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Infant feeding

Get advice and support with infant feeding from other users here.

Risks of Formula feeding on pre-term infants

154 replies

thisisyesterday · 06/01/2011 17:21

how scary is that?

i read a blog which mentioned it here

it was in a piece published by the Journal of Pediatrics, so something to take seriously I think.
makes me feel so :-(

OP posts:
FredCarnosCircus · 07/01/2011 10:29

This is a big issue for me. I had a pre term baby, was told he needed formula to survive, but was supported to express as well. 12 hours after his birth, a very junior member of staff sidled up to me and very quietly suggested that if I carried on mix feeding, it would be very difficult to establish breastfeeding. He had seen my birth plan with my very pro breast feeding intentions, and felt I'd been given poor advice. So, with his help, I basically defied all the more senior midwives on the ward, and we cut off the formula.

It was very difficult, DS's weight dropped horribly and, without the use of a NGT, DS would have died. But we did establish breastfeeding (and carried on longer than most).

But it took an 18 year old student and a lot of courage to go against the norm. It was clear that most of the midwives and paediatricians were solely interested in getting DS above the minimum weight, below the bilirubin threshold (he had jaundice, which was prolonged by breastfeeding) and perceived formula feeding as the best way to achieve that and get us out of hospital.

We ended up staying in hospital for 10 days - it was a difficult path to take.

FredCarnosCircus · 07/01/2011 10:32

I don't feel any bitterness towards the medical staff who were pro-formula, by the way. I think their intentions are sound and that they work under huge pressure. But I am very grateful to that student.

FredCarnosCircus · 07/01/2011 10:34

Very much used the word 'very' very much, didn't I?

FredCarnosCircus · 07/01/2011 10:37

You can ignore this post, btw :) I just saw the comment re being in awe of someone who established breastfeeding in a pre term baby ... I wanted me some of that awe Wink

tiktok · 07/01/2011 10:52

Fred :( :( you had a difficult time.

There is a tension between getting a pre-term baby's weight up and thereby building up strength and health, and supporting exclusive breastfeeding...no two cases are the same and not all experts agree on the best course of action in individual cases.

Many units add 'human milk fortifier' to expressed breastmilk - it's very highly modified cows milk - which makes breastmilk more calorie-dense and allows pre-terms to avoid ordinary formula.

But there is no easy answer.

Goingspare · 07/01/2011 10:52

As John Wayne would have said, aaaaawwww, FredCarno.

This thread has got a lot more interesting now.

RubyBuckleberry · 07/01/2011 11:57

'In past times is breast feeding a cause of good health or an effect of it?'

Both I would have thought. If you were breastfed yourself perhaps you are more likely to have healthy babies and healthy pregnancies and healthy breastfeeding. (I have no evidence for this btw before anyone asks). And it is clearly a cause of good health. In many countries today and in the past globally, it is simply a matter of life and death whether a baby is breastfed or not.

RubyBuckleberry · 07/01/2011 11:58

Great story FredCarno, its always the students isn't it! Inexperienced in so many ways but brave mavericks too Grin.

hazeyjane · 07/01/2011 12:01

Fred, I am in awe

I was in a similar position with ds, he had jaundice as well, and his weight plummeted when they took his feeding tube out and let me try feeding on demand (well actually to a strict 2 hour schedule). It is so hard because I desperately wanted to get home to my other children, was very ill post c-section and there was no care for the mothers in the baby unit, so I had to stagger around pushing one of those huuuge plastic cribs days after having had a section and with a leg the size of a small settee. And all the while you know that if you just gave a bit of formula, then things would start to even out and you would be allowed home.

hildathebuilder · 07/01/2011 12:27

Fred I am in awe too.

I don't usually post on bf/ff threads as I have mixed views once they blow up, but this one has really got to me, I do not take offence at any particular poster here btu really wish people took more care when talking about prem and sick babies where matters are often even more emotive than they are elsewhere.

I say that as the mother of a 29 weeker who is now 10 months and still bf. He's the only one who still is BF of the other mothers I know from my time in scbu, and was the only one who still was after 6 weeks post dischrage, although I know a few younger and older babies and mothers who managed it, they are the minority.

In my case I had a lot of support from the hospital, the midwives who got me expressing within hours and my milk came in in volume the day after DS was born (thankfully), the nicu and scbu staff espcailly the nurses who got kangaroo care going safely while DS was still on cpap and a bit unstable, the consultants who supported this, the lactation consultant who also helped, and just DS and my sheer bloody mindedness. Which is probably the main factor.

I agree that there should be discussion on these issues, am a lot of this thread is interesting. I know that there has been a request to change the title of this thread, and wish that had happened. This is because unless you have had a preterm or sick baby you don't personally know how difficult some of the issues with these babies are, and can be.

Prem mums know all about the risks of NEC, and other complications, at least in my hopsital. Many of us have children who have had NEC (thankfully I haven't)and lung and other diseases, many of us have faced regularly the thought that the baby may not make it, and do anything including trying desperataely to bf to help. In other cultures and other times, the babies would possibly have died. We know that. However many of us cannot get the milk in, cannot stay in hospital with the child, and feel desperately guilty about the fact the baby came early (as if we chose for that to happen), that we can't do much, that we aren't pregnant anymore, and often that we cannot even feed the baby we do have.

Also even with NGT tubes there aren't always choices, many pre term babies need more calories which is why nutriprem and infritrini are regulalrly prescribed as well as breast milk fortifiers.

BF should be supported but appropriately and not at all costs, prem mums are very high risk of PND, and also we are often medically advised (correctly) to give formula, or in my case to allow bottles when we cannot be with the baby overnight to encourage the suck reflex. I was also advised to give a dummy (for non nutritive sucking) The advice for prem and sick babies has to be tailored to the baby and the mum.

I was lucky back in March and I am still lucky as BF DS has also helped avoid hospital recently when he got bronchiolitus. But I do not know a single prem mum, even those who always planned to formula feed, who does not know, or is not quickly told why the babies need breastmilk more than ever. And I support this. I also do not know of a single mum even those who never planned to BF who do not express for absolutely as long as they can before milk dries up, they need other meds or there are other medically advised reasons. IMO and with teh experience of my friends It is after they start introducing the formula, or they feel they want to bottle feed to get the baby out of hospital often many weeks later that things change.

As I stated above my hospital is very good with these issues, I have nothing but praise for them, and the support they do give, but there are many factors including the fact you cannot stay in hospital with a prem baby for months on end, which must be taken into account in this debate, and in the research and the statistics.

tiktok · 07/01/2011 12:43

Hilda the title was changed - the previous one was too stark.

It's really difficult for a discussion thread to maintain sensitivity - I offended someone yesterday when I was explaining statistics, and I didn't mean to.

When prem baby mothers are informed of how beneficial breastmilk can be, most of them do express at least for a time, you are right. Only a few don't at all - I tend to think the ones that really don't do it at all must have very great problems about their bodies or themselves or their mothering and I don't judge them for that at all (I hope I'm not offending anyone). I met a mother of very prem twins who had not expressed at all - in a unit where all the other mothers were or had been - and I don't know why she didn't, but the idea of it was just alien to her.

SCBU staff these days are pretty upfront about telling it like it is, and when you're told breastmilk can be life-saving, then of course you express - unless you have something major going on that prevents you.

You explain very well the dilemma between getting the baby's weight up so he can come home, and staying on breastmilk only. It's a v. difficult one.

FredKarnosCircus · 07/01/2011 12:59

Very good post, Hilda. I must hand back that awe as DS was only just pre term (34/35 weeks), so I simply haven't faced the issues you have.

Hazey, thank you Wink

hildathebuilder · 07/01/2011 13:17

Tiktok, I thought your explanation of statistics was spot on btw, and you have never offended me, in fact back in Juneish I found some of your comments very supportive. I also do not take issue with any individual poster, I just wanted to offer a personal view about the emotions which this kind of thread and post can evoke. As I stated above us Prem mums can be very senstive sometimes, and IME understandably so.

However I am not easily offended, and I am bloody minded. This is perhaps why I felt I needed to post on this thread. I fervently wish everyone had the support I had, and that all NICUs were as good as mine was and still is.

Fred you deserve the awe more than me, I was never questioned on what I wanted to do, just supported, and I always had the strength (with a help from DH) to question everything I was told by the staff, at every stage. I was and am lucky in this respect

Marrow · 07/01/2011 15:23

I knew I shouldn't have clicked on that link. I'm now scared for my baby and I'm already feeling dreadful that he is on formula Sad

He is six weeks old today but was born at 32 weeks. I had emergency surgery the day before he was born and that sent me into premature labour the next day. I was on intensive care for a week after having him and wasn't able to start expressing until he was four days old. I did have a bit of milk but because of the drugs I was being given I had to pump and dump.

Finally when he was 10 days old I was able to give him my milk but at that point was only getting a dribble out that the neonatal unit used to clean his mouth with Sad

I have expressed for hours but have no milk as I think my body just has no resources left. I had to have more surgery when he was 2.5 weeks old and was in hospital for a total of one month.

I am so, so upset that I can't feed him. I am on domperidone and still expressing but getting nothing. I can't let him latch on as I am back on a drug that is incompatible with breast feeding. Now I am terrified that he is going to be unwell because I haven't breast fed him. I cry every time I give him a bottle because I desperately want to feed him.

RobynLou · 07/01/2011 15:52

I think the important thing to take from this is not to put even more pressure on mothers of pre term babies who are struggling to produce enough bm, but to recognise the importance of bm banks to support these mothers and babies.

I didn't realise you could donate bm until DD was past 6 months last time (I enquired and you had to start donating before your baby was 6m) I'm 37 weeks pg now and throughly expect to donate as much milk as possible this time - I'm still feeding DD who's 3.5 so I should hopefully be a good supplier for a while!

I think the fact that you can donate bm and that there is bm available for babies who need it should be more widely publicised - I did all the nct classes and read everything I could get my hands on about bfing before I had DD but never came across the concept of donating bm.

tiktok · 07/01/2011 16:03

:( :( :( Marrow.

You and your baby are prime candidates for donor milk - is there a milk bank at your hospital?

You have clearly tried so very hard and left no stone unturned - I expect you have spoken to people who can advise you on expressing, and you know the key is to do it on both breasts many times a day. However, the early days when you were so ill, and the battering your body has taken, seem to have undermined your supply from the start, and being so ill prob meant you were just unable to overcome this.

Grieving for the lost experience is normal :(

Knowing, as I am sure you do, that your survival and health is way more important to your baby than your milk, is not enough to convince your heart, and you will feel an ache...but this will get better in time as your little boy grows and gives you the cuddles and smiles you deserve, because he has no clue at all he's not breastfed :)

The only other thing I'd say would be to check about the drug - very few drugs mean no breastfeeding. Latching him on, whether or not there's much there, would be lovely for both of you. You can find out if even a drop of your milk would be contra-indicated by searching here: toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

hildathebuilder · 07/01/2011 16:04

Marrow Congratulations on your DS.

Try not to worry about the formula, from your post it was the best thing for you and your DS in these circumstances. You need to get better, recover from your surgery and putting pressure on yourself will not help with this. Does your hosptial have a counsellor you can talk to, if not please try Bliss.

Also trust me it does get easier, and eventually most of us find a way to cope with what has happened.

Robyn I agree entirely. And thanks for mentioning this. I was going to post about milkbanking in my earlier post but it got so long I forgot to!

ChilledChick2 · 07/01/2011 17:33

Marrow, it's understandable that you feel guilty for FF as you want to do the very best for your LO. BF is the one thing I would encourage any mother to do for as long as possible, but there may come a time where, like other mums, you have to turn your attentions to ensuring your baby's survival rather than feeling bad about not being able to BF.

No mother should ever feel or be made to feel guilty about helping their baby stay alive.

Goingspare · 07/01/2011 18:13

Marrow your post resonates with me as I was ill after DD1 was born (also surgery, lots of drugs, a month in hospital, desperate attempts to express, etc.) and felt terrible about my inability to breastfeed, which I had just assumed I would do effortlessly. My DD was full term, but I got the impression she would have been given bank milk if she'd been preemie or sick; I'm sorry you haven't been offered this.

It will take a while to get over the whole experience, but please try to get beyond the guilt and anxiety over bf. I remember weeping buckets over a news report at the time about most formula milks (including the one I'd had to select on the spot in the maternity ward, having never given the subject a moment's thought) not containing a particular amino acid(?) vital for brain development, and grieving my daughter's lost intellect (I really did).

I also remember being on a real mission with DD2 2 years later - I had completely unrelated problems bfing her but was so bloody-minded about it I ended up feeding her well into her second year. Perfectly reasonable to have persevered and sought help, but I'm sure I was at some level proving to myself that I'd done everything I possibly could for DD1.

Try and put the matter aside as far as you can, and concentrate on getting well and enjoying your baby. The whole illness/hospital thing did delay my bonding with my DD a little, and I don't think feeding anxiety helped. We got there in the end, once I was able to look after her on my own, and I had undone my mum and MIL's good work with her by sleeping with her for a few months.

DD1 is 13 now, and I will never forget how I felt then, but I now feel no guilt about feeding because I know that I did my best and we were the victims of circumstances at the time. At another time neither of us would have survived the experience (massive infection, she had precautionary antibiotics after her difficult delivery, otherwise whe may well have had it too). She is now a great big, lively, happy, busy child and though I wouldn't normally say it, she's very bright and doing really well at school.

I hope you are back to full strength very soon, and that your baby thrives and does as well as mine has done. Take care.

thisisyesterday · 07/01/2011 19:33

Marrow, Hilda and Fred... my awe extends to you all as well!

It's so easy to sit at a computer and think "i know all the risks, if I had a prem baby i'd insist on breastmilk only", but it must be incredibly hard to go against what the majority of HCP's are telling you. especially when it relates to what is probably the most precious thing in your life and when that precious baby is already poorly.

I really have the utmost respect for all of you

Marrow- I feel for you, really I do. as I mentioned further down I stopped breastfeeding my first baby early on. we had problems, I started expressing, he refused breast, my milk supply went
He is nearly 6 and i STILL feel guilty over it. I know guilt comes with the territory (motherhood) but I find this really hard.
But it is important to remmeber that this is exactly what formula is for... when breastfeeding doesn't work that is when formula comes in. You haven't done anything to feel guilty about, you've tried your hardest and for various, very understandable reaasons it just didn't happen.

I wondered a couple of things though... someone further down mentioned about milk not "coming in" very quickly and their prem baby being supplemented

now, with a full term baby who is breastfed this is normal. you have very tiny amounts of colostrum until milk comes in, sometimes not for several days

when you have a premature baby, is that tiny amount of colostrum not enough? I mean, are hospitals generally happy with early babies just having the colostrum or are there reasons why they need a bigger volume and that's why so many are supplemented?

OP posts:
FredKarnosCircus · 07/01/2011 20:21

Thisisyesterday: I was told that DS had very low blood sugar and was at risk (exact level of which was never discussed) of becoming very poorly very quickly. The midwife suggested we tried breastfeeding, "but I would strongly recommend you permit us to give him formula if he doesn't feed properly." DS had no suckle reflex at that stage, of course.

It's so frustrating to look back now. I had just finished a very rapid labour, I was about to be wheeled into surgery, shocked and scared to have a premature baby and need post-labour surgery, so we went with what seemed like the obvious choice. We knew nothing about premature babies. But if I had my time again, I would find out exactly what his blood sugar levels were. But, you know, I was in no state to fight.

DH was a bit more feisty and refused to let anyone take DS off him, whilst I was in surgery. Apparently, security were present at one stage (anyone else suspect a bit of exaggeration?!). But he held DS under a heat lamp for 4 hours, rather than let him go in an incubator. Of course, this is the heroic story of the day ... no mention of the woman who held DS for the next 78 nights ... Wink

thisisyesterday · 07/01/2011 20:32

i think it's great that both of you were clued up enough to fight for what you thought was best though Fred. 78 nights? wow!
I know someone on another forum who fought tooth and nail to be able to kangaroo care for her baby who was 6 weeks early. He did fantastically, but the staff were awful to her, basically telling her that she was risking killing her son

I realise they are doing things exactly how they have been trained to do them though and in their minds it is "right" and I guess in that sense it must be hard when questioned by parents?

but another question, this might be one for any midwives/BFC's on here.... if blood sugar is an issue then is the amount of breastmilk/formula important? is there a minimum they like to give? if the baby was fed directly they wouldn't know how much it had had would they? so presumably just test again after a while?
is a tiny amount of colostrum enough to improve a small baby's blood sugar levels?

I also was "made" to give formula for blood sugar reasons (among others) with ds1. I wasx utterly clueless though. I assumed they would tell me to do what was best for my baby.

OP posts:
FredKarnosCircus · 07/01/2011 20:32

Also - they said he didn't have the weight to lose. DS didn't have the last weeks of gestation to lay down fat, so they suggested we didn't have time to wait to establish feeding.

They weren't wrong: his weight was critically low for a few days and he was horribly yellow with jaundice.

FredKarnosCircus · 07/01/2011 20:36

When I say 78 ... I just mean I held that child at night for weeks and weeks and weeks. DH wasn't up for night duty.
I didn't actually count Wink

FredKarnosCircus · 07/01/2011 20:37

I was clueless, too. Only fought because a rebel student got behind our cause!