Please help need advice on bf'ing - having DC3 tomorrow by CS, IUGR and probably going to SCBU

[loueytb3]

A bit of history. Had DTs at 35+6, both were IUGR and DTS2 went to SCBU. We weren't expecting them to be so little and so were unprepared for DTS2 being whisked away. I was hijacked in theatre about what formula I wanted them to give DTS2 because he needed feeding asap. It took a few days of pestering to get a breast pump sorted out and then get enough milk out to provide for DTS2 in SCBU and I never produced enough to feed him on my own. He had a mixture of EBM and formula while in hospital (through a tube) and eventually took to BF'ing but we never managed to exclusively BF. DTS1 was BF'd from the start but we were advised to top up every feed with formula as he was very small too. So in the end, I was doing a combination of FF, BF and EBF which was very time consuming.

Fast forward 4 years, DC3 now going to be born tomorrow by ELCS because of IUGR. Predicted weight just over 4lbs at 36 weeks and we may well end up in SCBU again. I want to be better prepared this time round. I have ordered a breast pump which I am picking up today so I will have that from the start and not have to rely on the hospital (They have a pumping room but its on a different floor from the ward and I won't be be able go get there for a couple of days).

I know milk doesn't come in properly for a few days - should I be pumping from the word go? What do I do if SCBU want the baby to be fed immediately and I can't supply the milk - give in and let them give it FF? I am not anti-FF at all and I want the best for the baby but just feel a bit ill-informed at the moment. Would be grateful for any suggestions - I will be checking replies all day but might not get much chance to post as I've got a ton of things to sort out.

nesw news

8-10 times a day is going to be a real struggle - I've done 5 so far today and I am hoping to get another 2 in before I go to bed. Hopefully it will be easier when I don't have to traipse back and forward to SCBU and wait for midwifes to do observations etc...

Midori - thanks - I will definitely do one overnight. I tend to wake up in the middle of the night anyway so will just do it when I wake up. I have a double
pump, but I've only used one side at a time as I'm still getting the hang of it I'm going to try and pump both sides together next time round and see if I can get it to work. I'm very impressed you managed to get 10mls of colostrum out!

Had a bit of a setback tonight as his blood sugars have dipped again. Am hoping that they will be ok before the next feed otherwise he won't be out tonight and they might have to go back to 3-hourly feeds.

Have you got a photo to keep with you? DH recorded DD crying in SCBU for me to play whilst expressing too - he just did it on my phone.

Unfortunately, when your LO is in SCBU, the early days are all about expressing and then trying to get skin-to-skin. But if you get your milk supply up, you can get then to EBF later even if formula is needed/used in SCBU.

For what it's worth, DD was in SCBU for her first few days, was tube-fed and didn't latch on properly at all till day 4, but we got her to ebf with no top-ups by 5-6 weeks old and we're still going strong at 6 months!

Best of luck!

Hope he manages to sort his blood sugar out tonight and can come with you rather than being in SCBU.

Is he just in a cot in SCBU rather than an incubator?

DS1 was born at 36 weeks (he's 6 now) and was 4lb 15oz so only a little bit more than your little boy but he was tube fed immediately (and I am so so angry about it because was never given any option they just popped a tube in without telling me) but our hospital had a transitional care bit on the post-natel ward so that even babies that were tube fed could be with their mums. Is there no way he can be with you on the ward...it must be so hard for you especially after a c-section.

DS2 was born at 32 weeks in November last year and he was 3lb 8oz so was obviously in SCBU in incubator and tube fed because he was just too teeny to latch on so can totally relate to having to hang around waiting for the mw's etc...in the end I ended up just going whenever I wanted and the SCBU would get a frantic call from a mw summoning me back!!

Really hope you can express some more and your gorgeous little boy will be with you soon.

Firstly congratulations on the birth of your little one!

Just to add my penny's worth please don't worry about the top ups, you are trying your best in difficult circumstances. The good news is the milk has come in now keep pumping! My ds was 10 weeks early and was on top up then tvn then fortifiers then breast fed and having ebm before finally exclusively being breastfed at 8 weeks. And i only stopped in the day at 14 months.

So it can happen - good luck

Sorry if this is not possible as i didn't have a c section but are you able to manage to get to scbu? If so how about seeing him then express - i did that in the middle of night as well as daytime. Even a stroke whilst trying not to cry helped.

With a C-section wound, you can still get in a wheelchair and get a porter or MCA to take you up. I did this a couple of times and wished then I'd been brave enough to insist on it earlier.

Me again. His blood sugars are back up again . They are going to keep him overnight and then bring him up to the ward first thing tomorrow. He is now jaundiced so is going to need phototherapy but they can do that on the ward. It might mean we have to stay in longer though, I was hoping we would be able to go tomorrow afternoon/evening. His last feed was mostly EBM but the volumes I'm getting out now have gone down, I guess because I'm tired. Am going to keep going though as I think from what you've all said the more frequently I pump, the sooner my supply will increase.

It's great so many of you have successfully gone to breastfeed after SCBU, I really hope we can do the same. I've got some videos/photos of him on my phone and I've been trying to do as you suggest and look at them while expressing. Not sure whether it's making any difference.

Japhrimel - they wouldn't let me go to SCBU until the next day, had to keep flat in bed to avoid spinal headache. I did ask them about going up in a wheelchair. I walked there the next morning once they'd taken the catheter out.

Yay :) Good news

Hope you've got your boy with you by now.

(am just reading a chapter on pumping - here are some highlights)

Remember your pumping doesn't need to be evenly spaced, you can cluster pump and your body will get the signal to make more milk (now!) when your breasts are 'empty' no matter how long its been.

Before you pump encourage your milk flow by massaging, lifting and shaking your breasts (let's hope the cleaner doesn't come in now...)

Start with faster gentler setting to mimic babies at the start of a feed.

Pumping should be as comfortable as nursing (too high a setting might actually mean you get less milk out - like a drinking starw that has been sucked flat).

At the end of your session try hand expressing to get any milk your pump couldn't.

This is the 3rd time, I've started this post, hopefully this time I will finish it....

Albrecht - thank you, that is really useful. Especially the bit on not needing to space out the pumping sessions, I have tried clustering the sessions this morning and it didn't seem to make any difference to how much I got out.

We got home on Monday finally. I have been trying to get 8 pumping sessions in but it's very hard work. I managed 8 yesterday and I'm on target for 8 or 9 today. However, although I've been doing more pumping over the last couple of days, I'm not really getting any more milk out, around 40-50mls per session and less in the evening. When should my supply increase? I am not giving up yet, but it would be nice to have an idea of when all this hard work is going to produce results. Apart from everything else, my back is killing me!

I've been trying to get him to bf but we're not getting anywhere at the moment, he can latch on but stops after 1-2 sucks. This afternoon he wouldn't even attempt to latch on and it was a struggle to even get him to take some milk out of a bottle. Any suggestions to try and speed up the process (apart from persistence)?

The midwife came yesterday to weigh him and wanted him readmitted to hospital because he'd lost some weight and he has mild jaundice (below treatment level). We resisted because it was within 10% of his birth weight. She came back this morning and fortunately he had put a little weight back on again so she's left us until Sunday but we're under some pressure to make sure he feeds well. Ironically, by putting pressure on us abut his weight she is pushing us in the direction of bottle feeding.

Nice to see that you and DS are home now.

I've just been having a flick through my 'Making more Milk' book for some more ideas. Albrecht mentioned breast massage before feeding. You can also massage and do breast compressions during pumping.

You could consider a galactalogue to boost your milk supply- popular herbal ones are fenugreek, shatavari and goat's rue. Or maybe your GP would prescribe domperidone if things don't improve. Galactalogues can help, but are only helpful as long as milk removal is frequent and effective.

Regarding, getting him to latch on/suck from the bottle, I'm not really sure tbh. I wonder if finger feeding might be helpful though.

Such a shame you're being pressured about the weight gain. It's so not helpful - did the mw give you any suggestions to get things going?

hth

Crikey - thanks, have been massaging before and during pumping. Sometimes it seems to help, sometimes it doesn't. I think I am getting slightly more out today, more like 60-70ml at each pumping session. Also, we've had a bit of a breakthrough with bfing . He managed to suck for a couple of minutes at lunchtime and tonight he fed for almost 10 mins on one side. My boob was much softer afterwards in comparison to the other side and he didn't finish his bottle so I think he got a reasonable amount. I'm only trying to bf him at every other feed as he is getting too tired but once he is getting better at it, I hope we can do every feed and slowly reduce the top-ups.

Hey that's brilliant news! You must feel really pleased.