Problems BF preemie 34+6

[pixiequeen38]

My dd is now 38 weeks corrected. We spent a week on the transitional ward as she was jaundiced and had feeding issues. I mainly FF via a bottle but started off with cup feeding, she wasn't able to latch on the breast. I then expressed colostrum and breast milk and gave via a bottle. I was told it may take a while before she could learn to latch and suck on the breast.

Since discharge I have been expressing using the Medela symphony but only been able to produce about 50mls each time and I do this 8 times a day. This is just about enough for a feed but sometimes when she's hungry she may take 60mls. I've only got small boobs - B cup. Since yesterday with using nipple shields and three meetings with the breastfeeding counsellor, dd has started to BF for 20 mins at a time. I have inverted nipples but used the niplette device through most of my pregnancy which has helped my right nipple but my left is still inverted. However, I am still able to get milk out from both sides. I think she has trouble feeding from the left side more than the right.

My routine every 3 hours is breastfeed from one side (alternate sides each feed which is what the counsellor recommended to start off with), then top up via bottle with EBM, then express both sides. It takes an hour or so in total and then I have to repeat it in 2 hours which is leaving me exhausted. I'm worried about just BF as she lost 10% of her weight by the time she was discharged but she regained her birth weight (4lbs 14oz) and more and therefore offing her the top up. I have received mixed advice about how much to feed her but I was told 150mls per kg so just under 400mls. How long do I carry this on for? The midwife just said she how she goes and be guided by her. Any advice would be much appreciated!

[ohanami]

Congratulations on your dd :)

My dd was 33+6 and didn't start to latch properly until about 3 weeks corrected. I also had flat/inverted nipples which didn't help. We carried on the feed/express/top up routine until then and gradually at about 3 to 4 weeks corrected she moved entirely onto bf. I still expressed a little as she would only latch on to one side easily when out and about so I'd take a top up in case she needed it. The real turning point for us was going back to the bf drop in once she was a little bit bigger (3 weeks corrected I think) and more awake, and they were able to find in about 30 seconds a different position - one that hadn't worked when she was a bit smaller but from that point on it felt like we were cruising. Every baby is different, but just wanted to share to show you that there is hope!

Try not to beat yourself up too much about if/when it will happen. You've already done a fantastic job persevering for this long. Weigh up each day by itself and don't feel too bad if you take a step back after a few steps forward. And be kind to yourself - you're still recovering from giving birth earlier than planned, and you're working flat out to do the best for your dd - you could think about topping up with formula every now and again if you need some respite from that relentless cycle.

Hope that's helpful - good luck, and enjoy those snuggly newborn cuddles

[pixiequeen38]

Thanks Ohanami for your words of encouragement. Wow, so you did the BF/top up/express routine for 9 weeks, that's amazing. I've bought a pumping bra so now I can express and top her up at the same time which has knocked 20mins off the whole routine which has been great. Which BF position did you try? I'm going to see the counsellor on a weekly basis to get some support. It would be amazing if I could BF without any nipple shields eventually as I feel I can't leave the house currently. dd takes ages to latch on as she's sleepy or gets irritable and thrashes around. Her mouth is small too so not able to get a good mouthful of the breast.

[Trace38]

Ours was born 34+6 and we were advised to offer each side until she's has enough and then exp after. It takes a while but she's now ebf bar about two formula top ups per day.

[pixiequeen38]

That's good news trace38, there is hope after all! How long did your baby take to ebf?

[lizzytee]

Pixie - wow! If you are expressing 400mls plus and bf then you are well on the way to building a full supply. great that you can get weekly face to face support. PM me if you happen to be anywhere near SE London as I run a drop-in bf group

[jmac88]

Hi Pixie,

I'm in a similar situation. Gave birth to my baby boy via c section on Friday 4th Dec at 34+4weeks as waters broke at 32 weeks. Luckiy we were only in SCBU for one night and after a week on postnatal ward came home yesterday! We have been doing three hourly feeds, offering him breast first and then topping up with expressed milk via bottle. He has anything between 15-40mls every three hours and i breastfeed him whenever he wants in between but he can only manage to suck for about 10-20 mins each time before he falls asleep. It is SO hard! particularly with the expressing as you are right, you end up with about 30 mins free during the whole routine! It sounds like you are doing amazingly well though. I have felt like giving up so many times in the one week we have been doing this so you are amazing to continue. Have you tried eating lots of oats? I ate so much porridge and flapjack I thought it would make me sick but it is really good for increasing your milk supply. Though it doesn't sound like you have a low milk supply to me.... My issue is that I cannot bring myself to express during the night as I'm so exhausted just from feeding him. MW told me yesterday that this could make my supply dwindle which has made me anxious. At his 5 day weigh in he had lost 4.5% of his birth weight but they want him to be gaining by Monday so feel a bit under pressure to fatten him up!

Anyway I feel your pain as it is so hard, hardest thing I have ever done I think. You are doing great though, just keep perservering as it sounds like from other Mums it does get better and will be so worth it in the end!

Lizzy I am in SE London (Peckham) where is your drop in group?

[Peasy1]

Hi Pixie,

Firstly congratulations! My daughter was born at 34+0 and I found it difficult not knowing many people who had been through having a preemie. I wanted to share my experience but my overall advice would be to do what you feel is right for you and your baby as everyone you speak to has an opinion!

My daughter was in NICU for 16 days and was breastfeeding with nipple shields before she came home. I managed to get her latched without the shield before she was discharged but they definitely helped her as she was getting really tired bf. She was exclusively bf for six weeks then started losing weight. Looking back I wish I'd sought more help with her latch but it was just before Christmas and my HV advised we started top ups. I spent two weeks doing the routine you describe which was exhausting. My husband was off work for Christmas and would give her a top UK whilst I expressed. I've never been able to get much expressing so was stressing a lot about it. In the end we decided to give her expressed milk as a top up where possible but to give formula when I couldn't express enough. I don't know if continuing with the top ups and expressing would have got her back to exclusively breast feeding but after many months I have accepted that what we did was the right thing for us at the time.

She is now 13.5 months and unbelievably I am still bf her. I never expected I would be able to for this long and it's definitely been an emotional journey. We continued with top ups and got into a routine of 2-3 top ups a day. I always bf every feed and offered a top up after certain feeds. Once she started solids we could have stopped all top ups bit kept one at bedtime as we wanted her to continue to take a bottle. I expressed once a day until she was 11 months when I decided I'd had enough of being attached to a pump every evening!

Our difficulty was that she was a slow feeder and would wear herself out. Top ups worked well for that and it's true that they do get more efficient when they get bigger. It's worth trying different positions as she gets bigger and seeking advice from bf counsellors if you need to. Definitely do what works for you and don't stress if that means bf with top ups. Good luck!

[Trace38]

Hi Pixie it was three weeks until she was ebf. Hope it's all going well. ☺️