Starting to breastfeed my prem baby

[BadNails]

Hello, I could really use some advice on this as I suspect I have a battle ahead.

After lots of backward steps owing to a suspected cow's milk protein intolerance/allergy, I am finally trying to get DD2 to breastfeed. We're now in SCBU (moved out of NICU about ten days ago) and she's 36+2 corrected.

So I have a series of questions really. She had a brady on me yesterday whilst I was attempting to feed her :( she was a bit sleepy and tends to fall asleep within a minute or two of me trying. What can I do to keep her awake?

Our nurse thinks my flow might be too fast for her. Should I use a shield? Is it common to use one for prems?

I'm aiming to have one attempt each day. Is that enough? I want to get her home for her due date!

I think I have loads more questions, but they've just gone!

Cheers if you can help!

Hi BadNails,

I don't have any experience of a prem baby personally but you could definitely get some support and advice through the breastfeeding helplines. They are on this page.

I think that Bliss also have a helpline here.

I have heard that it is common to use a nipple shield for prems as they have less fat in their cheeks so using a shield makes it easier for them.

If your flow is too fast, you could try feeding in a semi reclined position - have a google of biological nurturing for some ideas.

Hope that gives you somewhere to start and good luck.

BadNails my DS was born at 28 weeks and I wasn't able to start feeding him myself until he was 35+5.

Like you my flow was quite speedy, but with a lot bit of trial and error over a couple or three days I found that lying down was the best position for him. It was very haphazard to start with and he was topped up with my milk through his NG tube, but by the time he was about 37 weeks corrected we had it sussed and the tube came out.

I didn't use a shield (this was 15½ years ago), but I did have the most amazing midwife who came up to SCBU and sat and persevered with me until we had it sussed (or as close to sussed as we could). Once he'd been fed by me with no top up through his NG for a week we went home, a couple of weeks before his due date.

I'd try a couple or three times a day, don't stress if it doesn't kick in immediately, you will both find the best way. Remember it's all new to her and she's been used to having a full tum without doing anything.

Really best of luck to you both, and hope that you'll be home with her soonest. x

and keeping her awake - I used to tickle his toes, talk to him, jingle things that my older DDs had bought in for him to look at etc - anything really.

Hi BadNails
My son was prem and while getting him to feed was difficult, in the end I managed and went on to feed him for 15 months, so don't give up hope! Try and do as much skin-to-skin as you can, also blowing on her face and tickling her feet while you are feeding, and pumping her arm in a sort of circular motion should help to keep her awake. And I'm sure you've been told already but wake her up to feed her regularly, even if she doesn't 'ask' for it. If your milk flow is fast, you could try expressing some at the start of every feed - this can then be used for the staff to give her breastmilk for the times that you are not there (the staff at the hospital we were at did this for us). Also, expressing when you are not feeding her yourself keeps up your supply and ensures she is getting breastmilk. I found the staff on the ward extremely helpful and supportive and they are supposed to encourage breastfeeding so do enlist them. Otherwise, the links above are good.

One thing to bear in mind is that prem babies often have problems with their latch because their mouths are so small and this leads to pain for you when feeding. This can be helped by someone literally sitting with you and looking at the latch while you feed, but also just time and the baby getting older will improve things. I did find it painful to start with for that reason, to be honest, but I persevered and now that time is such a small part of our overall breastfeeding experience that it seems unimportant although it was difficult.

Good luck with it and keep on keeping on!

Is your supply ok? Are you expressing for non-direct feeds?

Realistically you would be best getting advice from a lactation consultant who has experience of supporting mums of prems. What region are you in?

Hi there badnails! I'm typing this while BFing my former 27 weeker DD so rest assured it can be done, just trust yourself and your DD! She too has cmpi but weve only discovered that in the last month or so, DD is 7 weeks corrected, or 20 weeks actual. Bradys are pretty common when it comes to feeding but if its any consolation she'd be having lots more on a bottle - is she still on supplemental O2? The sleepiness thing is a real premmie trait too. I'd strip her and change her nappy just before her feed, and hopefully if you time it right she'll remember shes hungry. But even if she dozes off after a while she's getting there, feeding is such hard work for them at first. You could try a shield if her latch is poor - a useful side effect is it slows the flow. We tried teaching DD from 34 weeks or so initially v slowly, just letting her nuzzle then 1 feed a day then up to 2 by week 35, then i roomed in for about 4 days and fed her as much as poss and she was home by 36 weeks. It ended up being v fast. initially was sent home bf with 2 formula top ups as she was losing weight even on hind milk top ups (i wanted to use fortifier top ups but it wasnt our nicu's policy) but we ditched those within 2 weeks as dd hated them, only took 35mls or so and they realised she only got an additional 8 cals a day, so not worth the stress. she fed 2 hourly for ages - i'd wake her up to ensure it but she now goes up to 5 hours at night and while shes still small on the 0.4th centile but shes gaining well, cooing and smiling. good luck!

Thanks everyone. We had another go today and I took some of the advice given. She absolutely refused to wake up until about 5pm! I tried everything - tickling feet, blowing face, changing her nappy, I even threatened to sing... Nothing! Then at five, bing! She woke up. Today's nurse stepped in and dropped her jaw and lo and behold, she latched on :) I don't believe she took anything, but it was a very good effort on her behalf.

We tried three times in total today, having read the advice. I'm really impressed by the quick turn around Poppet and RockStock managed. I thought it would take longer than than, although I appreciate all babies are different.

Poppet my DD is also hovering around the 0.4th centile (think she's slightly under, the charts are unclear!) She was born at 25+4 and I never thought I would be able to breastfeed her as she was so small.

organic my supply is pretty good. I've been expressing for over ten weeks and still managing about six times per day. I'm trying to push myself into increasing it to make sure I match her demand (am exceeding it at the mo) but it is hard work to keep the momentum going. I'm in Surrey to answer your question. None of the nurses have mentioned lactation experts/breastfeeding consultants, presumably there are some...

Thanks again, hopefully being armed with some of your advice will spur me on, certainly today went better!

Keep at it BadNails - I bawled and bawled the first few times thinking that it would never work and we'd never leave the bloody hospital (lovely as they all were, I wanted/needed to be home with my other babies too!). But one day it clicked, he clicked, I clicked and it was onwards and upwards from then on. I fed him until he was about 13/14 months, he was tiny, barely hitting the centile chart, until he was about two. Then he bloody grew and grew.

He is now 15, almost 6ft bloody tall and wonderful! Funnily enough I found some photos of him the other day from when he was this tiny scrap of nothingness and bawled again! I showed him and his comment was 'oh fuck - was I really that pathetic!'

I was at St Mary's with him, but we spent lots of time at George's too. Certainly in both hospitals, the midwives from the post-natal wards were more than happy to come and help me when I needed it - perhaps you can have a word with one at your hospital?

I've had a peek at your pictures - she's gorgeous. Keep it up, she'll be home soon.

You're getting great advice, Bad Nails. Just wanted to add that DS2 was in SCUBU for 8 weeks and I tried to breast feed as soon as the nurses said he should be ready. Nothing.

It wasn't until I'd had him home a week and all the stresses of SCUBU had faded a bit that it clicked for us. It sounds like you and baby nails are nearly there, but I just wanted you to know that as long as you're expressing there's always hope.

RockStock the clicking is what I'm hoping for

DD made me laugh yesterday, as she kept poking her tongue out as if expecting to be fed with no effort! I had expressed a little drop of milk out in an attempt to encourage her to open her mouth and then she just kept licking me..

Eye I think you may be right, it will no doubt be easier once she is home. I understand the theory behind forcing a routine onto babies, however it occasionally feels unnatural to be following a three hourly feeding regime. The problem is they won't discharge her until they are happy she can feed! She came off oxygen a couple of days ago and we were warned that it is actually the feeding which is the longest/hardest battle. No pressure then!

They're right, it is the hardest battle. But....it's literally one of those 'ping' moments and you're left wondering why you were stressing about it!

You did so well today, tomorrow's another one. Please keep us posted as to how you're getting on. I am excited on your behalf that you're at this stage.

Ah cheers RockStock, I will post again. Today DD certainly seemed to have a vague idea what she's supposed to be doing! It was slightly depressing yesterday holding a sleeping baby to my boob, saying 'come on darling, dinner's here' whilst a nurse loomed over me asking if she could help. I felt like asking for the instruction manual.

It would be easier if I hadn't placed pressure on myself some months ago to breastfeed as I had been so rubbish with DD1!

I shall let you know how I progress :)

www.surreybreastfeeding.co.uk/ (I don't know this lady at all, I just picked her up on a Google search)
www.lcgb.org/consultants_local.html

Your NCT branch may have a breastfeeding counsellor who can see you as well. They will be free :)

Not sure what you mean about forcing a routine onto babies?

Sorry short - late - off to bed before DH thinks I've deserted him :)

xpost organic - the doctors and nurses follow a regime of feeds. So DD was on two hourly feeds and is now on three hourly at 150mls per kg of weight. It ensures that she has sufficient nutrition/calories whereas at home it would be less scientific! I would probably be demand feeding.

I'll see how the next couple of days go and if there is someone I can speak to at the hospital. Thanks for the links, that is very kind of you to have had a look. My NCT membership is up to date, so may as well make use of it :)

Actually, I did find that when DS came home from hospital the routine that he'd sort of been on in the hospital actually transferred home really well. Handy it was, given that my other two had only just turned 2 and 3!

Forgot to say that DS2 had bottles for his expressed milk towards the end of his SCUBU stay. I was gutted to say the least but didn't want to delay him coming out because I was insisting on breastfeeding. Talk about rock and hard place.

If I'd known there was a good chance he'd get there despite having bottles I would have saved myself a lot of stress. Have come across other mums with prem babies on MN who've had same experience. It took a lot of support though.

Hang in there BadNails - sounds like you are doing great! Prem babies just are very sleepy, but anything you can get into her direct from the breast is good.

Once DD1 was home, I used to feed on one side, then change her nappy to wake her up a bit, then feed on the other side. I also used to take all her clothes off in an attempt to make her a bit more awake, but they get their in their own time.

Do the nurses/paeds say that you need to establish demand feeding in order to get her home?

I had prem twins at 33+4 and they're now 22 weeks. With dt2 they helped me hand express and he latched on immediately and with great vigour. At the next feed they gave him a tube feed while I was feeding and good me that this way he'd associate a full tummy with bf. We ended up using nipple shields during a sleepy phase as if he fell asleep I'd waken him and stick them on as much less effort for him. We now feed without again and it was relatively easy to get him off it. Dt1 who never went to scbu was quite another story.....

Wow she's a 25 weeker!?! Much, much respect lady - you're doing an amazing job. Astounding, big hugs for you and your beautiful wee girl. Trust me there's these fiddly couple of weeks or so then all the effort of the weeks and weeks of pumping will be worthwhile. You are doing brilliantly!!!

25 weeks is amazing! Keep up the good work!

I agree with what everyone says about one day they just 'get' it and you wonder why you spent so long worrying and crying! Once they get the hang of it is is astonishing how everything clicks into place. My DD2 was born at 33 weeks (amazing your DD was a 25 weeker!) and things really took off feeding wise when they moved her onto 4 hourly feeds. I had to stay in with her and feed her myself for 48 hours without any NG feeds and then we were allowed home.

Thank you so much for all of the good advice ladies. Yesterday I was preparing to deliver some good news. After a couple of days of hit and miss, my girl latched on for half an hour and took about 10mls :) to say I was over the moon would be a massive understatement.

For anyone reading this looking for some help, I combined a whole load of advice offered and waited until she was bright eyed and bushey tailed. Once it looked like she was falling asleep, I changed her nappy and changed breast. All of a sudden she seemed to understand!

So after a day of feeling like the earth mother personified, I returned to the hospital this morning to find today was a bad day. We've always had feeding issues and her gut appears to not be tolerating my milk again, so she has returned to Neocate (special hypoallergenic formula). This will be for around two weeks, so it looks like I'll be expressing and waiting again. DP raised the point of trying bottle feeds again :( . The problem is we have to in order to get her home.

Anyway, sorry for the downer, but I thought I'd let you know that we were getting there and thank you all again.

BadNails I had the same with DS. I didn't want to say things to put a downer on while encouraging you - they're all different. He was given some special stuff (medical term...), but also was given my milk through his NG. He was ok for a while, I think to about 18 weeks and then he lost a fair bit of weight very quickly (about 25%), they took him in and beefed him up with nutriprem (nutriprem was still on trial then..) and he came home (again) about a week later.

He seemed fine on my milk after then, but from about 13/14m he could only tolerate soya milk, so I was given soya formula on prescription for him. We tried him on full fat cows milk at 24m and he was fine again. I think (wonder) whether it's because their little guts are so immature and sensitive that they have 'off days' here and there?

Keep expressing and if, at the end of all this, the only way to feed her and get her home is to express and feed her with a bottle of your milk, then at least she will be home. Please don't be disheartened, it sounds like things are just going at HER pace and as I'm sure you have seen over the past few weeks - it is very much two steps forward and a giant leap back at times. But...other weeks it's onward marching.

You will be fine, she will be fine - you might not have everything exactly as planned, but that's children .

Chin up, I was thinking about you over the weekend and wondering how you were getting on. ((random hugs thrown in, because))

Hi badnails, I was on your other thread occasionally. Wow you are doing brilliantly. Well done for perservering, I know how tough it is. I'm sorry she has taken a step back with the milk. If it's any reassurance my DS took bottles and breast and had no problem switching between the two.

Re breastfeeding, if she is ready to start again soon- the thing that made the difference for me was to feed DS on demand when I was at the unit. So instead of latching him on at 'feed time' and then giving a top up I just fed him when he wanted to feed, expressed after and then fed again when he was ready. I did that for the whole day when I was there. I expressed at night and he had bottles and tube when I wasn't there. It took the pressure off feeling that I had to breastfeed and express full feed volumes. When he came home we went to breast only and it was fine.

IIRC you have another child so that might be hard going, but maybe for a day or two it might help.

Whatever happens you are doing amazingly well. It is so tough. I hope she can be home with you soon.

Hi BadNails. I hope things are going okay.

I was thinking about you this morning, and remembering back to when DD1 was born early and in SCBU. I think I ended up getting almost too hung up on breastfeeding - I think because I felt that in a way I'd 'failed' DD by her being born too early, and that BF was one thing I could do right. Now we did manage it in the end, and yes, of course BF is a lovely and very important thing you can do for your baby, but it isn't the be-all and end-all.