Pumping for a Preemie: Unexpected Birth at 27 Weeks

This mom of two had two very different birth and feeding experiences, from round-the-clock pumping for a preemie in the NICU, to a full-term baby who could instantly latch and feed.  Heather Harinstein shares her incredible journey of strength and perseverance to emerge from a traumatic birth experience and get the mental health support she needed to enter her second birth with very clear priorities and an approach that enabled her to thrive postpartum.

Name: Heather Harinstein

Children: Daughter - 6, and Son – 2

Occupation: Account Director at Microsoft

You’re a mom of two children, with two very different birth and feeding experiences.  Tell us about the birth of your daughter:

In 2015, my daughter was born unexpectedly after my water broke at 27 weeks.  I was admitted to the hospital and the goal was six weeks of hospital bedrest. I made it three days before she was born via emergency c-section, weighing 2 pounds 11 ounces at 28 weeks and 1 day, and was immediately rushed to the NICU, without me even seeing her. She then spent 62 days in the NICU, which became our new normal and our home away from home for her first few months of her life.

How does breastfeeding work with a preemie?

Being a preemie mom with my first child, there were a lot of challenges in terms of breastfeeding. While my daughter was in the NICU, I had a lactation consultant in my room right after my c-section, coaching me on how it would all work.  Luckily at that point I was producing a little bit of colostrum.  We used a syringe to get whatever drops we could get, and then that was taken down to the NICU.  Even before I was able to leave my recovery room to go down to the NICU and meet my daughter, my husband had to take the syringes down to the NICU nurses.  The colostrum was fed to her though a feeding tube, and once I was able to go down to the NICU that first evening, one of the nurses showed me how I could  put  some of the breast milk on a small cotton swab and rub it around her lips.  

It was very important early on for me to build supply, because at 28 weeks, you are barely in your third trimester, and your body isn’t really ready to be producing milk at scale. I had an incredible lactation consultant in the NICU who helped me get set up with a pumping routine for my 2-pound preemie.  I was pumping every 2-3 hours with a hospital grade pump and taking the milk to the nurses, all while I was experiencing all of the emotions of having a preemie in the NICU and of not being able to be with my baby. She was in an isolette and I had to ask permission to even put my hands in to touch her, so that was very hard as I was trying to produce milk and couldn’t even hold my baby or do kangaroo care or anything to help stimulate my hormones. It was five days before I could even hold her, and once I was able to, those first few weeks it was very limited with all kangaroo care supervised and approved by the doctors and nurses. Unfortunately, I didn't have a baby that I could snuggle any time I wanted to help provide the demand, so I needed the hospital grade pump to provide that demand.

Did you continue pumping the whole time she was in the NICU?

Yes. The NICU babies are kept on a very regimented feeding schedule of every 2-3 hours, so even when I was discharged and she was still in the NICU, I was an exclusive pumper on a strict schedule.  After a few weeks she came off of the respiratory support, and we were able to try nursing in a very controlled environment, being monitored by the nurses and the lactation consultant, and with doctor approval.  I learned that babies, even if they're healthy and doing well, don't physically have the ability to breathe, suck, and swallow until 37 weeks, so I couldn’t even try to breastfeed or give her a bottle because they just can't do all three things at once.  Until then, they’re dependent on the feeding tube, so all breast milk was given to her via the feeding tube for a few weeks.

Once we got to the point when she could breastfeed, the process was very managed.  Once a day they would take her off the feeding tube to let her try nursing or taking a bottle.  Up until then it was me exclusively pumping every 2-3 hours.  I carried my cooler bag of milk to the hospital, multiple times a day, and I would sometimes pump in the room with her while reading stories to her, all while she was laying in the isolette, and other times I would be pumping at home, in the car, or in the middle of the night, just as if I had a baby at home.

Even when she came home, after more than 2 months in the NICU, we had some feeding issues, and I was only allowed to nurse her once a day. Other than the one nursing session, I had to give her everything through a bottle, and even my breast milk was required to be mixed with formula to fortify it to provide more calories to my teeny tiny preemie.

I carried my cooler bag of milk to the hospital, multiple times a day, and I would sometimes pump in the room with her while reading stories to her, all while she was laying in the isolette, and other times I would be pumping at home, in the car, or in the middle of the night, just as if I had a baby at home.

Were you able to work up to what would be considered a normal supply?

No, unfortunately I was not. I was able to get her to what was needed while she was in the NICU, and I remember it was very stressful to make it to that point with everything going on. I was pumping around the clock like the mom of a full-term baby might do, but she wasn't home with us. Then when she came home, we were still on that strict schedule. It was a crazy routine.  She would be up in the middle of the night just like a typical newborn, and I would be pumping, and my husband would give her a bottle so that we could maximize the time. My supply never totally got to where it needed to be, and that was a big source of stress for me. I remember being on the phone with our lactation consultant from the NICU and crying because I just couldn’t get there.  She allowed me to have the grace and the permission to stop since it was causing more stress – a fed baby is best, and I was able to ensure she had breast milk through her entire critical time in the NICU, which was a big win.  I made it to four months of pumping, and because I had five months off of work, it meant that when I returned to work I was no longer pumping.  I had a small freezer stash, but not a whole lot, so we switched to formula at that point.

I remember being on the phone with our lactation consultant from the NICU and crying because I just couldn’t get there.  She allowed me to have the grace and the permission to stop since it was causing more stress.

That whole experience sounds incredibly challenging:

So challenging.  The other big piece for me is that there's a lot of stress that comes along with being a preemie mom and the NICU experience, and not having a traditional birth.  I worked very closely with a therapist a few years later and was diagnosed with post-traumatic stress disorder (PTSD), as are many NICU moms. When my husband and I decided to try to have a second child, I knew that mentally I had a lot to work through before I could even try to get pregnant, and the sound of the breast pump was a big trigger for me, since it was tied to such a traumatic part of my life.

When my husband and I decided to try to have a second child, I knew that mentally I had a lot to work through before I could even try to get pregnant, and the sound of the breast pump was a big trigger for me, since it was tied to such a traumatic part of my life.

How was the birth of your son?

I found out I was pregnant with my son in October 2018, and my daughter was 3 years old. After having a preemie, I was considered a high-risk pregnancy, so we had a whole bunch of additional precautions and monitoring, including getting a weekly shot to keep me pregnant and seeing Maternal Fetal Medicine specialists every two weeks. My goal was to have as close to a normal birth as possible, which would include trying to breastfeed my son if the circumstances would allow.  Luckily, his birth was the exact opposite of my daughter, and he was born via a scheduled c-section at 37 weeks, with zero NICU time.

After my son was born, and once we were in the recovery room, I immediately started breastfeeding him, which was incredible and a completely different experience than my daughter’s birth. Breastfeeding went really well with him in the hospital, and coming home went smoothly, but I did notice I was having some headaches. I thought they were really bad migraines, but it turns out I had very high blood pressure, so I had to go back to the hospital and was readmitted to labor and delivery six days postpartum for postpartum preeclampsia.   It’s something that I did not have during pregnancy, and I did not have when I was discharged from the hospital, it just came on suddenly. Luckily, my husband and son were allowed to come and stay with me while I was back at the hospital, so I was still able to nurse my son, and continue that relationship with him the whole time in the hospital. I did take a little hit to supply, but nothing too bad.

Once we got my blood pressure under control and we came home, my son had a latch issue, so I worked closely with a different lactation consultant to ensure my son was on track with breast feeding and gaining weight.  She identified a tongue and lip tie, and once we got that resolved, everything really improved from there.  I was very focused on controlling what I could control, and I told my lactation consultant very early on that I didn’t want to be connected to the pump all the time.  Even if supply took a hit, I didn’t want to pump day and night.  It’s part of the PTSD from the NICU and the pump being a trigger for me, and I learned to be an advocate for and focus on controlling what I could control – and to me that was the breast pump.  I didn't want to be connected to it any more than I had to be, and so I got pretty comfortable supplementing with formula, and then when I returned to work, I pumped when I was able to, but pumping didn’t dictate my schedule.  I went back to work after five months and started the life of a pumping, working mom, with a completely different experience than I had with my daughter.

It’s part of the PTSD from the NICU and the pump being a trigger for me, and I learned to be an advocate for and focus on controlling what I could control – and to me that was the breast pump.  I didn't want to be connected to it any more than I had to be, and so I got pretty comfortable supplementing with formula, and then when I returned to work, I pumped when I was able to, but pumping didn’t dictate my schedule.

What do you do for work and how were you able to integrate pumping into your work schedule?

I work in sales for Microsoft, so no day is the same for me in terms of my daily schedule and every day my pumping life looked a little different. Sometimes I would work at a Microsoft office, which was wonderful because we've got private mother’s rooms for pumping with refrigerators and comfy chairs and all of that. And then the next day I might be at a customer site, meeting with various customers all day, and lugging around bags of pumps and coolers of milk, trying to find a place to pump and probably pumping in my car, and just trying to make it work. It was such a wide variety of what my day looked like this time around, and then in March 2020, COVID hit and my pumping at work life changed again.

There’s so much pressure these days to breastfeed and avoid formula, which can lead to miserable experiences for mothers.  How did you get the confidence to pump and supplement in a way that really enabled you and your whole family to thrive?

I don’t think we talk enough about mental health, and this is something that I am focused on – I think the formula conversation ties in nicely since there is such a stigma around formula and so many moms struggle with breastfeeding, yet beat themselves up about formula.  They feel like a failure.  For me, with my daughter, she just turned six, and even though she was a two-pounder, she is now in the 95th percentile for height and she’s become an incredible little kid, and I only was able to give her breast milk for five months. I formula fed her after five months, and she is fine, so I think it was easier the second time around to give myself that flexibility. 

We talk so much about mental health, and unfortunately, I think a lot of people are either scared to seek help or are intimidated by the idea of getting help.  I’m a big proponent of therapy. I worked very closely with my therapist and I'm very open about it and I loved it. I think she really helped me put my head in perspective on a lot of these things.  For instance, one of the big things we worked on with my pregnancy with my son was about being in control - what are the things that you can control, and what are the things you can’t, and what are your must-haves, and what are things that you can live without. I knew that with my son, I would rather spend time with my kids than feel like I had to be connected to the pump feeling miserable.  It was the one piece I could control, therefore when I needed to supplement breastfeeding with formula, I did.  We all have challenges with breastfeeding, and we all have challenges with pumping and challenges with being a mom, and so I took it day by day and week by week, and it worked for us.

One of the big things we worked on with my pregnancy with my son was about being in control - what are the things that you can control, and what are the things you can’t, and what are your must-haves, and what are things that you can live without.

Now that we find ourselves a few weeks into this COID-19 pandemic, how are you approaching the pumping?

When I initially returned to work pre-COVID, my goal was to pump three times a day, and it very quickly became clear that it was not possible to do.  It turned into more like twice a day, and then probably up until March 2020, it was about once a day that I was pumping at work. I nursed him in the morning, then I would pump however many times I was able to at work, and then I would nurse him when I got home, and we did nursing on demand during the weekends.  That really worked for me and I feel like I reached my goal.  Once COVID hit and I was working from home all the time, I ended up nursing him about three times a day, and he got a bottle of formula before bed, and sometimes in the afternoon as well, and it worked out well for my husband and me.  Once the pumping was eliminated, I continued nursing my son until he turned 16 months, which was way past what I thought I could do.  I haven’t seen my pump since March 2020, and I love that.  Since then I donated my pump to a mother who needed it, but to be honest I really wanted to smash it with a hammer!

I haven’t seen my pump since March 2020, and I love that.  Since then I donated my pump to a mother who needed it, but to be honest I really wanted to smash it with a hammer!

Microsoft as a company is super supportive of working parents, and you had a generous leave policy and great resources and support when you returned, but you still work in a very male-dominated workplace.  How did that affect your experience returning to work and pumping?

I don't know if it's a gender thing, or if it's just different people having different levels of comfort with it. There are some males on our team who are totally cool if I mention that I need to go pump for 15 minutes, and some guys who see me lugging around my work and pumping bags rush to point it out and offer to help me.  Others get uncomfortable if I mention that I need to pump and say “oh I don't need to know what you're doing right now,” so I think it is a person by person thing. I have a really supportive manager and she's got two kids, and that makes a big difference. 

Is there any equipment related to pumping that you found to be helpful?

The game changer for me this time is that I got a bra that you can wear as a regular bra, but then you can also pump in it, versus putting that zipper pump holder on.  That’s been key for me.  A challenge for me was that I didn’t know how long my nursing and pumping journey would be, so I was hesitant to invest in a lot of accessories.  If you had told me back when my son was born that I would still be breastfeeding him 16 months later, I wouldn’t have believed you because I just never thought I would make it that far.  I did make the investment in those bras and it made such a difference and saved a lot of time for me during pumping sessions.

The other helpful thing was Kiinde bags, which are plastic bags that you connect to your pumping parts and the milk goes directly into them rather than into pumping into bottles.  You seal the bags when you’re done, and they’ve been key for me. It’s a couple less things for washing, and that makes a difference.  Those two things were really my saving graces for pumping at work.

Are there any online or in-person resources that found to be particularly helpful to you during the postpartum period?

Where I live there’s a hospital-sponsored breastfeeding support group that meets twice a week at the hospital, and then there's a “working moms group,” which is a subset of that group. We called it the “virtual village” and my son and I met up with that group as much as we could. That community is also on Facebook, and it has been a lifeline for me on this journey.  Most of the moms in the group were working moms, and there were first time moms and second and third time moms, and it was led by a lactation consultant who was a former labor and delivery nurse, so it was just a wonderful support group. I could never attend that type of a group with my daughter because we had to be so isolated and protective of her exposure to germs in that first year, so this group was a very special experience for me the second time around.

Looking forward, what are your goals as a working mom and how you balance the parts of your life?

Well, I don't think it's about balance. I think it's 100% about integration.  Most folks on my team at work have kids, and I probably have the youngest kids of the group, and I'm very vocal about my family and how they are a part of my life.  In the sales job I’m in now, I set my schedule. My number one priority, even though I love my job and the work and the impact I'm making for my customers, but number one I'm a mom.  If there's an event at school that I need to be a part of, or if I have the opportunity to go read to my daughter’s class, then I do it. I'm blessed by technology that support me, so people can reach me wherever I am. I can respond to emails, and I can take conference calls wherever I need to be.

My number one priority, even though I love my job and the work and the impact I'm making for my customers, but number one I'm a mom.

And I think even now, trying to look on the bright side of what's happening in our world today with COVID, is that it’s humanizing so many of us.  I’m getting to know my teammates and my customers with their kids and their families.  It feels like my son and daughter are becoming part of my work team even more than they were before. 

I think it’s just advancing the integration that we're all going to be able to have as we come out of the pandemic and reemerge into whatever society will look like post-COVID. I think the other big one is that our careers ebb and flow in terms of where and when we can give you know 110%, and sometimes we have to scale it down. I've been through that with my daughter’s journey in the NICU, and I've been through that journey being pregnant, I'm on that journey now as a mom of two. For me it's definitely mom first, and especially right now being a mom of little kids. They're my priority right now.

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