give my daughter her bath, change her diapers, and not feel like I was missing any of those (few) precious moments in the NICU.

      • My NICU tried everything to get my milk to come in, it just didn’t. For the convo going on below, I was a first-time mom (lost my earlier pregnancy at 18 weeks; had some minor milk leakage after that soon passed, but my boobs were still “untested”) and used a hospital-grade pump.

        Anyways, I used donor milk until my daughter was 5 weeks old, and then they switched her to formula. They had to save the donor milk for the sickest, neediest babies and surprisingly at just 3 lbs and 5 weeks old (32 weeks gestation) my daughter no longer fit that bill. I cried my eyes out because all you hear is “breast is best” and if it is supposed to be best for a full-term infant, what was going to happen to my little preemie? It is hard to transition from that thinking after trying so hard to pump and everyone rooting you on, when you “fail” (for lack of a better word) you really do feel like you’ve failed your baby. But, the neonatologist assured me that the donor milk had done its most important job (so to speak) in those first 5 weeks. For us, he was right. My daughter is 4 years old now and the picture of health.

        • I used donor milk while my son was readmitted for failure to thrive. It’s a wonderful thing that women who have a surplus would share something so important. Glad to hear your daughter is doing well!

  4. This is a wonderful and fascinating article. Thank you so much for sharing. My son is now 8 months and I’m feeling like my milk is slowly diminishing. I’m currently taking Fenugreek with no results. I work full time. So, maybe I’ll try listening to music or looking at my son’s photo while I pump. Thanks again!

  5. Yes, I pumped while my baby was in the NICU for 16 days. I listened to alternative rock! I held the baby as much as I could, skin to skin. Luckily, I had breastfed my first child so my boobs knew what to do. I made a lot more milk than what he needed, which was fine because we stock-piled it. I also breastfed him in the NICU. The nurses were shocked when he breastfed the same volume they wanted to feed him through a tube… or maybe it was a bottle at that point. They were afraid that the energy it would take him to breastfeed would wear him out before he consumed enough. This was in his second week of life (he was 7 weeks early). The little stinker had pulled the tube from his nose in the night. I realize my experience is not at all representative. I wonder if there are differences in breastfeeding premature babies among women who have their first vs. subsequent child.

    • I also wondered if there is a first-timer effect for breastfeeding moms relying on a pump. On average, the moms in this study had given birth once previously, but they ranged from 1 to 7 children. I also wondered about attempts to breastfeed these babies. They don’t report it, so I assumed that moms were relying solely on pumping. I’m not sure at what gestational age babies are developmentally ready to nurse on their own. I did read this article this morning that talks about how the focus in many NICUs is on “breastmilk” rather than “breastfeeding” – that is, bottle-feeding is encouraged, sometimes at the expense of baby missing out on opportunities to suckle at the breast. http://www.bestforbabes.org/booby-traps-series-booby-traps-in-the-nicu

      • They really want to be able to quantitate what the baby’s getting (and it’s usually not necessary). When Emily (my first) was six months old, she was hospitalized overnight with RSV, and the nurses really tried to get me to pump and bottle-feed her (once they got over being surprised she was still breastfeeding at all). I made them settle for weighing her diapers.

        One thing about second babies as compared to firsts is that the milk comes in a LOT sooner, in my experience and that of my friends/family. So pumping could be quite a lot more successful if it’s your second baby. But I’d expect the study to try and randomize the first-vs.-multiple-timers into the different groups.

      • My second kiddo is currently in nicu (23 weeker) and I did great breast feeding my first child, but am barely able to produce an oz every 2-3 hours, going on week 5 now. I must be an exception on the second time mother thing

  6. My baby wasn’t premature, but I’ve been pumping for a little over 10 months. When trying to establish a milk supply, I think that there’s not a lot that can take the edge off the exhaustion and frustration of having to pump 8+ times a day. If possible, I’d recommend trying to see the pumping time as personal time and doing something enjoyable (reading blogs, watching movies, playing games). It’s also helpful to find support from other pumping moms, to have flanges that fit and a hands-free pumping bra, and to recognize that it doesn’t last forever.

      • These are great tips! I think pumping can be such a chore, so trying to think of it as a relaxing, put-your-feet up “me” time is great advice. And yeah, pumping 8+ times per day on top of taking care of a baby – that exhausts me just thinking about it. I’m so impressed!

  7. I recommend renting a hospital grade pump rather than using the ones you can buy from the store. I bought one but found it was really loud and took a long time to pump. I ended up renting the model I used in the hospital (Medela) from a pharmacy. Made it easier, quicker, and less stressful.

  8. Great article. Yet more evidence that a happy, relaxed mom is better able to care for her baby. When I was pumping I always took a couple of breaths and imagined a flowing river streaming from my body. Worked every time i also used a hand pump bc my milk was shy and the electric pump was too loud so my office mates could tell what I was doing even with the doors closed.

  9. Pingback: I’m not pumping enough milk. What can I do? : KellyMom

  10. i pump at work, where i run from meeting to meeting and sometimes have trouble relaxing (what’s not relaxing about being half naked in a room the size of a closet at work?!). i do one of two things: (1) a picture slide show of my girls with “All is Full of Love” by Bjork in the background or (2) a 10 minute guided meditation from Jon Kabat Zinn’s book “Mindfulness for Beginners”. Of the two, I would definitely say that the guided meditation is my go-to…it helps me relax for pumping and gives me time to still my mind! i have started to look at pumping as true “me” time…

  11. My advice is beer! My little girl was rushed to a pediatric cardiac ICU on day 3 of life and then had heart surgery on Day 10 (stressful!). I was able to breastfeed her in the 2 days before we discovered her heart defect, but after that was pumping every 3 hours on hospital grade pumps (squeak squeak!) in an ICU filled with machines that were constantly beeping and sending off alarms (blip, blip, blip, beeeep!!). My OB recommended having a beer to relax me while I was pumping (because the alcohol wouldn’t get into my milk immediately). Not sure if this was the reason for my large supply (I was pumping up to 80 oz / day!), but it didn’t hurt and we had a freezer full of milk for 3 months after she got home.

  12. Pingback: Let-down Reflex: Too slow? : KellyMom

  13. Pingback: Establishing and maintaining milk supply when baby is not breastfeeding : KellyMom

  14. Great article! My son was only a couple of weeks early, but he was unable to latch or swallow properly and therefore could not be breastfed. I spent the first 6 weeks pumping 10-12 times per day AFTER attempting to nurse him. I also tried Mother Love More Milk Supply, straight Fenugreek capsules from GNC (I still have to take 2, 3x daily to keep my supply up) and Domperidone. My supply never reached a point where he could be solely fed by breast milk but I continued to let him nurse and supplement with the bottle/formula. It was more than exhausting! What helped me most was actually just accepting that I couldn’t feed him by myself. Once I gave myself permission to not have the perfect breastfeeding relationship not only was he magically able to nurse better but my pumping output also increased. I would like to note that while I started out with a rented hospital grade double pump I eventually switched to a first year’s single pump I received as a shower gift and saw my output was the same.

    • Thanks for sharing your story! I think the “perfect” breasfeeding relationship – or feeding relationship – is different for everyone, and it sounds like you found yours.

  15. wow, i am glad i stumbled on this site. My 13 day old daughter just had heart surgery and I have been pupmping with success until a nurse told me she was out of supply and I had to make more ( they found the supply yesterday) but since the 12th I havent able to produce that much. I tried oatmeal, pictures, showers, warm coco. I’m going to ask the dr about guiness or other herbal supplements. I was never offered the donor milk option. But I will keep trying. I think its performance anxiety and stress, the same nurse that told me they were out has been here for 4 days and I feel pressure when she comes around.

  16. I pumped while my 33 weeker was in the NICU. I thankuflly only had to spend 10 days there but those were very painful days. I was able to get my milk in faster than I ever thought because they allowed me to nurse my son in the beginning and then I pumped every four hours after that. I got my milk supply in quickly without having music or anything like that. I usually feed and pumped in quiet or with me singing to him. My little man is now 6 months old and my milk supply is still going strong. Mostly because I did return to work for the first four months of his life and then decided to stay at home.

  17. Interesting article. I had to pumped for the 6-7 days my 1 week old son was in the cardiac Icu after open – heart surgery. Thankfully we had been able to nurse the full week before his surgery and then after surgery starting the day he left the Icu for the regular floor. He is my third child and I had no problems with milk production. I didn’t use any of the techniques mentioned in the article. However I will keep them in mind if we ever are in a similar situation. My son is now 6 months old and still breast feeding.

  18. Pingback: The Apparent Breastfeeding Paradox: What is optimal nutrition for a premature baby? | Science of Mom

  19. My son was 8 weeks early and in NICU about a month. I had a fairly poor experience breastfeeding, unfortunately. I still feel pangs of guilt and sadness about it. I pumped since day one and attempted to have him latch 2 weeks in to no avail. After several meetings with lactation consultants and power pumping exercises (including supplements and beer swigs), I gave up. My production was horribly low and it really effected my self worth as a new mom (not to mention the fact that I had four months bed rest and an at risk pregnancy to deal with emotionally). What bothered me most was the implication by consultants – and sometimes peers – that I could be doing MORE for my baby. What a cluster!

    My preemie is now 10 mos old (8 adjusted) and although he is still thin, he is thriving. Not one illness since birth. I feel very lucky, but often wonder if We could have breastfed successfully in a healthy pregnancy environment…

    Thank you for sharing this article and info. xo

    • I’m sorry that you had such a rough experience. When breastfeeding doesn’t go well, I honestly think it is harder on the mom than the baby these days. So many of us are so committed to breastfeeding that it is just a huge let-down when it doesn’t work out. I’m sure that you did everything you could. It IS harder for moms of preemies to get breastfeeding established. Another preemie mom commented earlier that the best thing she could do for her preemie was accept that breastfeeding wasn’t going to work out and spend her time holding her baby instead of pumping. I think every mom has to decide for herself when to make this call and then carry on, but I know it is hard. Best of luck to you and your thriving little guy:)

  20. Im at week 4 of pumping baby still in CVICU and its hard. But I keep trying. I have other children I breastfed, but with my daughters heart condition, it was too much work for her, pumping while listening to classical helps. I was finally able to hold her which helped my production, then she had a setback which caused my stress to soar and milk to stop, hopefully it comes back : ) Love hearing all the tips.!

  21. I HAVE TWINS IN NICU. THEY HAVE BEEN THERE FOR 9 WKS. I HAD THEM AT 23 WKS. I’VE BEEN PUMPING AND I’VE ACTUALLY GOT ALOT STORED BUT CONCERNED THAT I WON’T MAKE ENOUGH WHEN THEY COME HOME. ANY SUGGESTIONS

  22. Pingback: Expressing Milk for Your Baby | a2z lactation

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