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Advice and perspective please - BF son in ICU

(20 Posts)
BR44 Sat 27-Apr-13 17:24:19

DS2 arrived yesterday afternoon after an unexpected and speedy induction at 39+5. Left me a bit shell shocked.

After initial breathing difficulties he's been diagnosed with a chest infection. As I write this he is just 24 hours old but has already improved a lot. He's out of the incubator and maintaining body temp, his gas levels have normalised on their own and he looks and seems well. He's having antibiotics twice a day through a cannula. The doctor is very happy with his progress and said this morning that if he feeds well today he can be moved to the post natal ward with me tomorrow.

So, feeding. I tried to bf him last night but he just fell asleep in my arms and could not be roused. He was given aptimil through the night. This morning I expressed 4 ml of colostrum which he was given with some aptimil at 9 am. At 12 I bf him and his latch and tenacity were fantastic, but I've no idea whether he ingested much/any. He did seem to be swallowing. I tried to express at 2.30 and could get nothing at all. Not a drop. Very disappointed. At 4 he was given aptimil. I am going to try and express again shortly, and whatever I get will go towards his 7 pm feed, after which I have said I want to take him to the breast again and see what happens. Even if I have no milk yet I feel it's important for both of us physically and psychologically.

Does what I've described here sound worrying or normal? The staff here are supportive but because he's fighting an indection I think they are more concerned about knowing exactly how much he is getting than they would be otherwise. I remember with my first child feeling very unsure for the first few days about how much he was actually ingesting, but after a few days it was obvious he was taking enough.

I know chances are that if I keep healthy and keep putting him to the breast and expressing my supply will sort itself out, but I would really appreciate some advice about how best to achieve this and how to approach the situation. I bf my first son exclusively and will be heartbroken if I can't do the same for this one after this bumpy start.

Is it ok/normal to not be able to express much after 24 hrs? If I had him here with me I would be putting him to the breast almost constantly, but as this is trickier with him being in icu I feel I need to try and achieve the same result through expressing and to be honest it all feels a bit wrong and confusing.

tiktok Sat 27-Apr-13 18:01:14

Congrats on your little boy and sad that he and you have had a bit of a shock.

It is absolutely normal for any expressing to produce not much in the first days - 5 ml would be about average. The average amount of colostrum transferred with a breastfeed on day one is 5 ml at a time.

You need to ensure your technique is good - this should be hand expressing, not a pump, at this stage. Midwife should show you. Expressing should be at least every 3 hours, but if your baby is feeding well 'direct' then you don't need to express as often as this. It's not clear from your post why he is not being breastfed direct anyway - is it really just because they need to know precisely how much he is taking?

Is there any reason why he cannot be skin to skin with you ('kangaroo mothercare') so you can respond to any feeding cues he gives you?

Lets hope he can be quickly sorted out and discharged!

BR44 Sat 27-Apr-13 18:18:03

Thank you for responding. I've just expressed and reckon I got no m

BR44 Sat 27-Apr-13 18:25:28

Oops. Meant to say no more than 3-4 ml. I am going back shortly to feed him directly and am going to be pushier about feeding him myself tonight.

I've been expressing with a pump, not by hand, so I'll ask about this too.

tiktok Sat 27-Apr-13 18:51:20

Good luck for later smile Yes, push, and ask for reasons why he can't just feed direct from you - you are an experienced mother, you know what effective bf looks and feels like.

The fact you have been given a pump rather than support to express by hand (or a choice) is a hint the staff may not all be up to speed with bf, to be honest. Pumping with a pump is appropriate after the milk comes in, for mothers who will be required to do this round the clock for some time...that's not so much the case with someone expressing colostrum for a short time. With hand expressing, you get every drop going into the container (usually a dish) and none on the flange/tube of the pump. Some women get on just fine with a pump right from the start, but I would say the consensus is for colostrum to be expressed by hand. might help you.

TwitchyTail Sat 27-Apr-13 19:25:50

Not an expert (you've got Tiktok for that smile ) but just wanted to reassure you everything sounds 100% normal for a newborn having a bit of a bumpy start, like many of them do, including mine (prem/jaundiced). I couldn't express half of much as you're doing, he latched but did not swallow at all from the breast for 3 days and was given formula, and yet we established ebf by day 5 and remain so at 9 weeks. He's now a porker who feeds like a champ.

What helped us: keep putting to breast (first, so he is hungriest), hand express the colostrum into a syringe (like squeezing pus out of a zit!), skin to skin as much as possible, express 3-hourly with hospital grade double pump once milk in and give after putting to breast until he is feeding properly. Don't worry about the formula - priority is getting his physical health sorted.

You'll get there in the end, I have no doubt smile

TwitchyTail Sat 27-Apr-13 19:28:40

PS to clarify, I never got more than 1ml of colostrum, often less, and only got 10-20ml with the pump once my milk was in.

tiktok Sat 27-Apr-13 19:35:49

Glad things worked out well, Twitchy - I agree the OP's baby sounds as if he will be fine after the difficult start smile

I have seen mothers hand express into a syringe - I think it's a good alternative, as you can sorta 'catch' the drops that come out if it really is a drop-by-drop process (and it can be). I said a 'dish' but it doesn't have to be. A little cup (like the plastic ones they give pills in in hosp) is another choice. Whatever works best smile

Springforward Sat 27-Apr-13 19:36:34

I had to express for DS to get him started with BF and IIRC in the first 24 hours I would do well to get 5ml each time, he was fed with a syringe.

A friend's little girl had to stay on neonates for a couple of weeks and I think her experience was similar to yours. Once home she did mixed feeding by choice, and she did get her supply established and baby's latch was ok.

Fingers crossed all goes well for you.

BR44 Sat 27-Apr-13 20:25:00

Thank you all so much, I feel altogether more positive after reading your comments and giving the boy a feed. Regardless of how much is coming out today there is no doubt that he's a strong, instinctive feeder which gives me great optimism. I can see from his jaw that he's swallowing not just sucking - if was a good 3 days before I felt this with my first child.

I am going back down to feed him again at 10 and the next time I express I will do it by hand into a cup. Noticed earlier that there is even a poster on the pumping room wall that explicitly states that hand pumping is usually more effective in the first few days anyway. Baffling...

I too am confident that in a couple of days we will be feeding happily and he'll have no need of 'topping up' (a phrase I have come to irrationally loathe). I keep having to remind myself that he's only just over 24 hrs old and its been a challenging 24 hours at that. Twitchy tail - huge congratulations on your little boys progress! It's really heartening to hear.

Thanks again for the words of wisdom. Now my main problem is that I missed dinner (served at 5.30 for gods sake!!), the cafe is closed and I'm bloody starving!

TwitchyTail Sat 27-Apr-13 21:34:07

Thanks BR44 smile It's great that your boy is already showing such strong feeding signs, I bet he's going to do really well. And in the meantime send someone out on a supermarket run to keep your strength up, preferably Waitrose (if your hospital food is anything like mine was, you didn't miss much...)

ffscatmove Sat 27-Apr-13 21:40:55

BR44 sounds like you're doing an amazing job despite poor practical support in RL (thank heavens for MN, eh?), good on you for standing your ground. Your little boy may have had a bumpy start but you are doing your utmost to change that - you're a super mummy!
There will be a pile of takeaway menus behind the nurses / MW station, ask if you can borrow and treat yourself!

BR44 Sun 28-Apr-13 03:12:43

Thanks all! Just been down for another feed and the boy was on good form - probably the most receptive and alert i've seen him. All wide-eyed and a bit blown away by me and the world - magic. To be fair, I don't feel the staff are unsupportive of BF as such, it's more the overall attitude 'well this us just what we do wirh babies in icu' with the formula that I find odd. It would be so easy for me to just stay in bed tonight and let them get in with it and I can completely understand why exhausted, shell shocked first time mothers in this situation would just go along with it and not invest the time in establishing bf in these early days that is so helpful in the longer term.

Anyway, enough musing. Biscuit then sleep.

glorious Sun 28-Apr-13 09:11:44

br44 I just wanted to say that we had a rocky start too and some very poor advice from the hospital staff but we got through it and DD has been ebf since we left hospital (she's now 12 weeks). It is totally exhausting and so stressful so you have my sympathy. sounds like you're doing great.

tiktok Sun 28-Apr-13 09:15:22

BR, all that sounds great.

When the dust settles a bit, tell them, either in writing or verbally, what your impressions were. The hospital will have an infant feeding lead, and if they are a Baby Friendly hospital as well, they will want to know.

glorious Sun 28-Apr-13 09:37:52

Yes that's a good suggestion from tiktok. The hospital took my complaint about attitudes to and support for breastfeeding extremely seriously and I was invited to meet a number of senior staff. They have identified a number of training issues and put some new plans in place. They were actually quite grateful for the feedback as they're working towards baby friendly status. So in a few weeks when everything's easier I'd recommend thinking about it, I felt much better for having done it.

BR44 Mon 29-Apr-13 17:42:53

Update - the boy is out of icu, with me, bfeeding well, no formula, blood sugar levels good. This morning a midwife told me we were a textbook example of good bf practice. Victory!

Thank you all very much for your input. It really helped at a time I felt a bit confused and vulnerable.

glorious Mon 29-Apr-13 17:49:03

Hooray br, congratulations. Textbook, eh? Well done to you both smile

tiktok Mon 29-Apr-13 18:18:37


TwitchyTail Mon 29-Apr-13 22:01:21

Brilliant! smile All the best to both of you.

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