Expert: Joanna Liberty - 12/21/2011

Question
Hi, I'm currently expressing for my twin boys whilst they are in the neonatal intensive care unit for premature birth. I am acutely aware of how important it is that I continue and that they get enough of my milk so they can grow and develop quickly and stabilize so they are able to come home.
I am not having trouble with my first let down, it comes quickly and promptly when I first put on the electric pump. My nurses have just asked me to try and get a second let down but I don't seem to be able too. I know the feeling of when my milk comes in but I do not feel it after finishing pumping or whilst expressing or a few minutes later. There doesn't seem to be a decrease in flow before it starts again either. But I do get the feeling of my milk coming in twice before I do express. I feel it come in about an hour after I express and then again another hour after that. Could both letdowns be coming in BEFORE I start expressing and that is why I don't notice it? I really want to do what is best for my babies and whilst they are in hospital, this is the primary care I can give them.

Answer
Hi Magdalena,

Congratulations on the birth of your twins! You are doing an amazing job pumping and providing your milk for them while they are in the neonatal intensive care. I imagine that is a very stressful situation for you and your babies, and you're doing a great job.

I would recommend trying to pump again after you feel the letdown that you said is about 30 minutes after you express your milk. It is difficult to pump, but when you're under the stress of your babies in the NICU, it can be even worse. Being around your baby or having something like a blanket or pajamas that your babies wore recently might help too.

There are also tricks that you could try to get another letdown while you are pumping - those include autogenic training where you use relaxation and mental techniques to cause a letdown. Some mothers will watch videos or listen to CDs of babies crying to get a letdown. You can also try to change the speed/suction of your pump to stimulate letdown too. There are a lot of options, but don't feel bad if you aren't able to do it - pumping 30 minutes later would work too!

Again, you are doing an amazing job pumping for your new babies! Keep up the good work and don't stress yourself out!