Ticktok and others, how best to get a preemie to breastfeed? Conflicting advice from MWs.

[Poppet45]

So DD arrived as a big surprise at just 27 weeks. I've been pumping milk (by hand as I wasn't getting on with the machines) for seven weeks now and by doing it 9 or so times a day for about 30 minutes a time during the day and twice at night for an hour or so I've managed to build my supply up to 1.2L a day. This is a big emotional commitment and has really kept me sane because I've been able to do something positive for her every day. But now comes the tricky bit and I don't want to screw it up, DD has been on continuous feeds, is now trying hourly bolus feeds, then comes two hourly, then three and at some point when she can get all her milk without using her nasogastric tube it'll be a big step towards her coming home. But how best to do this?? She's been put to the breast a few times - mainly for a nuzzle and just to acquaint herself - she hasn't really latched on, or fed other than lapping at milk I've squeezed out for her. She's 34 weeks and still v small (3lbs 14) and has a small hole in her heart so can be a bit 'beepy' on the sats monitors. I realise we'll have to build things up slowly but my MW was very keen for her to take bottles when I can't be at the hospital to feed her (I also have a toddler to keep me busy) but from what I've read this is not a good idea. She says a bottle is more like breast feeding than a cup or syringe, and more 'satisfying' for the baby plus as she put it the bottle is a way of getting DD out of hospital then you can work on BFing. But I'm worried that between bottle feeding her and then pumping milk and looking after my DS I won't have time to devote to teaching her to feed at the breast at home as well so I'd rather she cracked it in hospital. Does anyone have any advice or tips on how best to get a premmie to feed?

Prem babies not my specialist area, poppet - and I should add you have clearly done a sterling job as hanging on in there with a tiny, early baby and expressing round the clock like this for all that time is not an easy task at all.

If you can, try to share this book www.amazon.co.uk/Breastfeeding-Special-Care-Babies-Sandra/dp/0702025445/ref=sr_1_1?s=books&ie=UTF8&qid=1318114475&sr=1-1 with your midwife and other healthcare people.

Any SCBU worth its salt should have a copy, IMO :)

There are pros and cons to giving bottles in your situation - it's not cut and dried.

Hope you come to a decision that's right for you.

My DD was born at 34 weeks and was in SCBU 2 weeks so nowhere near as long as you've experienced. To say it was an emotional rollercoaster for me is a huge understatement so goodness knows how you must be feeling. Well done for hanging in there so far!!!

I obviously don't know the specifics of your situation but I can tell you how bfing worked for me. At each day feed I would try bfing and then she'd be 'topped up' via her tube afterwards. I would then sit by her cot and express. Once she'd started getting the hang of bfing and it was clear she'd actually taken in some milk from me the nurses started dropping the amount given afterwards, but still fed via tube. Obviously this got less and less till we were ready to room in and it was just me feeding her. Noone mentioned giving her a bottle at all and i don't recall seeing any of the other babies in the unit being fed by bottle. Any feeds done when i wasnt there were via her tube still.

Is there a reason why your DD can't be fed top ups via the tube still?

ps have you looked on the bliss website? theres loads of info and forums on prem babies www.bliss.org.uk

Hi poppet. It sounds like you're doing a really wonderful job with the expressing. I remember how much work it was when I had DD, who was dc1. It must be such an undertaking with a toddler.

The midwives/nurses also offered me different advice when I was trying to establish BFing with DD. There was one midwife who was the specialist feeding coordinator so rightly or wrongly I tended to listen to her. Do you have anybody like that on your SCBU?

Unlike some other staff, the specialist lady said it was ok for me to let dd nuzzle in at my boob, and lick the milk if there was any dripping. Some of the others said she had to be either feeding or else I should remove her from the boob. But the specialist said that it was good for DD to associate the boob with comfort, and to get the idea milk came from there.

Anyway, on the establishing point...
At the time DD was on SCBU the staff bottle fed babies (with mums permission only) if they seemed awake enough at feed time. But they were just about to all be trained in cup feeding, with the intention that they could cup feed those babies who mums were hoping to bf. Again there was disagreement between the staff over whether bottle feeding could cause nipple confusion, bottle preference etc.

There was one mum on our ward who was determined to bf so wouldn't allow the nurses to bottle feed. She had school age children and was in hospital for all the feeds during the school day and at least one evening one. Then she came and roomed in at hospital for I think three nights, and the hospital ensured the baby was thriving on BFing before letting them home.

I was more fussed about getting DD home than about getting her BFing. So I let them give her bottles. And actually I even gave her some bottles myself. She was my first child and I just didn't know how fabulous BFing was, I think I might have a different attitude now.

Anyway, we got DD home on bottles of expressed milk. I kept offering her the boob but not every feed by any means. She was so sleepy and I also if in honest quite hated the feeling of rejection when she looked at my boob with her mouth pursed closed.

I've had a look at her records and she was just over 37 weeks gestation and weighed 4lb 10 when she finally 'got' BFing. I guess we were lucky that she was getting weighed twice a week to check she was thriving. So basically one feed she latched on and fed from me. After that I totally breastfed (also had to express a bit to relieve pressure). I knew I was producing enough milk for her so I just went with it.

A few things we did which may help was
1 I took her off the hospital bottles, which were really just dripping milk into her mouth. We went onto tommee tippee closer to nature which she needed to open her mouth to take, and actually make an effort to get the milk out.

2 her milk in bottles was always room temperature, Woth the idea that she would prefer milk from my boob as it was warm.

3 I fed her her bottle with her kind of sitting on my lap facing me, not in the snuggly cradle position, again so that she would hopefully prefer boob.

I hope some of that is helpful. All the best. It really does sound like you're doing a fabulous job.

I had my first go at BFing my ds yesterday, he was born a week ago at 32 weeks. I had a crap start at expressing milk (due to literally zero support from MWs on the postnatal ward, would've given up altogether if it wasn't for one nurse on the NICU), but have been doing my best and he's now only getting an occasional top-up of formula mixed with EBM. He seems to know what to do to bf, but he's used to his little stomach automatically filling up every 3 hours with no effort required, so I know it'll take time. Anyway, my point (finally)... at no point has anyone suggested giving him a bottle, as they know I want to bf. Once he's taking feeds orally, they'll cup feed him until I can totally feed him myself. I would resist all efforts to give him a bottle tbh, I don't want him getting confused, he's got quite enough to get his little head around!

My dd1 was born at 29 weeks and in SCBU for seven weeks. Atb31 or 32weeks I started trying to latch her on, but until the day she was discharged,she did latch on quite well but only did one or two sucks at a time. She was bottlefed when I wasn't there. On the day of discharge I tried nipple shields and she fed for 15 min! At home I topped her up at night since she wasn't settling after those feeds, but now that I have dd2 who initially also wouldn't settle well at night, I think the topups weren't necessary. I think dd1 just wasn't strong enough to feed properly without the help of the nipple shields at first, and after the first few weeks I stopped using them and after a day or so she was fine. (Unofrtunatley I wasn't, due to infections etc, so I had to go back to using them, but she wouldn't have needed them any more.) Another mum on the ward I know for sure managed to bf her son exclusively once discharged, even though he'd been born at 28 weeks and bottlefed when she wasn't there. She also had a toddler at home. So I wouldn't worry too much about you little one getting bottles when you aren't there. Also, the sucking motion is very comforting for babies, so cup or syringe feeding them takes away an opportunity to satisfy their need to suckle, that might be worth considering.
I wish you all the best and hope she comes home soon!

this is a complicated issue, but ultimately a matter of what is more important to you.

in my experience, keeping a baby just on the breast and tube feeds is slower, with longer in hospital, but easier once you are home as breastfeeding is fully established and you'll be set in a nice routine.

however, bottle feeding when you are not able to be at the hospital, and even giving top ups by bottle instead of tube after breastfeeds will get baby home quicker. your baby must be without an NG tube for about 48 hours minimum before coming home (or that's how it was when mine were in SCBU). tired babies feed more easily from a bottle as it just pours in and they swallow automatically. they have to work to get it from the breast.

i wanted my little ones home as fast as possible - i had a 30 weeker in 2009 and a 34 weeker just 4 weeks ago. i expressed, and put them both on bottles until they got home although i did let them 'have a go' at the breast so they learnt the technique while in SCBU. once at home, it took about a week of intensive breastfeeding and stress to switch them to exclusive breastfeeding instead of bottles.

btw - CONGRATS on the amazing pumping you're doing - your supply is much better than mine ever was while pumping exclusively!

Thanks for all the lovely words and great suggestions! Just to let you all know Willow took her first feed yesterday, latched on within 5 minutes or so and supped for 20 minutes. Today she was sleepier but after a nappy change and a new babygrow she fed for 35 minutes! I'm so much more nervous about whether she's getting enough this time though. Perhaps it's because she's 3lb 14 whereas DS was 9lb 6 when he was learning all this.
Really, really interesting the cup/bottle issue it isn't as clear cut as it would be for a term baby. In the end my mind has been made up by the most progressive consultant in Willow's unit who has suggested to all the mws that if she wants to nurse when I'm not there to give her a cup. As soon as I heard that I'll admit to a sigh of relief because I was umming and ahhing and just not sure. My heart wants her home fast, my head wants her home BFing. I know it will be the slower route but we're on day 51 so far and I am happy to wait an extra few days to a couple of weeks if it means I have help on tap to ensure Willow is fully BF rather than me ending up struggling at home with her and DS (2 years) bouncing around the place. Also playing on my mind is the fact I want her home, really, really safe and well as another lovely lovely mum on my antenatal thread who also had a premmie lost her beautiful wee daughter to an unknown cause in the first week or so home from hospital. I am now v v v nervous about our own homecoming because I don't have the strength to deal with that degree of pain after all our weeks of battling.

Firstly - hand expressing? Wow. That's amazing.

Secondly - don't assume bottlefeeding would be easier and therefore you would be home much quicker - if you have a good flow, there may not be much sucking required once DD latches on. My DS only fed for 5-10 minutes at a time and hardly seemed to 'doing' anything but we were home within 48 hours of the tube being out. (32+4 at birth, in neonatal for 3 weeks). No problems with feeding since.

I have nothing useful to say at all. What you have done (and are doing) is truly inspirational. I wish you all the best and hope desperately that you are soon home and happy with your new baby.

Poppet, you are one amazing lady with an amazing supply for your little girl. It sounds like she is doing really well if she is feeding at 34 weeks - although premmies can and do feed at this age, it often takes up to 38 weeks- due date for them to get feeding together. i second the suggestion of checking out the BLISS website - they have a really good booklet on breastfeeding which you can download and their parent forums are good too.

I'm mum to an ex-27 week baby (now 5, also born with a small hole in heart which resolved very quickly) and I think I found the transition to breastfeeding the hardest part of the NICU journey, partly because it was so quick. She took her first proper breastfeed at 34+1, I then started spending more and more time at the hospital to feed her (partly because I was terrified she'd be given a bottle if I wasn't around), at 35 weeks they said make arrangements to room in and at 35+6 she came home, 3 days after her NG tube came out and a week after she came out of the incubator. I too was continually anxious about how much she was getting but in truth we never really looked back. Do bear in mind that the tube feeds tend to be way bigger than the individual oral feeds babies take by themselves. You may also find that you need to tail your supply down to her needs given the really impressive amounts you've been expressing.

Just wanted to say I am so incredibly impressed with all of you who have managed to express and breastfeed prem babies. My two DDs were both full term but I had to express and cup/syringe feed for a week with both of them while my milk supply established, and I found it absolutely exhausting. To be able to express and feed for the length of time you have is really amazing and so dedicated.

As a first-time breastfeeder (and mum) I have no wisdom to add, but just wanted to say what a fantastic and inspiring thing you are doing for your little one.

DD2 was also a 27 weeker (now a fit and healthy 5 year old!). We spent just over 10 weeks in SCBU and it was really only the last few days when she really took to bf, and if I'M totally honest it wasn't until we were home and she could just feed when she wanted to and it was all soooo much more relaxed that it all took off.

I had two older dc so it just wasn't possible to be at the hospital all the time so she was bottle fed ebm when i wasn't around. She was just the messiest cup feeder in the world - her chart in the morning would say so! So when I wasn't there she usually had a bottle. It made no difference - she swapped happily between breast and bottle - which was handy as she could have a bottle of expressed every now and then at home.

It was fab to get home and i immediately stopped the infernal expressing - a huge relief! Hopefully you're on the home straight now and she'll soon be home. I'm just now thinking back to the day we brought J home - happy memories!