Breastfeeding premature baby, help please!!

[featherbag]

Hi all, really hope someone can advise and/or reassure me. I'm writing this in the mother and baby room in the neonatal unit where my ds has been since his birth on 2nd October at 32 weeks, weighing 5lbs 3ozs. I've worked really hard with expressing, and despite a rocky start he's been tube-fed breast milk just about every feed. A week ago I started bf him once a day, then went to twice, yesterday I did 3 consecutive feeds and today I'm doing 4. The plan is to room in tomorrow night and Sunday night, then take him home on Monday if his weight's gone up. He dropped 7ozs in the week after birth, and has only just regained and passed his birth weight today.

The problem - when I'm bf him, he never seems to latch on for long. He'll have 5 or 6 good sucks, then fuss for a bit, then another couple of sucks, then half-hearted sucking/licking for a minute or 2, then seems windy and uncomfortable. So I wind him, then start again. This morning he fed for over an hour, but I would say only about 15 minutes of that was feeding, the rest was fussing/winding.

I'm terrified that after rooming in for 2 nights his weight will have dropped and they won't let me take him home. I'm struggling a bit if I'm honest, it's getting harder to stay positive and not just sit and weep when I'm not at the hospital. I'm convinced he can't possibly be getting enough food from bf, and that it's the tube-delivered breast milk that's been increasing his weight. If anyone has any words of wisdom I'd be forever grateful.

[tiktok]

Dashing, and I hope someone else will post, too, but check out these sites:

www.skin.kangaroomothercare.com/index.htm

www.bliss.org.uk/

[snowchick1977]

Im not sure if this will help as my dd was born at 36 weeks, she wasnt in special care but did drop to 5lb 12.

She had trouble latching on at first as she was so sleepy. I was determined to breastfeed and had to pump milk and feed her with a syringe, which the midwives did for me a few times.

I was stressed and they advised to feed her a bit of formula to try and get her to feed.....at that point i just did what was best for her, which was to feed her.

It turned oyt that she took only an ounce and then I carried on feeding her, and she was ebf for 10 weeks with no issues.

Just do what is right for your baby, and for you, to cause you minimal upset and stress.

Hugs xxxxxx

[Yorky]

I can't offer much advice as I have no preemie experience, but I wanted to say how well you've done so far. I know expressing isn't my idea of fun and I think you've done brilliantly from what must have been a pretty scary start.
Don't forget his tummy is only tiny so little and often is the way forwards and you'll get used to each other

[KD0706]

Hi featherbag I think it sounds like you and your DS are doing fabulously.

My experience is different in that I took my DD home on bottles of expressed and worked on BFing at home. But we got to ebf and she still has a bedtime feed now at almost 18mo so it is possible. My DD was born at 31+1, she was smaller than your DS at 3lb3. But she was the equivalent of 37-38 weeks gestation before she even latched on. So I think it sounds like you and DS are doing wonderfully that he can feed from you already.

Although older than your DS when she started feeding, I wonder if it might give you comfort that when she did feed from me (and she was probably a similar size/weight to what your DS is now), she always took what seemed like such a tiny short feed, and only ever from one side per feed.
How much are his tube feeds in volume? I think at that weight DD took 50-60 ml every four hours. In our case I think my boobs were so used to just emptying themselves into a pump, and she needed such a small amount for her teeny tummy, that she just needed the short feed.

I hope that gives you some comfort. I know you want your DS home ASAP, of course all mums want that. But honestly if the rooming in doesn't go well at first, the hospital will work with you and I bet within a few days you'll be back on track. The hospital want DS out of there ASAP too.

As I type I've remembered a baby who was on NNU with DD. she went in to room in with mum and in the first couple of days lost weight and struggled to maintain her body temperature out of the heated cot. Her mum was really upset in the second day of weight loss. But literally 2-3 days after that they went home, having cracked the BFing.

You will get there. You are doing so well, much much better than I was at the same stage.

[slalomsuki]

Congratulations to you both for getting this far with breast feeding.

I thought I would share my experiences with you. I have had 2 prem babies, the last one at 32 weeks.

My experience is that the strong sucking reflex doesn't kick in until around the 35/36 week. Ds2 took 3 weeks to really feed and prior to that we had feeding sessions like you describe of trying for an hour with only a few real sucks. It's very hard work for a prem babies to suck and so they will then look like they are sleepy but still latched on. This is normal and don't panic the sucking will increase and the feeds get shorter over the next few weeks. They have very small tummies and a slower digestion system compared to full term babies so work on the principle it's little and very often.

They also need to be kept well wrapped up when in the overnight room away from the heated environment of SCBU. I had endless caps, bonnets and socks to help the body temp and keep the weight on.

Good luck I know how anxious you can get bur it does get better.

[featherbag]

Thanks for sharing your experiences, it does make me feel better to know others got there in the end! I've been rooming in since 3pm, and will be here til Monday morning when we'll hopefully go home. He had quite a long feed at 3, then a very short one at 7 and is currently asleep. Keep your fingers crossed for us, and all tales of your NNU/bf experiences are gratefully received!!!

[Firestone]

Hi Feathers, I had DD at 34 weeks and she was 4lb12, we managed to establish bf and like snowchick was advised to express and top up with a syringe after each feed until about week six when the HV said she was fine and not to bother. DD used to feed for about 5-10 minutes a feed, despite this she did (after a bumpy start) put weight on steadily. Good luck, it sounds like you are doing wonderfully

[CreepyCaesar]

Sympathies OP. DS was born at 35 weeks weighing 5lb 7oz but went down to 5lb, he didn't even latch for 7 days and that was with a nipple shield. So he was only pippette/cup fed for a week, I remember thinking how little it seemed to be but they have such tiny tummies. Took about 6 weeks of faffing with shields before I got rid of them and was able to feed him with no trouble.I fed him for 6 months and he is now 3 yo and enormous!!

Have you asked at the hospital if your latch is ok etc?? The midwives were amazing with me and I def would not have persevered if they had not been so supportive.

You are doing a brilliant thing for him and don't lose heart. I remember saying to my midwife in tears after weighing him that if he went below 5lb then I was formula feeding him. She was really encouraging and at the next weigh in he had gained loads.

Well done for all you've done so far and keep positive if you can

BTW I had DD in Dec last year, she was 3 days late and weighing 9lb 4oz with a suck that could pull your boob off!!!!! I found it all a bit odd, she was massive!

Lots of love x x

[Mampig]

Hi featherbag and congrats on new baby!! I think you are fabulous!! I just noted that you said fed at 3 then 7. Could you increase frequency to at least 2 hourly even if baby doesn't seem hungry? It will really help with your supply and also works on the little but often principle which would be how newborns normally feed? IMO you should feed as much as you can especially in this tense time where weight is so important for your release from hospital.

[MadameJ]

Hi, my DD was born at 34 weeks and needed a NGT fitted and I was also expressing so she could have that. I think like others have said their suck reflex isn't great and I think it's quite tiring for them (as they should still be tucked up nicely inside you!!).

I wasn't allowed much skin to skin with DD initially as she had severe jaundice and had to be left under the lights as much as possible but as soon as I could, I literally spend every second with DD either in bed or in a sling, this meant I could ofer the breast every time DD murmured and it really worked. Within 5 days of being home we were exclusively breastfeeding and didn't need to top up with her tube and it was removed. You will receive loads of advice (some good, some bad) but try to find what works best for you and your LO. Good luck x

[featherbag]

Thanks for the encouragement everyone, he fed more or less constantly from 8-10pm, he's been asleep since but grizzles a bit every now and then so don't think it's going to be long before he's awake again. I had wondered about topping him up with ebm via bottle, but the NNU nurses don't seem keen. When he wakes next I'll buzz for the nurse and ask her to check the latch. Got a feeling it's going to be a long night...

[byanothername]

featherbag, huge congratulations. You are doing BRILLIANTLY

I'm rushing this off as am on the go, but I couldn't not post. I have been EXACTLY where you are now, with a 32-weeker. It was very difficult and I remember this stage so well. I felt tearful, desperate and aching to get my baby out of hospital, but faced the same difficulties you do. I was in another country and they weren't very helpful or supportive. And at one stage I remember even wanting to literally bang my head against the wall of the hospital corridor with frustration.

I think by reading your post you're nearly there, you're nearly nearly over the hill. Persevere, be patient. Each day your baby grows is a little step of the way towards it being easier. You have managed amazingly so far, and I promise you, promise you, promise you, you will do it! You'll get home and you'll be flying! Those links given to bliss etc will give you support.

When we eventually got home (after seven weeks! abroad, and different rules!) I fed fine, but in the end it turned out my dd still needed a bit of help for other reasons so I bf her with a medela supplementer (full of expressed milk) round my neck at the same time. I'm sure you won't need that step yourself, but all this just to say that my dd was bf with this supplementer for 4 months in the end, after which she fed amazingly and is still at it aged 2!

At this stage, you think it will never be possible to get home and feed, it will. I felt like I was in a black hole. But when you come out the other side - eventually! - you'll have a great, great sense of pride.

Sorry so garbled but please PM me any time of day or night if you need some support

[featherbag]

Well, very nearly gave up, he didn't pass urine or open his bowels from 3am til 11am, the nurse weighed him and he's lost 62g since Friday, taking him back to 5lbs 2.5ozs. He rarely cries, I've had to wake him a couple of times when he's slept 4 hours without waking for a feed (as instructed by the staff). When he does feed, it's very half-hearted and not for very long, but my boobs are so full now he probably only has to open his mouth and swallow, hardly any sucking required! Had bee getting up to 140ml from 20 mins expressing though, and doing that 6-8 times a day, so will take supply a while to dip back down now I'm banned from expressing.

The staff have checked his sodium levels and all his bloods are fine, so I've agreed to persevere with bf but if he's still not making much effort or feeding for very long by tonight I've said I want to top him up after a feed with expressed milk via a bottle. They've said whatever I decide is fine, but I am going to try my best to ebf, even if we have to continue working on it at home.

Thanks for all the support, it's really helping me not to go insane trapped in this tiny stiflingly hot room!

[KD0706]

Omg they've banned you from expressing?? I'd be really worried about mastitis or at the least blocked ducts. Make sure you're vigilant just in case as the last thing you need is you getting ill.
When I started BFing DD I was still expressing the second breast after she'd fed from the first. But I had nobody to advise me what to do, I just made up my own rules.

I know it seems so disheartening that your DS has lost a bit of weight, 62g isn't actually that much you know. If the worst case scenario is that you have to top up a bit with bottles that's honestly not the end of the world

But I have my fingers crossed for you and I'm looking forward to hearing how well your ds is getting on with feeding.

As many other posters have said, you are doing so so well already.

[hildathebuilder]

oh, I feel for you. My ds was a 29 weeker, and we also got there in the end, but he also had a phase of losing weight just before we left (he went to 1900 grams not sure what that is in pounds nearly 5 maybe? He was nearly put onto nutriprem but not in the end, but as well as all the other points it is sometimes the case that prem babies need higher calorie requirements than just bf especially if they are using energy feeding, which your ds is now doing.

i would be very wary about not expressing at all, but yes supply may take a dip but it evens itself out over time. i actaully carried on expressing a little for months after ds came home as he was always happy to take a bottle. In my experience also don't be afraid of giving bottles to get your ds home. it is easier once you are at home, and it will still take a bit of time to get the balance right. And if you give the occasional bottle of ebm its still the same milk, and later you may be very glad your ds will take it, I know I was

in my case ds woke up at about term but even then still fed a bit on off on off for several months, that was normal for him. until about 40 weeks though his feeding was very erratic and I look back and realise just how much he slept during that time.

Finally when i was at your stage bf was the be all and end all and i worked myself up into a right state about it. DS managed, but it really wasn't worth the stress I caused myself. I am glad i perservered, but unless you have had a prem baby no-one really knows how hard it can be to keep on. I went to la leche and nct but they were uselss with prems, and i think we all have to find our own way, but that can include giving yourself a break, and perhaps ds a bottle. Good luck

[featherbag]

Plan B - we're going to try a nipple shield at the next feed. Anyone had any experience with these?

[Needsomewine]

Hi, not read the whole thread but just wanted to say nipple shields are great! I have used them with both my dc with no effect on supply etc. The medela ones are the best I think.

I have recently had to give up bf my 2 weeks early born dd as she was feeding ok but very sleepy and like you say, an hours feed was only 15 minutes of sucking/swallowing. She did gain weight but only in small amounts. I bf my dd1 successfully though so have learnt that not all babies are the same! I think you will get there in the end but your ds may need topping up for a while. This will help him get bigger and in turn have more energy to feed. I would definitely continue to express if I were you. NOT expressing with dd2 and her only taking minimal amounts of milk have dwindled down a preiously good supply. I am still expressing now for dd2 but am convinced if I'd started expressing earlier I wouldnt have to use any formula. So in a nutshell keep doing what you're doing but if you feel ds hasn't fed well, express so that you keep stimulating your supply for him. Good luck :)

[verylittlecarrot]

Please PLEASE get advice from a trained bf counsellor before using nipple shields. They work for some but can stuff up breastfeeding for others. Do speak to a real expert, please!

[crikeybadger]

Agree vlc that they need to be used with caution, but I'm sure that I've read somewhere that sometimes they are recommended for prems because they don't have enough fat pads in their cheeks to enable them to suck effectively, so the nipple shields can help.

I wonder if the Bliss helpline would be a good place to get some support featherbag?

Anyway, hope you are managing to stay positive, fingers crossed things work out for you.

[crikeybadger]

btw- what was the reasoning behind not letting you express?

[featherbag]

Thanks for the replies - I've been told not to express as long-term it'll make the engorgement worse as it'll encourage oversupply.

I've heard people say they'd had problems with bf after using nipple shields, but tbh at the minute there's nothing to stuff up, if he drops below 5lbs I'll have to seriously think about bottles anyway. Apparently they're more beneficial for prem babies as it means they don't have to work as hard. Hopefully he'll take to them and start putting on weight, which needs to happen even if just to keep me sane!

[makingmama]

I'll be back later, but just wanted to say a massive well done! You're doing brilliantly I know from experience how stressful and hard it is, I had ds1 at 34 wks, he was 3lb6 born. We managed to exbf for 6m, then bf until he was 17m.

[KD0706]

We tried nipple shields but the ones we had were mahoosive compared to DD who at that point was less than 4lb and she just couldn't get her mouth around them.

I didn't know there was a bliss advice line, but it might be an idea to give them a call. From anecdotal experience of friends I think nipple shields can cause blocked ducts as the baby isn't emptying the breast sufficiently. And that coupled with the sudden stop in expressing makes me concerned for your poor boobs

Oh, DD kicking off. Back later

[featherbag]

Nipple shields are magic! He's just fed for a solid 25 minutes, to the point of actually making himself sick, and my boobs feel SO much better! The relief is indescribable!

[KD0706]

Ok, sorry. Just wanted to add that I got all sorts of conflicting advice from the NNU staff re BFing DD. I think they were fabulous nurses and of course am eternally grateful for what they did for DD. but BFing was clearly not their strong point.
So if you can get some specialist advice I'd think it's well worth it.

With regard to bottles, not sure if you've given any thought to what you might use if you were giving top ups. But at our hospital even the slow flow ones they provided were really almost free flow in that drops of milk dripped into DDs mouth even without her making much effort. And the teat was quite rigid so could be pushed into her mouth, again without her making much effort.

So at home I put her onto tommee tippee closer to nature bottles which required her to open her mouth wide to get it in her mouth, and she actually had to make an effort to get the milk. I really think this worked for her as a good transition to BFing and I think meant she didn't get a bottle preference, whereas she might have done if I'd left her on the easy flow hospital bottles.

I'm not sure how much help this is, as you're so much further ahead than I was when DD was a few weeks old.