If your baby is premature or ill and unable to nurse frequently and vigorously, you will need to pump your breasts regularly to keep producing breast milk. Milk production and release are affected by your emotional state, your physical condition, and your pumping routines. The following hints should help stimulate your milk supply and condition your let-down reflex (milk ejection reflex). They will help you to provide the maximum amount of breast milk for your baby and to prepare for breast-feeding when your baby is ready.

1. Ask for help from a lactation professional.

   Seek the advice of a lactation professional as early as possible. Many hospitals have lactation consultants on staff who can help you create a plan to make the most of your milk production. This person will also be able to help you adjust this plan to your baby's changing needs and abilities.

2. If possible, rent a hospital-grade electric breast pump.

   It is best if you can rent a hospital-grade electric breast pump from a local hospital or pump rental station. Ask for a double collection system that allows you to collect milk from both breasts at once. This saves you a lot of time. To find where you can rent a pump, call Hollister at 1-800-323-4060; Medela, Inc., at 1-800-TELL-YOU (1-800-835-5968).

   You can also get small electric, battery-powered, hand-operated, or foot-operated pumps. Although these pumps are cheaper, generally they are less effective and less comfortable than hospital-grade electric pumps.

3. Follow a pumping schedule that is similar to a healthy newborn's feeding schedule.

   This means you will need to pump every 2 to 3 hours, allowing one 5- to 6-hour interval at night (pump 7 to 8 times each 24-hour day).

4. Pump each breast at least 10 minutes.

   Pumping each breast 10 minutes is usually sufficient to empty the breasts well; however, some women need to pump longer. If milk is still flowing well after 10 minutes, pump an additional 5 minutes. Even if milk stops flowing before 10 minutes have passed, continue pumping for at least the full 10 minutes. If you pump both breasts at once you may not only save time but also may raise the prolactin level in your blood. Prolactin is the hormone that produces milk.

5. Relax.

   Relaxing can help trigger your let-down reflex. Sit in a comfortable position and relax your entire body. Practice the relaxation exercises taught in childbirth classes. Think about your baby, look at your baby's picture, play soft background music, or read a good book or magazine. If milk flow does not begin after 5 minutes of pumping, stop. Concentrate on relaxing and then start pumping again in 5 to 10 minutes.

6. Massage your breasts.

   Gentle massage of your breasts can help start milk flow. Start at the chest wall and massage with a circular motion about the size of a quarter, gradually moving toward the nipple. Stroke your nipple with the heel of your hand or gently squeeze or roll it between your thumb and forefinger.

7. Warm your breasts.

   Taking a warm bath or shower before pumping can enhance your let-down reflex and improve the flow of milk. Placing warm compresses on your breasts can also help trigger the milk ejection reflex.

8. Drink a lot of fluids.

   A good rule of thumb is to pour yourself an 8- to 12-ounce glass of water or juice each time you sit down to pump.

9. Eat a balanced diet.

   Try to eat fewer processed snack foods (cookies, cake, candy, etc.). Instead, eat more fresh fruits and vegetables, whole-grain breads and cereals, dairy products, and other sources of protein. Continue taking your prenatal vitamins.

10. Keep a diary of the amount of milk you pump each time.

    You may get different amounts of milk each time you pump, depending on the time of day and how long it has been since you last pumped. However, the total amount of milk you pump in 24 hours should steadily increase during the first 2 to 4 weeks of pumping.

    By 2 weeks after delivery, a generous milk supply for a single baby is about 24 ounces every 24 hours. (Mothers of twins or triplets need to produce more milk.) You should aim for production of at least 20 ounces every 24 hours even if your baby takes little milk now. It is easier to keep producing a generous supply of milk from the start than to increase your milk supply later when your baby begins taking more.

    Even if your pumped volumes are lower than desired, don't give up. Often a mother's milk production climbs when she is able to put her baby to her breast.

    Check your diary to make sure you are pumping at least seven times each day.

11. Be patient with yourself.

    You'll need time and practice to get your body used to pumping.

12. Start breast-feeding your baby as soon as possible.

    It is important to start breast-feeding as soon and as often as your baby's medical condition permits. Offering your breast to your baby whenever possible during your hospital visits will get your baby used to nursing.

    Always pump after nursing to express any residual milk. This will make sure that your breasts are emptied well and that you keep producing a generous supply of milk. Once your baby is breast-feeding exclusively and gaining weight well, you can begin tapering off the amount of pumping you do.

    You will probably need to keep pumping until your baby weighs at least 7 pounds and is a few weeks past his due date.