Please help need advice on bf'ing - having DC3 tomorrow by CS, IUGR and probably going to SCBU

[loueytb3]

A bit of history. Had DTs at 35+6, both were IUGR and DTS2 went to SCBU. We weren't expecting them to be so little and so were unprepared for DTS2 being whisked away. I was hijacked in theatre about what formula I wanted them to give DTS2 because he needed feeding asap. It took a few days of pestering to get a breast pump sorted out and then get enough milk out to provide for DTS2 in SCBU and I never produced enough to feed him on my own. He had a mixture of EBM and formula while in hospital (through a tube) and eventually took to BF'ing but we never managed to exclusively BF. DTS1 was BF'd from the start but we were advised to top up every feed with formula as he was very small too. So in the end, I was doing a combination of FF, BF and EBF which was very time consuming.

Fast forward 4 years, DC3 now going to be born tomorrow by ELCS because of IUGR. Predicted weight just over 4lbs at 36 weeks and we may well end up in SCBU again. I want to be better prepared this time round. I have ordered a breast pump which I am picking up today so I will have that from the start and not have to rely on the hospital (They have a pumping room but its on a different floor from the ward and I won't be be able go get there for a couple of days).

I know milk doesn't come in properly for a few days - should I be pumping from the word go? What do I do if SCBU want the baby to be fed immediately and I can't supply the milk - give in and let them give it FF? I am not anti-FF at all and I want the best for the baby but just feel a bit ill-informed at the moment. Would be grateful for any suggestions - I will be checking replies all day but might not get much chance to post as I've got a ton of things to sort out.

[hazeyjane]

Sorry can't write a longer post atm, but you may be able to ask for donated breast milk, I asked for ds, but wasn't able to have it, worth asking though.

I asked for hospital pump in my room (are you having private room? - I got one as matter of course because ds in scbu) and scbu sent up a photo of ds to stick on the pump. I pumped ever 3/4 hours, for 10 mins even though I had no milk for 2or3 days (lots of empty bottles!)

I got someone to wheel me up to ds as often as possible, but always got someone to check whether I was able to see him first (couldn't go into scbu during rounds). When I was well enough I got a room in scbu, and asked for a bfc to come and help establish b'feeding, as ds had no suck reflex (nipple shields helped with this)

Sorry can't post more atm. Dds just woken up!

[rosielum]

My daughter was in SCBU for first month, the hospital we were in really promoted expressing and facilitated in whatever way they could. The first couple of days you produce literally about 10drops of collosterum then 20drops then its 10mil and it just keeps increasing. The first few days I hand expressed then moved on to hospital grade expressor. In our area we have breast feeding support councellors who will come to the hospital immediatley after birth to help you, worth asking health visitor maybe?

[Tortoiseonthehalfshell]

It's also possible to express colostrum before the birth, so it's there in reserve, but I don't know whether the hospital will be willing to take it, what their storage facilities are, etc. So that might only be helpful if you have a midwife you can talk to today.

[loueytb3]

hazey - I did ask for a hospital pump last time (several times), but it took them 3 days to get it to me. Apparently they couldn't find one...I don't know about private room, I did last time round. Will probably pay for one if I don't get one. I don't remember them offering donated milk last time round, not sure if they provide that service? Will ask.

rosie - thanks you've reminded me about bf counsellors - I think I saw one last time round. I've got to go into hospital today for more monitoring so I might see if there is one around to talk to. HV system complicated as the hospital is in a different borough so my HV won't necessarily know the setup.

[FlubbaBubba]

Colostrum is better for the baby in the first couple of days anyway - it's important for baby to be suckling on you anyway.

My DC3 was in SCBU for a wee while too. As I'd been trying to get labour going, I'd been pumping in advance, and my milk came in, in full force, the day after he was born and the MW and BF counsellor (sp?) told me it was because I'd "primed" my boobs first.

My SCBU team told me they'd feed my boy formula (and he was massive, so was frequently very hungry) but I refused and demanded that they came and got me every time he needed a feed (there were no beds available in the SCBU). I also set my alarm clock every 2 hours and went through anyway to either cuddle or feed him.

Good luck. Let us know how you get on.

[tiktok]

Hope all goes well.

You dont need a pump to express colostrum - in fact hand expression can be easier and more effective at 'harvesting' these small quantities.

[Albrecht]

You can hand express colostrum and use a small needless syringe to collect the droplets from your nipples (even before the baby is born, so you have some ready to go). Your colostrum is custom designed for your new baby (more info from LLL here) and a newborn tummy is tiny so they don't need much.

The other point to pumping straight away is to stimulate your supply as if the baby was nursing, so you need to pump 8-10 times a day including in the night (more on volumes etc from Kellymom here)

Remember to ask to do skin to skin kangaroo care if poss.

And take a note of bf helpline numbers into hospital in case you have any questions.

National Breastfeeding Helpline
0300 100 0210

La Leche League Helpline
0845 120 2918

National Childbirth Trust Helpline
0300 330 0771

Good luck!

[organiccarrotcake]

If you visit www.ukamb.org you can see if there is a donor milk bank at your hospital which would be far safer to top your own milk up with if it's required than formula, given that your baby is small and early. Obviously you can only do what's possible, but, if there's donor milk available (and if there's not a milk bank in your hospital they may order it in if you insist) then it's well worth it.

Of course, your own milk is better for your LO even than donor milk (although both have a protective effect on the bowel that formula doesn't), and with the advice lines above you'll have the best chance of it working out.

Good luck and hope it all goes really well :)

[loueytb3]

Thank you everyone, this has been really helpful. I will have my phone with me in hospital so the phone numbers will come in very handy. I've checked the website organic but my hospital doesn't have a milk bank unfortunately. I will ask whether they can obtain donor milk.

flubba unfortunately I know that the postnatal ward is on a different floor from SCBU and I won't be able to move for at least 12 hours because of the spinal. That's what worries me, because I won't have much control over what is going on upstairs. I need to prime DH to make sure he knows what to do.

[loueytb3]

Update - had a little boy yesterday morning - he weighed in at 4lbs 8oz so initially escaped SCBU. We did skin to skin for ages and he attempted a few sucks but not much. Managed to hand express 1ml of colostrum into a syringe (thank you to the person that told me about that) and he had that. However it's all gone a bit pear shaped since then. Because he was small, they had to monitor blood sugar levels and it became apparent that they were too low. We were told that we had to give him formula to get them up. They did go up, but still not enough and he wasn't regulating his temperature either so they took him off to SCBU. I'm still unable to move so haven't seen him since. DH is bringing in breast pump this morning but I will try and hand express some more in the meantime. They were going to put him on 2-hourly feeds in SCBU and were talking about putting a tube down.

[TruthSweet]

louey - congratulations on your new little boy. I'm so sorry he's had to go to SCBU with out you. Would the Infant Feeding Coordinator/MW to help you with hand expressing while you wait for DH? At this age every ml is of benefit and hand expressing is the easiest way to harvest colostrum in the early days.

Again, congratulations and all the best.

[crikeybadger]

Congratulations!

Poor you, not being able to see your little boy. Must be really hard.

Agree with Truthsweet to carry on hand expressing as much as you can, those previous mls will get 'lost' in a breast pump.

Can someone take you to SCBU in a wheelchair?

[Albrecht]

Congratulations on your new baby! Sorry to hear your not able to be with him right now.

But thats great you managed to hand express some colostrum for him already. Agree with the others, every drop of colostrum you can get into him is precious (think thats what crikeybadger meant rather than previous!). Can you ask them to put a nightie or something of yours in with him so he gets your smell?

Hope you are reunited soon, get some rest while you can. (Remember your dh can do skin to skin with him too.)

[crikeybadger]

, yes that was supposed to say precious.

[loueytb3]

Argh. I'm getting RSI from all the hand expressing. Milk still hasn't come in. I've been trying today to express every 3hrs but still only getting minuscule amounts out, it feels as though I'm going backwards. Have tried massaging beforehand, using a pic of DS3 to stimulate supply and a MW has watched me to check I'm doing it right. Have sore boobs already. I've managed to bf him a couple of times today and he is attempting to suck but we can only try for 5-10 mins before his proper feed because of his blood sugar levels. I've also had a stupid battle just trying to get basic things to express into as the postnatal ward tell me to get it from SCBU and SCBU say the ward should have syringes/stoppers. Felt like telling them that they were making it 10x harder than it needed to be.

Any suggestions for trying to increase supply gratefully received!

[TruthSweet]

louey - now you are on day 3 has the Infant feeding coordinator discussed perhaps moving to an double electric pump to try to increase breast stimulation? You can still hand express before or after and then pump to increase breast stimulation which might help. Massage before hand expressing (down towards the nipple) and if you do decide to use a pump massage/compressions during pumping can help.

I'd tell the ward/SCBU that they aren't helping TBH but then I am a pain in the behind when I'm in hospital re. bfing/pumping

The usual things like drinking to thirst (not X litres a day), having a pic of baby/something with baby's smell, and a little bit lentil weavery perhaps but studies shows it works audio galactogogues might help.

[sneezecakesmum]

My DD had DGS 2.9 years ago. He was also 4.5 lbs with IUGR. unfortunately DD had a placental abruption so DGS was very very poorly needing resuscitation. The paed said to DD to express (hand or pump) and DGS was tube fed. To the best of my knowledge DGS wasnt given any formula at all and just intravenous fluids until DDs milk came in properly after a couple of days. His digestive system didnt need formula and their stance was the opposite to your hospital in that they only wanted DDs colustrum and bm. His blood sugars were also very unstable and they used a glucose solution to stabilise them. They felt his hypoxic birth could cause bowel problems, hence no formula and the colostrum was so important.

To cut a long story short DGS was sedated for 2 1/2 weeks before she could even attempt bf and amazingly he took to it after all that time and bfed merrily away, so even after a time bfeeding can still work! Express the milk anyway you can, an electric pump worked well for DD.

He thrived on breast feeding and has no bowel problems.

[crikeybadger]

Are you managing to get much skin to skin with him louey? That is supposed to really help with pumping output.

Kellymom also suggests using a double pump in addition to hand expression for extra stimulation. (even if nothing comes out)

I've added the link for the Marmet technique of hand expression as it gets lots of good reports. If you're getting sore, it could be that you're pulling the skin. This way, you roll the skin to mimic the action of the baby sucking.
you probably know this but here it is anyway.

You absolutely don't need these battles over syringes. Your priority should be rest and relaxation and the staff on these wards should be doing everything they can to make your life easier- not harder.

Fingers crossed your milk comes in soon. x

[loueytb3]

Crikey - not getting much skin to skin, will try and get more tomorrow. You're right, that should help. Will have a look at that link too, thank you.

Truth - they will let me pump from tomorrow. I've got a double electric pump here, just need stuff to sterilize the bits with after using it. They said they wouldnt suggest to anyone trying to pump before day 3.

Sneeze - its interesting that hospitals have such different approaches. We basically had no choice re formula. I hope we are as successful as you were in getting bfing going.

Managed to hand express nearly 1.5mls tonight which is the best I've managed, was quite chuffed with that! Am going to try and express during the night and then go and give DS3 a bf first thing tomorrow. Fingers crossed my milk comes in soon

[crikeybadger]

Good idea to express in the night loueytb3, and that's great that you are expressing a bit more. Must be hard work and exhausting.

How is DS3 in himself now?

[loueytb3]

Think my milk is starting to come! I managed to express during the night and first thing and got just over 20mls out! Gave DS3 a bf at 9am and then the EBM in a bottle, followed by some formula. He is doing well, onto 4-hourly feeds and theyve just switched him to aptamil from the high sugar formula. If his blood sugars stay stable before the next feed then i think they will discharge him from SCBU today. I'm going to pump in a minute and see how much I get out. Would be nice to get my supply up so that I can express enough to feed him with. He is not going to get enough from bfing at the moment, not quite got the hang of it.

[Hopalongcassidy]

I had DS at 35 weeks, and he was in SCBU too. He was given formula until my supply got going, while I pumped.

I found that, after the first couple of days of pumping both boobs every 3 hrs round the clock, my supply rocketed, it didn't take long at all. I had a rough delivery, surgery and spinal headache, so didn't see him for 4 days, til he was well enough to be brought to me.

Although it didn't seem possible in the early days, things changed incredibly quickly, ng tube came out, we were discharged fully bf at 7 days, and went on to fully bf for 18 months, no tummy probs at all Just so you know it can work out from a rough start!

Hope all works out for you both

[crikeybadger]

Yay!
Great news!
Remember, you'll need to aim for 8-10 expressing sessions in 24 hours to keep your supply going.

[midori1999]

I expressed for my DTD2 whilst she was in NICU. The first few days were SO depressing, I managed to hand express 10ml of colostrum after the girls were born, but after that it was a few mls at a time. She was very prem and only on 0.5ml every two hours, so luckily the initial 10ml lasted a long time.

I asked about donor milk and it would have been available, but the staff said not to worry too much and they got a BF counsellor for me to speak to. I also has access to a double hospital grade pump, both on the ward, on NICU and they also gave me one to use at home.

The breast feeding cousellor explained how it was important to express every 3 hours or so, which must include at least once at night, between about midnight and 6am. She suggested using the double pump and pumping on both sides simultaneously for at least 15 minutes, whether anything was coming out or not. Once my milk came in I had loads and by about day 9 I was getting about 200-250ml at each pumping session, so loads.

Keep at it, you'll get there.

[FlubbaBubba]

Excellent nesw louey - you've "primed" your boobs well :o :o