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Any advice on bfing a premature baby?

(11 Posts)
TheGrinchWearsStripes Sun 23-Sep-12 22:37:52

Sorry, this will be long!
I have been lurking on this thread for a while, reading everyone's journeys of feeding with deep admiration. It has been so inspiring to read the different stories.
I have name changed just for this, although probably who I am is solvable!
There have been some posts recently along these lines, all of which have helped me immensely, but I just thought I would see if anyone had any ideas of what I should be doing. 
My DS was born 2 months premature. I was really ill just after his birth, and did not start trying to express for several days- and when I could eventually, it was a bit hit and miss, and certainly not the recommended 8 times in 24 hours. I did finally manage to express enough to fulfil DS's needs (given through a nasal feeding tube), but I never achieved full lactation. Still, I was determined to bf, so I persevered. When DS was 34 weeks old, I was finally "allowed" to try bfing him. His breathe/suck/swallow coordination was nonexistent, and he fell asleep at the breast more often than not - even the NNU staff could not rouse him. I was told that he was still young, and to give it time and patience. Then, three days later, I was suddenly told that I should room in from the next day so as to establish demand feeding ready for discharge. Slightly shell shocked, I did so. It was a disaster. DS cried with frustration and hunger for most of the night, and after one particularly traumatise 2 1/2 hour session I demanded a top up. As he had pulled out his feeding tube for the umpteenth time, I was told that the only way to do this was by bottle. I fed by breast and bottle for the next 24 hours. He put on weight and so was discharged. The discharge sheet said that demand bfing had been successfully established. 
At home we continued this feeding pattern. We try a bf, although he does not seem to take much, despite being watched by at least 20 different people in the hospital, plus a lactation consultant here at home. I then give a bottle top up and then pump. I eventually tried exclusive bfing, but he put on so little weight that the HV suggested a bottle of formula every night. Unfortunately this tipped my supply, already on a knife-edge, into crisis. This was two weeks ago and I have struggled ever since with both getting DS to bf, and with my supply. I am currently on domperidone (thank you monkeypuzzletree for the recommendation) which is helping greatly, although i'm still nowhere near enough. I also pump regularly, drink loads, and take fenugreek. DS bfs 2-3 times a day, although rarely seems to take enough to be satisfied without a top up. This is now either breast milk or formula.
So I have two questions. First, am I missing something obvious I should be doing? And second, how do I time pumping, when I feel I should be trying him at the breast as well, plus having to bottle feed? It is also made even more complicated by the fact that he hates to be put down, so often cries while I pump.
I am really quite angry at the amount of bad/conflicting advice I have been given right from the beginning (haven't even scratched the surface here!). Any thoughts or ideas would be welcomed with gratitude.

beancurd Sun 23-Sep-12 22:56:21

Sorry you have been so very let down by those who should have supported your early days bf.

I think you really need face to face support. In the immediate check your domperidone dose is at the max, check your pump is hospital grade and a double pump, pump every three hours where poss and cluster pump if you get a window of opportunity. Prioritise pumping over sterilising even as you are better having your pump hanging around so you can do more sessions than you are waiting to sterilise it to do it properly. When you get a latch if you do breast compressions you may help more milk transfer, if latching is happening switch nursing would help up milk intake. I imagine you know all this though...

It is amazing that you have provided so much bm despite your tough start.

MiniPopsMum2012 Mon 24-Sep-12 00:59:38

Oh goodness, I could have almost written most of your post (unfortunately), you are doing an amazing thing at such a hard and traumatic time. My little one was born 10 weeks early and thee

AnxiousElephant Mon 24-Sep-12 01:10:28

I would try to exclusively breastfeed and pump after every other feed to increase supply/ top. I would try to avoid formula if possible because this puts a baby off the breast because it takes longer to digest. A tiny breastfed baby will want to feed very often, at least 10 times a day and probably much more at first. You definately need to try to breastfeed every feed if you can, which will help. No longer than 2 hourly between feeds. Lots of naked skin to skin time - baby moon, i.e. rest and feed and nothing else for a few days if possible. Do you have support on a practical level or other children to care for?

MiniPopsMum2012 Mon 24-Sep-12 01:15:25

(sorry, on my bloody crap phone) and the whole breastfeeding thing was a complete traumatic fiasco.

Have you tried contacting the bliss helpline? They might be able to offer some advice.

I used to offer breast first, then bottle of expressed milk. After Minipop was fed & asleep that's when I would express for the he next feed.
This does mean you're in a horrible cycle of just feeding & expressing and sterilising and not much else, including sleep. Which can be sole destroying. I managed this for 14 weeks before my supply disappeared and I had to fully formula feed.

My supply was rubbish, I never really got any proper milk supply no matter what I did. I had three courses of domperidon, was on fenugreek, expressed 8 tines a day etc... But I had to face facts I just didn't make milk. My boobs never really increased in size or hurt during pregnancy etc....

And that combined with Minipop's lack of interest at breastfeeding and inability to make the right face (I also think nicu nurses decision to bottle feed him at 32 weeks didn't help) meant breastfeeding just wasn't going to happen for us.

That doesn't mean it won't for you though, you just need to right support.

I disagree with curd (sorry), but bring the mum of a premmie sterilising is very important IMHO. Get a Milton cold water steriliser & keep it all in there.

Wishing you the best of luck, what you are going through is so so so tough, but you are amazing for what you're doing,and it sounds like you are doing all the right things - & it does get better.

Minipop is now 7 weeks corrected and a right little pudding, he laughs, smiles and is getting really good at lifting his head up - 17 weeks ago I never, in a million years - - thought I'd got to this stage.

Good luck xxx

MiniPopsMum2012 Mon 24-Sep-12 01:18:27

And do not feel guilty/bad if you have to use formula. It is not the end of the world, despite what you may be made to feel like. The most important thing is getting your little one bigger and stronger. If you can do that with breast milk fantastic, if you can't and need formula too then so be it. Xx

AnxiousElephant Mon 24-Sep-12 01:25:58

Mini pops I do completely agree that it is individual choice whether people choose to breast or formula feed, but you do need to decide which will suit you both better i.e. not just baby. If you want to breastfeed then using formula will lead to less and less bm produced as baby will feed less. That said, plenty of bright, happy and healthy children have been raised on formula.
What do you mean 'made to feel like?' MiniPops. hmm
I for one am certainly not in the habit of making mums feel bad for not breastfeeding, infact in some cases I will ask if the mum wants to continue or change if I can see mum is exhausted and unhappy breastfeeding shock

TheGrinchWearsStripes Mon 24-Sep-12 01:42:45

Thank you all so much for the replies! 
beancurd the sterilising isn't too bad, two pump attachments and an Avent steriliser do make the job quick. 
anxiouselephant no other children and a wonderfully supportive DH, although he does have to work of course... I have been a little brief on the skin to skin of late so will try upping that again.
minipop so sorry to hear you had all this too. I did see you on another thread mentioning the reflux, which also struck a chord with me. How amazing that you got to 14 weeks with so much going on - you are an inspiration! Lovely that minipop is doing so well now. I must say that's love watching the new things DS can do every day.  I look forward to the first laugh!

beancurd Mon 24-Sep-12 10:07:06

Sorry mini I wasn't clear...I meant IF sterilising is getting in the way of pumping (it does sometimes) then pump and dump in preference to using every drop. Supply being the bigger issue for the op. Great that it isn't a barrier for you op.

Can you go back to the ibclc or a baby cafe of similar?

TheGrinchWearsStripes Mon 24-Sep-12 11:48:52

Oh that's interesting, beancurd - I hadn't really taken on board the pump and dump as an option that's better than not pumping at all. That helps with trying to figure ou t what should be the priority to do, thank you.

AnxiousElephant Mon 24-Sep-12 22:24:08

If you hand express then a clean bowl is all that is required smile Your lactation advisor of maybe HV if they have been trained with bf advice can show you how if you don't know already.

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