Help me breastfeed my preemie out of NICU

[Angharad78]

DC was born last week at 34+5. Whisked straight off to NICU where they’ve been receiving excellent care. No major problems beyond prematurity. Breathing unassisted since day 3, a few other interventions but nothing major. Now, baby is still v small and has a nasal feeding tube. When they get the hang of feeding from the breast, they can go home. I’ve moved to an adjacent room to help this process with the nurses coming to get me every time they wake to feed. They’ll continue to get tube fed until they are sustaining feeds.

So MN, help a mother out. How did you get your sleepy preemies to focus on the boob for long enough to satisfy the consultant and get home? And hints, tips and encouragement grateful received.

(I’ve tried singing Mariah Carey to them but that’s just pissing off the parents in the next bay)

Congratulations! I had ds at 35 weeks. He wasn't tube fed but had jaundice and slept under a light.. Lots of skin to skin. Remove some layers to wake your dc.!

I had to use a nipple shield with my preemie as he had trouble sucking and sang lots of inane songs while tickling his feet and cheek! Good luck it's hard work! Congratulations on your new baby!

It was horrible but I had to use a spray bottle of water and spray my preemie twins when they fell asleep to wake them up :/ also stripping them down so they're a bit cooler.

Another less horrid tip is to feed them in somewhere dark (hard in NICU but you can cover them with a Muslin) and this makes them have to open their eyes and can help them be alert.

And yes to nipple shields! Life saver!

Congratulations! I've no experience of preemie babies but just wanted to wish you well and say breast shields helped me as my baby struggled to latch onto nipple and it was v sore. Continued for a year so it worked. Mariah will help, of course. Good luck

Just wanted to say it's great that your hospital is supporting you to breastfeed. In my area they gave all preemies bottles and encouraged you to pump which makes it so difficult to transfer them to the breast when they get home. Take advice from the hospital and ask to see the feedimg specialist if you are struggling. From what I've heard hospital's only do preemie breastfeeding I'd they've got good feeding support available.

Has anybody talked to you about breast compressions? Dr Jack Newman video on YouTube explains it well. Essentially a breast compression helps milk flow to baby and milk flow is the absolute best way of keeping a sleepy baby awake and feeding actively at the breast.

Congratulations, you are doing brilliantly.

I had twins at 34 weeks

The trick is to build it up gradually and accept you aren't going to be out of there tomorrow or even next week

They may not even be showing cues for suckling yet

Ask the hospital if they have a breastfeeding consultant / there was a really good chart she showed me about how to build up time. Don't put pressure on yourself to force it if they are just too sleepy at this stage

Just try every feed - if they don't look like they are interested then tube feed them and try again next time

They will want to record how long you feed for - at my hospital you had to have all feeds being a certain score and had to be fully off nasal tubes before allowed home - stronger twin was reliably fully on breast within 10 days or so - smaller twin who was a lot weaker and sleepier took 2 weeks

Hmm I expressed and gave that in a bottle until I got home. I still put him directly on the breast every chance I got which made the expressing easier. The bottle reassured the nurses because they could see how much he was getting.
He always breastfed like a champ despite being a tiny little thing with a big boobed mum.
Maybe we were just lucky though.

Be prepared they'll likely discharge you before your baby - I was home after 2 nights and had to spend 3 weeks travelling to visit my babies

If you plan to breastfeed- DO NOT INTRODUCE A BOTTLE OR A DUMMY!!

Please do not. Also no topping up with formula.

I am a breastfeeding consultant; I also have breastfed my 34 weeker form NICU until now (she is a boob monster and 18 months old)

So, while in NICU I spent all day, everyday there. Once she was strong enough, we put her to breast when it was time for a feed. Even for her to lick etc.

At the beginning, they'd top up with milk via tube. But shortly after, when she was feeding, they stopped this and started to test her blood sugar levels.

We were in NICU for two weeks. We may have been out earlier if I went straight to bottle but I was determined!! I used nipple shields which I WISH I never did... they took 5-6 months to wean her off these. They are a nightmare when out and about- trust me!! Xx

And yes, I was discharged and sent home but I was there 8am-9/10pm roughly! They cup fed over night for me xx

Unfortunately same experience here, I was discharged and baby was on expressed via tube and bottle and then put to breast while I was there normally between 7am and 9pm managed to leave after 2 weeks but breastfeeding just didn't work he was too used to the bottles and by then I just wanted him home and if that meant bottles I didn't care

Just plead to stay (they let me stay in a flat only when it wasn't needed by anyone else) I wish I had put my foot down more as I really wanted to breast feed but close on impossible when your not there for every potential feed.

As for breastfeeding tips in general skin to skin when ever you can and lots of ticking toes, hand express a little before just to help the let down and give them a little taste so the know what all the hard work is for. dc2 took to it like a duck to water but wasn't as early, still needed sone encouragement in the early days.

Congratulations!! Lovely time of year for a squidgy new born, dc2 born Christmas Day

Thanks for all the support! Really, really means a lot. I’ll definitely look in to chest compressions and try different, non-Mariah ways of keeping them awake.

congratulations on your new wee bundle! I had a prem baby although no nicu just hdu/scbu. Stripped her down/flicked her feet to keep her awake. She took expressed feeds/cup feeds (very weird especially if getting phototherapy as the milk glows!) and she breast fed fine at home. Also useful to be able to express and bottle feed so you can get a break. I think teat confusion is probably overhyped - mixed feeding either expressed or formula is not going to harm anyone

Mine was born at 34+2 and it took 10 days.

I started bf during the day on day 7 with NG tube still in for night feeds and then on day 9 they had her room in with me for 24 hours without the tube in and that did the trick.

DS was 34+2. He did really well during the day but really struggled at night when they really need to eat for milk supply etc.

Compressions/massage definitely helped.

When it came to going home- they gave me a ‘10 mins till we come and weigh him”- whatever you do don’t feed him.
What she forgot to do was give me the heavy wink when she said it. Rule abider that I am- I didn’t feed him- and sure enough he was 20g short of the gain he needed for discharge.

She was all- did you feed him? I said- no, you told me not to. She said- well I didn’t expect you NOT to do it when I walked away.

We were definitely ready for discharge….

Congratulations! When I had my preemie the hardest thing was the lack of interest from the nurses in breastfeeding, so it sounds like you have a really good start.

Preemies need to feed every 2-3 hours (check with the nurses), you will probably need to wake them for feeds. I found it was best to try a breast feed every time, at the start of the feed, and then top up with formula. You should then try to express a bit after the feed to keep your milk supply up. As time goes on they will need less and less formula.

If the baby starts to fall asleep, blow gently on their ear, tickle their feet etc. Feed on one side, change their nappy to properly wake them up, then feed on the other. Make sure you are alternating which side you start on or you may end up lop sided - ou can put a bracelet on the wrist you fed from as a reminder.

One thing no one told me is that it takes longer for your milk to come in with a premature baby. The nurses convinced me there was something wrong when my milk didn't come in on day 3. It came in on day 5. I later read that this happens when a baby is premature as they need more colostrum.

I needed a LOT more food than the hospital provided and constantly sent my partner out for extra food.

My DD wasn't prem but she was very small and very poorly (GBS sepsis) with two weeks in NICU / SCBU before we came home on her due date. As a result, she was also tube fed and it took what felt like an age for her to learn how to BF. We did end up combi feeding, but that was mostly my rubbish supply, rather than her lack of skill (dropping weight down to the 0.4th centile in the end and the only way we got out of SCBU was after i started topping up with formula).

Things we did that helped with the BF was stripping off, tickling feet, breast compressions / massage, switching sides, stopping half way through the feed to do nappy change to wake her up. We also did "eat, play, sleep", rather than "eat, sleep, play" routine, so that she was more awake for feeds.

Once she got bigger and stronger, she made great progress on her own and i kept up the BF until she was 9months and i went back to work.

Congrats on your new arrival Make sure you look after yourself as well - NICU / SCBU life is so different to what many parents experience that i felt it quite a lonely and stressful experience. Hope your little one is home soon.

Agree with @latelydaydreams deff do a feed before that last weigh in and it didn't feel it at the time but they want them home just as much as you do! They deal with this day in day out, I was beside myself towards the end thinking it would never happen but the nurses were amazing, will never forget them waiting by the door for me to see the tube removed as a surprise

33+4 here. Breastfed our way out of NICU!

Firstly - be patient. Just keep trying, putting them to the breast and having a go. Pumping reassured me that I had plenty of milk for when she was ready (and in the meantime, she was being tube fed the milk).

I second what everyone else said about keeping them at least vaguely awake when feeding (fighting the sleepiness!). Removing her babygro for skin to skin also made her slightly less cosy and if she seemed to be dozing off, laying her down for a few moments was usually enough for her to rouse and wonder where I was. Her feet got a lot of gentle tickling.

Also at this time of year... Rest assured they will want them out if they can. In our case the twice weekly weighing showed she was putting on weight at a rate greater than just the tube feeds - although it didn't feel like she was feeding from me too, she definitely was on double rations. We came in the Sunday before Christmas when she turned 37 weeks exactly to find she had "pulled out her feeding tube overnight so they thought we would try without". Magically, a number of other babies at a similar stage had done likewise the same night... I moved onto the ward for two nights and it was about 24 hours in when you could see she suddenly started experiencing hunger for the first time in her life and suddenly started feeding properly. Once she had got the point of it, she was away and never looked back. We were home for Christmas.

These are all really encouraging stories. Thank you! I can’t say our trust is especially pro-bf (no lactation consultant etc but the NICU consultant was adamant I should try and room in when she started to show more interest)

@YorkshireTeaCup - It has been lonely and isolating. Just not what we expected at all. Hoping we also get home for Christmas like @GolfForBrains

I had a 34 weeker and ended up expressing and bottle feeding. She was just too tired to breastfeed and after two hospital acquired infections and some questionable care I just wanted her out of there. I tried to get her breastfeeding once we got home but she never got the hang of it. I expressed for 9 months so she got a decent amount of breast milk, just not from source.