Feeding a slightly early baby - advice please!

(43 Posts)
lotsofcheese Wed 17-Apr-13 14:27:58

I'm 35+5 & just had steroids for possible delivery by CS on Friday.

My last baby was extremely premature & I expressed for him for 3 months - I eventually got a good supply going but sadly he wasn't able to breast feed for various reasons (he was on oxygen & was too weak to suck).

This time, I'd really like to be able to breast feed, but wondered if anyone has experience of feeding a baby of that gestation?

I've still got my pump, know how to hand express & am prepared to consider top-ups till feeding is established.

I can't face leaving another baby behind in hospital again so I'm really keen to get feeding going.

All advice/experiences appreciated. Thanks

NotSoNervous Wed 17-Apr-13 14:32:17

Sorry no advice but fx all goes well for you Friday

elfycat Wed 17-Apr-13 14:54:12

I had DD1 at 36+2 (waters went at 36+1).

I stayed in hospital for 3 days while her sugars stabilised. I was hand expressing colostrum, BF, topping up with donor/ff if her blood sugars were low every 2 hours and ending with a BF. That is starting every 2 hours so one hour of feeding and one hour off - for 3 days. It was a bit tiring but worth it as she then BF successfully for months.

I hated expressing though, it didn't really work for me long term. You seem to have more successfully done that bit. I perservered for a few weeks as it boosted my milk supply and was well worth the effort.

elfycat Wed 17-Apr-13 14:58:09

Good luck for Friday. The early ones need a bit more hugging = sit down with your feet up, make people run around after you and snuggle.

Marsupials have developed a system of having early babies and then getting them to snuggle, rest and latch when needed. I think early babies need the same sort of treatment.

lotsofcheese Wed 17-Apr-13 15:31:47

Thanks - it's good to know that a combination of breast/expressing/formula can work.

The neonatal unit DS was in & which this one will too is very focused on BF (too much so in my personal & professional opinion) & I know it will be up to me to be assertive about top-ups etc.

DS was 31+5 but a really good weight and already had the sucking reflex.

I'm assuming you can stay in hospital if DC2 needs to? In that case, all being well, try to breastfeed for as many of the feeds as you can (presumably to schedule if on SCBU) and ask for other feeds to be tubefed/cupfed as appropriate. DS had a mixture of formula and EBM until I was pumping enough to cut out the formula, and he was tubefed for about a week and a half (some breastfeeds with EBM topups), until they took out his tube and he was cupfed overnight (rather than bottle) then I roomed in with him.

I hope everything goes well and you get good support flowers

nananaps Wed 17-Apr-13 16:04:57

Hello.
I had my baby at 36+5. Also had 2 doses of steroids prior to delivery.
He weighed 5Lbs 14oz.
Fed almost continuously day 1,2,3 &4. On day 2 i asked for a formula top up as i could smell ketones on his breath and saw no evidence of milk in his mouth.
Milk came in on day 4.
I was in hospital with nothing else to do other than feed so it was ok.
12 weeks on we are well established and weight gain is fab.
All the best for Friday grin

habhann Wed 17-Apr-13 18:13:59

I had my lo at 35 plus 5 weeks. C section. Colostrum for 3 days then milk came in. Co- slept , side lying position made feeding easier post section. Still breastfeeding @ 25 weeks ..good luck

lotsofcheese Wed 17-Apr-13 18:20:41

Thanks so much for advice - all messages are helpful. I'll take my phone in so I can read over messages while I'm in hospital.

I'll be in for a few days because of c-section & thereafter will ask scbu if I can room in - although the last time they were very short of rooms & we only got 1 night - despite 95 days in the unit & home oxygen.

I'm just worried about feeding issues keeping us in longer than necessary as the unit are very anti-formula & follow the WHO policy to the letter. But I'm ready for them & all your advice is ammunition for me - thanks!

tory79 Wed 17-Apr-13 22:29:21

I had ds at 36 weeks, had steroids prior to section. He was absolutely fine, slightly jaundiced though, and had tt. However, we got stuck in hospital for 5 days as he lost 13% and we had to stay until he had gained. I think this was due to the tt, and also my milk did not come in for 4 days - I think its fairly common for a cs to delay it a bit.

I fed him on demand, and also expressed a bit to give to him as top ups as well. Stopped this when I left hospital though.

However, bf worked well for us, and still going at 19m.

Good luck!

sar1133 Thu 18-Apr-13 03:36:39

I had ds at 33 weeks spontaneous labour after waters breaking. He was fed through tube for a week but I kept trying him at the breast and did regular kangaroo care. This all seemed to help. He was cup fed or bottle with ebm when I wasn't there but as I roomed in I was mainly there. We used nipple shields for 2 weeks as well. He was allowed home at 14 days as he had cracked the feeding. X

OrangeFootedScrubfowl Thu 18-Apr-13 04:33:09

35.5 weeks and a caesarean. They'll hopefully let you stay on the maternity ward for a few days, and then go straight to rooting in on scbu. Feeding might be just like a term baby if you are lucky. Hope it all goes well.

OrangeFootedScrubfowl Thu 18-Apr-13 04:33:37

Rooming in I meant of course!

MrRected Thu 18-Apr-13 05:29:50

DD born at 35+6. No steroids, vaginal delivery. Spent 3 nights in hospital. She fed like a charm.

HadALittleFaithBaby Thu 18-Apr-13 07:17:16

We're in a similar position. DD born Sunday - VB but rather rapid! Weighed 5lb 4oz. I'm bf but she needed top ups because she is very hungry bit quick to fatigue. My milk came in yesterday so I've started expressing and she's on a combo of breast feeds, EBM from a cup and formula top up from a cup. Hoping gradually to establish more BF so we can drop the cup. We're thinking of going home today but its daunting!

lotsofcheese Thu 18-Apr-13 07:44:34

Thanks everyone - have had a shocking night's sleep due to the steroids - forgot how manic they make you.

It's the 2nd injection today at lunchtime, followed by another scan to check fluid & then the consultant will decide. If it's not decided today it will be on a daily basis.

elfycat Thu 18-Apr-13 09:33:57

My early-one was a few years back now (4) and the little, yellow, scrawny baby has turned into a thumping pre-schooler who is still in bed at 0930. She's not early any longer (more's the pity).

One thing thar irritated me was that people wold dismiss that she was premature. 'Oh well she was just early, not prem then'. I'm sorry but the medical world lumps her in with all the other early babies for a reason. I think it took her 2 years to catch up after her early start and having to be readmitted to scbu with very toxic jaundice at day 8 (but that was just her and isn't that common).

But after that jaundice episode, and all the medication she received while they were finding out the problem, including antibiotics in case of meningitis, she acted like a newborn for at least 3-4 months. not properly prem, grumble grumble...

minipie Fri 19-Apr-13 20:40:46

good luck!

dd was born at 34 weeks, it took 3 weeks to establish breastfeeding and get let out of SCBU (lots of pumping in the meantime)

BUT

I believe the reason it took so long is not just because DD was premature and sleepy, but also because she had an undiagnosed tongue tie. so, if you do struggle, don't forget non early baby related issues might apply too!

lotsofcheese Fri 19-Apr-13 22:03:46

Thanks everyone - I ended up having her last night by EMCS.

Her blood glucose has been low despite formula top-ups on the post-natal ward, so she's in SCBU.

Went down earlier for a cuddle & discovered they're topping up my tiny 1-2 ml hand-expressed volumes of EBM with IV fluids-glucose - aaargh! It's not really enough for weight gain so have asked them to top her up with formula, either by bottle, cup or NG.

Had some lovely cuddles with her too. Hoping we can push the feeding so we can get her home ASAP.

minipie Sat 20-Apr-13 08:10:06

congratulations! and best of luck with getting her home soon.

elfycat Sat 20-Apr-13 09:01:41

Congratulations!

It took DD1 about 3 days to get her glucose levels to settle. 1-2ml of expressing sound about right (ime - I only ever got 1ml at a time) and it's packed full of what she needs. Have you been able to see a feeding advisor? I'd recommend it before you leave, it just gives you that bit more confidence.

Enjoy those cuddles. And drink lots. SCBU is always so warm.

lotsofcheese Sat 20-Apr-13 12:50:16

Thanks Elfy - I must have forgotten from last time how little milk I produced to start with! I'm less than 48 hours post-section so perhaps a bit ambitious at this stage to be expecting much more.

BabyCheese isn't waking up for feeds & is being fed through a tube. Today there were large aspirates from her tube. I think she's needing more time to get going with the feeding.

HadALittleFaithBaby Sat 20-Apr-13 13:30:52

Ah congratulations! You're about 6 days behind me. Keep persevering with the early expressing and remember your milk will kick in soon! It's early days, hang in there.

TwitchyTail Sun 21-Apr-13 19:26:11

Congratulations!

I had my son at 36 weeks. He would latch but not suck at first, so had expressed colostrum and formula top ups (low sugars) for 3 days. Pumped from day 2 to stimulate supply. We always tried him on the boobs first to keep his hand (tongue?) in so to speak. He got the hang of it on day 4 and by day 5 we were ebf. Still ebf at 8 weeks, going brilliantly, doing it right now grin <tmi emoticon> Definitely possible, good luck!

TwitchyTail Sun 21-Apr-13 19:33:42

^^ Oh, and I second the suggestion speak to a feeding coordinator - I don't think I would be breastfeeding now if it wasn't for their advice, particularly about establishing supply with a lethargic jaundiced baby who cba to suck.

elfycat Mon 22-Apr-13 13:37:19

That jaundice is just great isn't it TwitchyTail hmm I think the impact is greatly underestimated.

How are you gettig on lotsofcheese?

lotsofcheese Mon 22-Apr-13 19:39:35

Thanks for asking. I'm now home & my milk has come in nicely. I'm expressing 6-8 x day& getting a good supply. She is being fed by tube & no longer needing formula top-ups.

My young missy is a bit uninterested in the breast - she tries to latch on but my boobs are so big the nipple barely fits in her mouth.

The unit have asked me to think about whether I would rather she had breastmilk through her tube or in a bottle.

She's always pulling her tube out & I feel it's distressing for he having it passed. But on the other hand, it could be a nail in the coffin for BF......

Having a teary/hormonal day which isn't helping either.

lotsofcheese Mon 22-Apr-13 19:43:58

And I'm not able to get in that much for feeds, which isn't helping either. Am sure if I was in more often she could get more practice at BF - so feeling guilty about that

Also got a 4 year old who is in nursery & i can't drive post c-section plus no family support nearby.

HadALittleFaithBaby Mon 22-Apr-13 19:46:05

We had the same problem. What with DD being small and me being of ample breast. The nurses supporting me at the hospital suggested trying nipple shields - I think they gave me a these ones. If you use them you have to express afterwards to prevent blocked ducts etc because they don't drain all the milk but its been a great stop gap getting her into the habit of latching. I started using them Thursday and she's now latching without it most of the time.

lotsofcheese Mon 22-Apr-13 19:54:20

Thanks for the tip - I'll ask the unit about nipple shields. I've also asked if I can room in before she gets home so I can get a prolonged period of time with her, rather than rushing in/out around DS's nursery hours.

The staff are very supportive of BF.

HadALittleFaithBaby Mon 22-Apr-13 20:30:40

It's great that they're supportive - my unit were too. I'd have given up without their help (especially since DH kept pushing bottles!).

minipie Mon 22-Apr-13 20:42:02

lotsofcheese, I greatly sympathise as DD was much the same, sleepy and uninterested and wouldn't open her mouth enough to get my nipple in. it's so great that you have a good supply though.

please don't feel guilty about not being there for more feeds. I was able to be there for virtually every feed (as have no other children unlike you). however I really don't think it helped her 'get it' any quicker, she took her own time about it. there were mums in SCBU with me who were only there for one or two feeds a day and their babies got the hang much quicker than my dd (prob due to DD's tongue tie I now suspect).

I resisted using bottles for the EBM due to worry about nipple confusion but am still not sure whether that was the right decision tbh. I now think, do what you have to do to get her home quickly, even if that means bottles - I don't personally think that would mean the end of BFing provided you keep pumping and keep trying to latch (such hard work I know ESP if you have another DC).

rooming in was a bit of a catch 22 for us, I was convinced rooming in would help her learn to feed, but wasn't allowed to room in until she was feeding well enough confused. do press for it though, I suspect as you are an experienced prem mum they may give you more leeway iyswim.

very best of luck.

lotsofcheese Mon 22-Apr-13 21:37:11

Thanks everyone. I'm feeling very torn & like I am being a crap parent to DS.

You are right: Life will be much better when I get her home. I can give him more attention & concentrate on her too.

So maybe that is the way to go. Just discussed things with DP & we both agree that bottle is better than NG feeding for her. I just hope I've done the right thing.

TwitchyTail Mon 22-Apr-13 21:46:27

Aw don't feel guilty lotsofcheese. I was able to "room in" with my son from the start and, like minipie, it made no difference - he just had to be ready for it, which only happened after we went home. You've done brilliantly getting your supply going which is half the battle - it will be there ready for your daughter when she gets round to it smile

I also had the massive boob/tiny mouth issue. I found doing the breast "hamburger" (google it) and basically squashing whatever nipple/breast I could into his mouth helped a bit.

In your position I would go for bottle rather than NG too. I know all babies are different but having a bottle first didn't affect my baby's ability to latch and breastfeed at all.

elfycat Mon 22-Apr-13 21:49:08

When I mixed fed for the first few days I was told to use a syringe and to get DD1 to gently suck on my little fnger which had been cleaned within an inch of its life As she sucked I gently pushed on the plunger and she drank the milk (expressed and donor/ff). If she wasn't sucking I didn't release milk.

My BF advisor suggested it so she didn't get used to a bottle teat and confused while we worked on estabblishing BF. Have you had a chance to speak with an advisor?

I would say that NGs are irritating beyong belief and bottle would be more comfortable and is certainly not a wrong decision. You are doing great and you must be so tired with recovering from the birth, hanging out in hospitals not restful and then the nervous energy of trying to make best decisions.

lotsofcheese Tue 23-Apr-13 13:41:06

Thanks again everyone - your thoughts have helped me get some perspective. I phoned the ward this morning & she has taken all of her feeds by bottle, so I'm glad we made that decision & her NG tube is out.

She may get home in the next couple of days, on a hot cot grin

I'm still expressing, but have a lumpy area on my right boob, despite regular expressing, massage, hot shower etc - hoping it doesn't turn into mastitis.....

lotsofcheese Wed 24-Apr-13 21:56:51

I'm now having a confidence crisis - can anyone offer some advice?

DD is taking EBM from a bottle 3-4 hourly. She gobbles the bottles down. I am (just) keeping up with her by expressing round the clock. My right boob is making only 1/3 volume of the left side, after yesterday's lumpy area.

We're using nipple shields as she was having difficulty latching on without, but she takes a few sucks then just holds it in her mouth before falling asleep.

I'm rooming in tomorrow (I hope, if her jaundice is better) to try & crack the BF. She'll be coming home this weekend & I feel under pressure to have her exclusively on the breast, as I won't have time to express, bottle feed & look after DS.

Any advice on how I can encourage her to take more by breast?

minipie Wed 24-Apr-13 22:05:37

have the lumps gone now? hope so. hopefully your supply will recover soon if so.

you may be doing all this already but here are some ideas...

strip her off so she's more alert for feeds

squeeze some milk into the nipple shield so she gets an instant reward

use breast compressions when she is sucking so as to make it easier for her and more like bottle fast flow.

(controversial) try to persuade nurses to give her bottle 4 hourly not 3, so she is hungrier when you offer boob. I found dd wasn't much interested in boob while she got 3 hourly NG feeds.

good luck, you're doing really well and it's great that she is feeding well from bottles, at least that means you have an option to get her home if you want. hope rooming in goes well.

lotsofcheese Wed 24-Apr-13 22:09:22

Thanks for the quick reply!

Yes, I'm squeezing a little milk into the shield before feeds.

She is 4-hourly & trying with boob 1st but only making it in for 1-2 feeds daily - but rooming in will do more.

She is stripped as jaundiced & on light therapy - am also doing nappy before to wake her up.

lotsofcheese Wed 24-Apr-13 22:10:19

Yes, managed to get rid of the lumps, just hoping it didn't affect supply too badly.....

minipie Wed 24-Apr-13 22:26:19

oh, having jaundice will make her so much sleepier and less willing to put effort into BFing (at least that was definitely the case for us) so hopefully it will be a different story once jaundice is sorted. to be honest I wouldn't be trying too hard with the BFing while she is jaundiced as it will only dishearten you!

glad the lumps have gone, come on right boob!

do try not to put yourself under time pressure, though that is easier said than done I know... if you want her to come home this weekend and she hasn't quite cracked BFing by then, a bit of mix feeding isn't a disaster, or if you want her to be EBF, then a few more days in hospital till she gets it isn't a disaster either (though I can fully understand it might feel like it)

lotsofcheese Wed 24-Apr-13 22:33:50

Thanks for the reassurance. Just want to know I've done everything possible.

minipie Wed 24-Apr-13 22:47:03

totally understand. sounds like you are doing everything possible, it will just take a little more time till she feels ready. on the plus side, it's amazing how quickly they can go from being uninterested to totally getting it once they are ready. hope that happens for you v soon, SCBU is so frustrating!

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