DS in neonatal unit BF advice needed please

[mrsissue]

Hello,

I posted on here last week because I was 34 weeks pregnant and wanted to know how to increase my milk when my baby arrived and I got lots of good advice. The thing is my son decided to arrive 6 weeks early and is in the neonatal unit, he was moved to the nursery today and the doctors seemed really keen for my son to start properly breast feeding (he is being fed through a tube at the moment) but the nursery nurse didn?t really seem very interested in helping me. I asked her if I could put him on the breast before his tube feed and she said there wasn?t much point because he won?t be able to do it until he is 36 weeks so it?s going to be at least another week.

Now I know that prem babies have difficulty with BFing to start but my DD was 6 weeks early and she managed to latch on and have a bottle and go home at 35 weeks. I just don?t know what to do, I?m expressing but only getting 20ml max every 3 hours and my son is on much more than that in his tube feeds so I don?t think I?m going to have enough milk for him when the horrible nursery nurses allow me to feed my child, does anyone have any advice on how to increase my milk so I will have enough for him. At the moment they are mixing my milk and formula.

I am getting up in the night to express and every 3 hours, drinking plenty and taking fenugreek capsules. I asked if I could take my son out to hold him before I expressed and was told no because he was settled, so I?m not getting that much skin to skin with him either.

They seem to want me to sit in there all day looking at the back of my sons head and change his bum and clothes, which I like doing but I also have a 13 month old DD who is getting a bit upset because she is missing her mummy and I generally feel like a crap mum to both of them, I?m so emotional I burst into tears on the way home.

Sorry it?s a long ramble, and please if you have any advice on how to increase my milk please let me know.

pps don't worry about your milk supply, all that expressing will have been plenty.

Ohh, mrsissue!

how lovely - it sounds as though you have ahd a much better day!

even though dd2 was term we were not allowed to hold her or take a picture for a week (she was still having szs so i know just how frustrating sitting by an incubator can be )

fingers crossed that the rest of the staff keep to the plan x

Crikey - you have such a lot of great advice here. I just thought I would add my tuppence worth as I have just been through what you are currently in the midst of. First of all you are doing really well and if you feel emotional from time to time give yourself some time out. It is the most challenging experience and you have to keep yourself strong to be able to look after your babies.

My DS was born in May at 33 weeks. From the v. start he had a strong sucking reflex and when I held him he started to root even though one of the nurses told me this couldnt happen til he was 34/35 weeks. I later found out that this is rubbish and that studies have found that preterm babies as early as 27/28 weeks have been shown to have a sucking reflex.

The way that I went about things was as follows.

1. I insisted on having skin to skin every day. I made sure that this was agreed with the consultants that came around every morning and had this written up in his care plan (esp. after one nurse told me I couldn't have my baby out of the incubator)
2. I made myself familiar with all the wires and monitors so that I could act confidently with the nurses - this makes a difference as they need to get over their perception of kangaroo care as risky.
3. Next I insisted on an appointment with the lactation specialist in the hosp - all hospitals should have one. Again I made sure that the care plan included her advice.... which was simply to make sure that I tried the baby at my breast twice a day at alternate feeds.
4. I had to go slowly as I had great expectations but realised that although my boy was doing all the right things (lapping, sniffing, and sometimes latching on) he was very sleepy and often fell asleep during these sessions. Around 35 weeks this changed and he began to latch on with intent!
5. In our second and third week he was beginning to have actual feeds from me but the nurses were still topping him up with EBM mixed with extra nutrients. He gained weight at a phenomenal pace and by the end of the third week had reached his goal weight to go home. As a result the only issue keeping him in the hospital was whether he could feed independently.
6. Finally I got the lactation specialist to advise the nurses that to establish BF fully they would have to allow me to demand feed - which would mean taking him off his 4 hourly schedule. At this point comments were made about my supply and whether I could provide enough for him. Obviously its hard to know if you are not able to put the baby to the breast enough times a day to establish BFing. After a lot of to-ing and fro-ing they agreed that I could try demand feeding for a day, and then asked me to room in for 2 days. After the 1st we were doing fine and so we were discharged! HURRAH.

Sorry this is a bit of a ramble but if you have any questions at all please please do message me and I would be most happy to give you the benefit of my experience if it would be useful.

DS is now fully breast feeding and looks to be a boobaholic just like his sister before him!

Good luck with it all. You are doing just fine.

Mamahotfoot!!!

I've changed my name since you were last on here.

Thanks for posting. Howya doing?

x

SpeedyGonzalez Hey there honey! - I should be in bed.... and so should you! I knew it was you from the Montezuma choccies!

Just had a few more thoughts about milk supply.
I think it is really common for women to feel that they are not producing enough. I heard this in the SCBU milk kitchen over and over. Obviously there are things you can do to boost your milk supply like eating, resting (difficult when baby is in SCBU and other child is at home) taking fenugreek, dill, eating oily fish, porridge, icecream and of course chocolate. ...and drinking lots

My BF person told me to pump little and often. I never managed to do 8-10 times a day as first advised by the nurses. I also did not get up in the night to pump...But I did try to pump first thing in the morning when supply is at its most. Thereafter I would try and pump just after I had held my baby as that is also a good time to get the most milk. Some days I managed 4 or 5 pumping sessions and others just 1 or 2. I found the hospital pump a bit brutal and actually managed to express by hand just as effectively.

At the beginning my supply was not as copious as it was when I had a full term baby. I felt like I was as dry as a bone - however I was producing just what he needed. Preterm babies stomach's are smaller than a walnut - so it doesn't take that much to fill them up! As soon as I was able to put my babe to the breast as and when he demanded, my supply magically increased.

Hope that is helpful....

Hi

I hope you are well, I just wanted to say that there's lots of good advice here. My ds was 29 weeks, he had a suck reflux sometime in week 30 (after he was about 10 days old) and despite still being under 3lb at the time he definitely knew what to do.

He would have come home at 34 weeks bf, if he'd only been able to keep his temperature up.

In respect of his cares, do them when you can, but lots of people only manage 1-2 times a day if they have other children. That's normal. DS was my first and on a good day I did 3-4 times, but often one or two was all I could do too.

On pumping I saw the lactation consultant at my hospital. She was actually nearly enough to put me off bf for life! however I did pump and ds is now bf. I also rarely pumped at night after a doc who had a prem told me she never had. So overall i tended to pump 6 times a day including as I went to bed, and just as I woke up. It was enough for me. By the time DS left scbu i donated several litres of milk as he wouldn't need it. I was lucky but as others have said ds only had a tiny stomach so he didn't need much. Also remember preterm milk is different to term milk for a baby. Usually its higher fat and so if your body is making less milk, the milk it makes is more like cream (or gold top at least).

Kangaroo care is important, try to aim for an hour at a time before a feed. one hour in one go is supposed to be better than more ocassions for less time. Because my ds was so tiny I had to wait 5 days to hold him and that didn't affect him or feeding. We caught up later.

Personally I avoided demand feeding until long after DS came home. This was the right thing for us. DS was too little to demand to be fed, and found feeding too exhausting to try every feed. (remembering he was 30 weeks at the point we started BF and about 3lb in weight that's not surprising) We were on 3 hours so we started with one feed then two (but never 2 togther) and worked from there topping him up when he got too tired. He would never have got home if he was demand fed. So there are different views about this and they can all be valid. Trust your instincts and your baby about the way to go. When you have a prem rather than a term baby and that does sometime mean they need routine to get enough food in. My DS took unitl week 36/37 to regularly demand to be fed, and even then he would have tired days when he just wanted to sleep. I always took those to be the days when he was trying to grow. I was told by the staff on a number of ocassions he was still little and as such sometimes he just needed a break.

Do carry on making your views known. Also if you want to speak to the docs, in my hospital after DS left intensive care and went to SCBU the best thing to do was to find out when the ward rounds were and speak to the docs at that stage, they would be with the nurses with charge for DS for the day and you could agree the care plan with them then. On a couple of ocassions we also asked to see a doc and it was always arranged when we did. Again the nurses who were caring for DS were always involved in those meetings to write the agreed form into the care plan.

Finally try to give yourself a bit of a break. It's hard work having a prem, even if you were half expecting it. You still have just had a baby, you have an older child to care for, its an emotional rollercoaster even if your child is well but small, and you want to do what you can for them with conflicting advise about what that is. (Even when the advise is in part from MN). Look after yourself. Try to sleep (That's why I didn't pump at night my supply was better if I was well rested and many people find the same as the emotional side of having a prem does take its toll). Take any offers of help you get.

Take care and congratulations