tiktok, bfing gurus, bfers, interested parties of all creed and colour... heyulp! bfing a preemie baby... top tips please

[Aitch]

don't know where to start, really...

dd is two weeks old today (blimey) and put on her birthweight on wednesday so that's great. however of course she didn't start putting on weight until her formula top-ups, topping up with ebm didn't do the trick.

her weight gain today was only 30g (last few times has been double that or more) and i do put that down to the fact that i've been pumping more and therefore have been giving her more ebm top-ups than formula.

question is... what's the tipping point? she is gaining, i am producing more milk (not heaps, but volume-wise we are on target for the SCBU calculations). we were told to give dd 280mls per day in top-ups as well as bf, but with the formula it's been more like 350ml.

so do i accept the 'slow' weight gain and think of dd's longer-term benefits having protected my supply, or do i want her on formula but with more energy to feed, iyswim?

midwife has suggested one top-up of formula, and at the next topping-up with ebm, this seems like a reasonable compromise to me, but am i missing something.

[ourdoula]

First of all, well done, I know from experience that BF a premature baby is hard. But give her time, and your body, remember that the more she feeds, the more milk you will produce and your body will provide the exact content your baby needs even without the formula. Formula milk actually contains less calories that Breast milk but it just digests less easily so even though she may be full for longer, her body does have to work harder to digest it. Maybe you could speak to a lactation consultant or even a BF councillor as they really know what theyre talking about, and however knowledgable a midwife is about babies, she is not an expert in breastfeeding. Try www.nctpregnancyandbabycare.com (NCT) or www.abm.me.uk (association for Breastfeeding Mothers) or maybe la leche league, sorry I dont know the email address for that. Good Luck, and dont panic youre doing a great job!

[Aitch]

cheers, is that right about the bm being less calorific than formula? thing is, the baby is tiring imo before she's getting to the point that the fattier milk is coming through. (not that my milk seems to be that fatty anyway, it never seems to separate in the fridge other than with a little creamy slick on the top).

how did you give up formula top-ups with your situation, if you don't mind me asking?

[Bumperlicious]

Aitch, so glad you are out of hospital and both safe.

Am wary of advising wrt to feeding a preemie, but one thing to say is I wouldn't pay too much heed to how your milk separates, I'm sure it isn't proportionally meant to be that much anyway.

When you say "i am producing more milk (not heaps, but volume-wise we are on target for the SCBU calculations)" how are they working this out? What you express is not an indicator of how much milk you are producing.

How regularly are you feeding. If you think she is tiring before getting to the fattier milk I would suggest feeding more often. The shorter space between feeds the less chance your milk has to separate between feeds (in v rudimentary terms!).

I guess the most important thing is to get her fattened up and more energised. Building up your milk supply with a view to trying to get to exclusive bfing can come later when she is stronger.

Sorry if that isn't much help, but I just wanted to give you some kind of answer.

[bronze]

The other option is for the odd feed to express immediately first so she gets some hind milk.
I found that I had to do this with dd as otherwise she seemed to spend most feeds only getting the fore milk.
You're doing well though as shes putting weight on.

[Aitch]

of course it helps, you dolt.

funnily enough i've kinda been doing that anyway, re the spacing out less, but then after doing that she's put on 'less' weight so now i don't know... and of course i'm sitting with the pump on a lot, becuase i was figuring that if dd sucks after i've got all my 'foremilk' out then maybe she's getting the fattier stuff but that might not be right.

the scbu calculates a ml requirement daily based on their weight, and because we're bfing (with a limit of 15 mins) they want her to have 7x40ml top-ups as well, in whatever form.

[Aitch]

ah but bronze, i think she's only putting on weight cos of the formula, though...

[lulumama]

aitch, you have mail. not related to Bf though!
i think ml for ml, breast milk has the edge on formula. i would get specific advice from one of the four helplines... your hospital might well have someone on site who is an infant feeding co-ordinator or some such,

topping up can be a mixed blessing as you know, and i don;t know wnoeugh about preemies to say really

[Bumperlicious]

Why with a limit of 15 minutes?

[ourdoula]

Its up to you with the top ups, you could gradually decrease the amount and increase how often you offer the breast or you could just offer the breast every 2 hours or so and stop the formula completely. Good idea with the expressing first so she can get to the hind milk before she tires, but if shes got plenty of wet nappies etc then im sure shes doing fine. The support and info you can get from a Lactation consultant will be invaluable though they will really be able to help. And also the amount you can express has nothing to do with how much your baby will get as her way of getting it is much more efficient than an expressing machine!!

[Aitch]

she has prodigious amounts of poo and pee, so no worries on that front. [costing a fortune in nappies]

the 15 mins thing is that apparently it's been Proven with Proper Research that babies tend to get what they're gonna get in that time, and with dd being prem there is a point at which she's exhausting herself to get calories which isn't practical. don't all jump down my throat... it's what i had to sign to before they'd let me out.

[tiktok]

Aitch - not my specialist area (feeding prems) and you need someone with a lot of specialist knowledge and experience....it is a matter of careful individual judgement to decide how much formula a baby needs in order to have the energy to breastfeed well, and also how far you can 'accept' a slow weight gain. The main thing is always to protect the milk supply, whatever is happening hour by hour, day by day, in terms of calories going in and weights. And you are doing that.

Formula and breast are more or less the same calorie-wise, but it's a hard thing to judge, because breastmilk's fat content is dynamic - it changes, as you know, with the amount of milk in the breast. Less milk = fattier milk. However, volume is the crucial thing - a low milk supply does not mean 'oh well, there's not much of it, but it's creamier'. Get a good volume going, and we really don't need to worry about the precise calorie value.

Babies do use up more calories digesting formula, which is why as (non prem) babies grow, they take larger volumes of formula (generally speaking) but do not appear to do this when breastfed (generally speaking) after the first weeks, anyway.

But none of this really translates to prem-care in the SCBU - they like to see the mls going in.

You can boost the calorie content of formula and of ebm with human milk fortifier, which is (despite its name) a cows milk formula. It makes whatever milk the baby is having more calorie dense, which can be a good thing for teeny weeny babies whose tums can't take large volumes. You can also do a bit of lacto-engineering (bronze's idea of expressing immed after a feed).

But if you are protecting your milk supply, then that is, IMO, the main thing. Then it will be there when dd needs it, when she is stronger and bigger

[Bumperlicious]

Have you looked at the kellymom pages on bfing a preemie?

It sounds like you are doing the right things, lots of feeding, lots of pumping to maintain supply.

I think that lulu is right, oz for oz bm has higher fat content, so if feeding properly DD should put on more weight with BM than FF. So I guess the crux is why is she getting more FF than BM? E.g. too sleepy, poor latch. Figuring out that will make it easier to figure out how to improve things.

[Aitch]

she's not that un-strong, though, tikkers. in fact i'd go so far as to say she's quite feisty. you know she was only in scbu for one night, don't you? she's at home with me now, in her silly hammock. (which i'm soooo glad i have, apart from when dd swings in it.)

[tiktok]

The 15-min thing sounds arbitrary to me. The point is not to tire the baby out - fair enough, and very sensible. But this is best judged (surely) by watching the baby...sometimes, 15 mins might be too much, and at other times, 20 mins might be fine. Does this make sense? If the baby is really not feeding effectively or much, and looks like she will zonk out in the next minute and not manage to get the formula/ebm down her...then that's when you stop, yes?

But test these ideas out on someone who is there with you and more expert than me on prems.

[whomovedmychocolate]

Personally I would try and reduce the top ups and offer her the breast as often as possible - sadly this means you do have to feed round the clock but within three days your supply should get there entirely.

BTW your milk has as much fat in as she needs. I think my milk is unusual in being about 50% cream on separation - what can I say, I eat a lot of fat!

You can try expressing twice on the same breast and feeding from the same breast twice too - that will mean that the boob will get emptied properly and fill up entirely and there will still be milk left in the expressing boob which will be creamier the next time you offer it (IYSWIM).

But honestly if she's growing, you are doing the right things already.

If you get really desperate, I'll wizz you a pint of mine in the post and you can feed it to her - that'll fatten her up

[tiktok]

Oh, one night???!! Gosh - she must be strong! In that case, the 15 min thing is surely a rough guide, and no more?

[Bumperlicious]

Interesting about the 15 mins thing. In normal circumatances the advice would be to feed for as long she wants, but they must have their reasons I guess.

Like tiktok says, preserving milk supply is key, for later when she is stronger.

What are you doing with all the milk that you express?

[lulumama]

aitch, please check your inbox when you have two seconds! i think i sent the email to the right address

[Aitch]

yes, that's kind of what i've been doing as well, tt. if she's feeding strongly then i'm not unlatching her to a timer. i'm going to give her a feed just now, actually.

re the prems. ime so far the paeds have been teh absolute WORST at supporting bfing, and are much more concerned about her putting weight on at all costs.

[Aitch]

lulu, sorry, i got your email and then completely forgot to reply... [twit]

[tiktok]

Bump - there is a trade off with prems, though. They are so sleepy and easily tired - we don't need to worry about 7 pound bruisers, who can feed as long as they want and if they get tired they can just sleep a bit longer. The prem baby can get too tired to feed well, and it's a balancing act.

[lulumama]

s'alright, had sudden panic it had gone to a totally different random person !
i think you might be a bit busy to answer email immediately.

[Aitch]

lol whomoved, i'd gladly accept! [not repulsed]

[bronze]

Can I be really naughty and say ignore what they said in scbu and do what feels right for you.
I had to fight to get them to allow me to take dd home as they weren't convinced me solely breastfeeding wasn't enough for her. I was going to discharge against advice so evetually they agreed on the condition my HV agreed. She did (shes a goodun)
I carried on doing what felt right and dd went from strength to strength being discharged recently having reached the required milestones with ease.

As someone said they (scbu)like to see the mls going in and if they can't they think you're starving the child.

[SparklyGothKat]

How are you topping up? NGT tube or bottle?