Early baby - scbu and breast feeding

[Babycameearly]

Hi All - I'm desperate for some advice please.

My first baby was born early by EMCS last Wednesday - he weighs 4lb and is in scbu. He's doing really well and I'm desperate to build his strength and get him home (leaving hime every night is killing me)

I've expressed from day 1 and have gone from producing 1ml of colostrum to 80ml whenever I express. The nurses on scbu encouraged me to breastfeed from day 2/3 and (thanks to nipple shields) I think we've cracked it to a point!

My problem - when I'm not there to do his feeds my baby is tube fed my EBM - no problems at all and although it's not nice to watch him being tube fed I accept that it's for the best. However - 2 days ago we managed 3 feeds whilst I was there, he fed for about 20 mins each time and fell straight to sleep after, Nurses were over the moon and agreed not to top him up with tube feeds whilst I was there and to try to 'normalise' him with on demand feeding - all good and I was bursting with excitement at his progress.

Then yesterday - I went in early, did his first feed - he fed for about 20 mins - then the nurse (diff one from yesterday) said 'right, we'll top him up with a tube feed'. I asked if we could carry on from day before and leave him to settle and demand feed ( I was staying all day to be available for him as I have done since he was born). She said no, not a good idea, I want him tube fed. Cue tears from me - I was so disappointed but had to relent as I felt pressured / didn't want him to go hungry.

Can anyone offer advice? I know he's still tiny and don't want him to go hungry but I just want to establish proper feeding and develop a stronger bond - we're not allowed to pick him up / cuddle him other than at feeding times andd I feel like I need him to know I'm there for him. Everything I've read on breastfeeding says to try to establish on demand feeding asap and obviously I can't do this...

Thanks x

I'd speek to his doctors and see what they say, ds3 was 8 weeks early and 4 lb 4oz. I expressed and cup fed because they said it was realy important they knew how much he was getting in the early days so we cup fed ( so not to interfere with bf) a certain amount then bf inbetween to get him used to the breast.

Luckily ds was only in nicu for 4 days and then we were transferred to the ward. The tube feeding stopped after the 2 nd day but we did have a problem with one of the night nurses putting the tube back in over night, probably because he took so long to feed.

See if you can have a care plan written in his notes. How early was he?

Thanks - it's so frustrating as he feeds really well when I'm allowed to feed him. He was 5 weeks early. Another thing - he was feeding last night before I left and the nurse came and said 'we'll stop him in a bit because we don't want him to feed for too long as it'll disrupt his next tube feed...' I thought babies fed till they were full and din't want to stop him as he was happy / nuzzling in etc...

It does seem odd if he's feeding well that they are so obsessed with the tube feeding, where I was they were happy to cup feed him rather than use the tube, they do like to measure milk intake as when they are so small they use alot of energy feeding and trying to keep their body temperature up.

It can be abit of a vicious cycle in the early days , if their not getting enough they don't put on weight because they are using all their energy to feed and keep their temperature up.

Is he in scbu due to being small or are there other health concerns

Any chance that you can talk to some one who you feel happy to devise a feeding plan which can then e explained to all staff?

Thanks - like |I said the nurse who had him on Monday was happy for him just to breastfeed whilst i was there but yesterday's nurse seemed hell bent on tube feeding (she seemed to think I just didn't want to watch him getting the tube down and suggested I wait outsde - that's def not the case and I don't mind seeing it as I know that in the first few days and whilst I'm not there it's for the best...)

He went to scbu as he couldn't regulate his temperature and needed fluids - he's off the heat mat and drip now though and is holding his own. He's been weighed this morning and has put on 2oz since his birth last Wed :)

Congratulations!

It's going back a little now, but when DD1 (33 weeks, 4lb 11oz) was in SCBU, she was mostly tube fed with the occasional bf for 2 1/2 weeks, and then switched to demand feeding when I went back in to room in with her for 2 days before we brought her home. I think the nurses like the tube feeds because they know exactly what the babies are getting, and they can be regular - so different from when you'll be at home.

I don't think it's always about them being hungry, but if you bf and then they have their tube feed as normal they can get too full and then it all comes back up again!

Why on earth are you not allowed to cuddle him though if he's a 35-weeker? I know that early babies need a certain amount of rest time to grow, but I would have thought that being cuddled is the best medicine!

You will get through this - it's such a shock isn't it, but in just a few weeks, you'll have your DS at home (and be wondering if he's ever going to stop feeding!).

Hello there. We came home ten days ago after two weeks in scbu, my dd was born at 33 +2 weighing 3lb 12oz. She quickly went down to 3lb 6oz and was tube fed ebf whilst in the incubator. She did go very sleepy for a few days and returned to a womb state, so I was unable to feed her and had to bank my copious amounts of milk I was expressing in the freezer!

We were allowed home when she got to 4 lb 3 oz and are now feeding on demand with no problems. She is still a very sleepy baby and will easily go four hours without a feed if allowed to. Except of course at night when she feeds on the hour!!

Try not to worry about your establishing on demand feeding whilst in there. I would allow them to top him up, he probably will not get especially hungry while the tube is still down, but will still feed if offered. Just play it their way until you get out, it will be quicker and better for baby. Their ultimate aim is to get his weight and energy levels up to a certain level and then they will probably remove the tube and observe you feeding for a couple of days before discharging. Are you able to go in and stay with him as that's what I did toward the end of our stay to really get feeding established. Hugs to you, I know how you feel, you just want to take them home it's stressful xxx

Have to add, some of the nurses are very militant about handling- challenge it. You are his mother. I was meekly accepting their instructions for a couple of days, then I thought, hang on a minute I've had a truly shitty time, horrible birth, long stay beforehand, can't take baby home, I'm damn well having her out for a cuddle if I want to. They can't stop you, they can only advise. As long as he is getting plenty of rest periods and his temperature is holding up it shouldn't be a problem. And having him close will boost your milk production. Honesty I had a different set of rules off them with every shift change, I learned to just let it wash over me and gradually take more and more confidence in my own care of my baby x

Hi babycameearly and congratulations on your son. I have been where you are and it is so frustrating when different nurses tell you different things! I am and on your behalf. I can really relate to the frustrated tears and the feeling that you can't say anything. ((Hugs))

My DS was in for a long time and towards the end of his stay we did as you started to do- demand fed in the day time and tubes/bottles of EBM at night. There is no reason why you should not continue to do that. His weight is being monitored after all. My DS was on the four hourly SCBU feeding schedule but when I started to demand feed it was more like every two hours. It was great to start like that because I had an idea of how often he would feed before we roomed in. It also helped my supply- I would not have been able to express his night feeds if I had also expressed tube top ups.

I am also really about the cuddling thing- he is NOT their baby, he is YOURS. If you want to- pick him up. Have you read about kangaroo care? It should be good for him and help feeding get established. I also agree with the poster who asked about rooming in- has that been mentioned?

Is there a nurse you get on with well? Maybe try to have a chat with one you click with and get a feeding plan put on the notes? Also, I know it is really tough but don't be afraid to stand up for yourself.

I have an ex-prem and am training to be a peer supporter, we are trying to improve things for mums in my local unit and one of the things we are trying to work on is feeding plans with one nurse responsible. I think that your posts illustrate why this is so important.

Good advice from wretched while I was faffing about posting!

Just to add, once I was confident I used to just get my son out myself, and do skin to skin for hours. Some nurses didn't like it but I didn't care.

We were on two hourly feeds at first although this changed by day 5 and we demand feeding to a certain extent, he wasn't supposed to go longer than four hours.

We were home 10 days after birth, as he couldn't control his temp. Going home weight was 4 lb 1 oz x

It is outrageous you are told not to cuddle him outside feed times - clinically, this is the best thing for him and there is masses of research about this. You may have to fight the staff if they are uninformed - go to www.kangaroomothercare.com for the research and ask them to read it if they are truly unfamiliar.

You need to ask for a consistent plan which all staff adhere too - very poor practice to confuse and contradict in this way.

Grrrr :( :(

Hi Babycameearly. Congratulations on the birth of your son. I had premature twins in SCBU who were tube fed for 2 weeks, mainly ebm but also some formula. The frustrating thing in SCBU is that there doesn't seem to be a policy for everyone to follow and some nurses were better than others IMO.
One of the twins was often sick after being fed because I think some nurses were a bit militant about wanting to follow a strict guideline on how much to give on a certain day.
I also felt quite vunerable while I was there and mostly just went along with what was suggested as I believed that they knew best. But after a shift change, one nurse told me that she thought the previous nurse had been at fault to top up twin 1 after he'd been at the breast becuase it made him sick.
It's such a tough time for you at the moment, but it sounds like he's doing well and hopefully it won't be too long before you can room in with him.

Hi Babycameearly, huge congratulations on the birth of your son. I have a DS who was born at 32 weeks, weighed in at 3lbs 8oz, so have an idea of your situation. I never managed to get him to BF so you have done brilliantly to establish it, I know how stressful it can be with 'helpful' nurses hovering over you or, as in my case, trying to shovel your boobs into the mouth of your screaming baby!

As others have said, this is YOUR baby and you can insist that the care is as you would like. You sometimes don't feel like that when your baby is in SCBU and I look back now at my time there and wish I had been able to put my foot down more.

I used to sit for hours with DS tucked down the front of my top, he was so happy there. I was once told not to as he was nil by mouth at one point and I was told that he would be upset if he could smell my milk. I challenged it and he was fine. Don't be afraid to disagree.

I would find a nurse that you like and have a chat about what you want the feeding plan to be. The only reason not to BF would be if your baby is too tired or cold. Otherwise I really don't see why the tube would be better.

When I was in there was a girl that refused to let the nurses give a bottle or tube and she breastfed when she was there and requested that her baby was cup fed the rest of the time. The nurses grizzled about it but they did it.

Most of the nurses I met in the SCBU were wonderful and really happy to help. Find one you like and trust and request a chat.

Lots and lots of luck and hope you get to take your little one home soon. It's a magnificent day.

You would think a 35 weeker who is feeding well, putting on weight and holding his temp with no other problems would be nearly ready for discharge

Have you asked them if he will be going home or into transitional care first, do the hospital have a weight policy for example does he need to be at a certain weight to be discharged or does he need to have gained a set amount of weight

Our hospital policy was feeding well, 24 hours off the heat mat and some weight gain (ds gained an ounce and a half) x

Hi - not much to add except my personal experience was that different nurses do things differently. I hope you feel ok about challenging it. I should have and didn't until the 3rd day. Then had a very bad conversation which got too emotional however it did alert other staff to the issue and my baby was out the next day. When I get to laptop I will post a link to a leaflet with guidelines for professionals about breastfeeding multiples. Obviously not relevant to you but it has a handy section on care in SCBU - first piece of advice is to encourage skin to skin contact. Good luck and congratulations.

our DS was 34 weeks, and 4lb5. he was on SCBU for 3 weeks, and was tube fed EBM, with gradual introduction of breast feeds, starting from 1 a day, to 3/4 a day, and once his temp was stabilised, i stayed over the weekend with him to EBF before he was allowed home. the staff were brilliant, however they did occasionally top up his bf's via the tube, but only when we were just starting to bf. once we were doing several feeds a day, they didnt bother anymore. we were never told we couldnt handle him, just to minimise time spent out the incubator in the early days til he could control his temp a bit better, but we did frequently open the hatch to touch him and we did all nappy changes and tube feeds while we were there. def find a nurse/dr you can talk to and agree on a care plan thats workable for everyone, and get it put in writing so all staff stick to it. i got a good leaflet too on establishing bf with babies in scbu, al have a look for it and let you know..

Congratulations OP! You've already had some brilliant advice and I second shouting 'kangaroo care' at anyone who tries to stop you cuddling your baby

Not really advice but a hopeful story for you. I wasn't allowed to see my baby in SCBU for a week as I was too sick (34 weeker) and after that I only managed 2 practise bf before she was ready for discharge as I was running back and forth looking after DC1. The rest was tube feeds and bottles of formula and ebm (i was a terrible expresser). They didn't even suggest cup feeding (none of the bf counsellors believed in nipple confusion!) They let me stay overnight before I took her home to check she could demand feeding without losing too much weight but that was the first time i got to bf her properly. So try not worry too much if you miss out on some feeds or they seem to top up a lot. It didn't seem to make much difference in the long run (still bf now at 14mo )

Maybe try and grab a helpful dr or nurse to give you the criteria for discharge as its all about jumping through certain hoops but it helped me to know what I was working towards. Please don't let this one nurse get to you because it sounds like you are both absolutely doing brilliantly, in particular 20 min feeds sound fab! and I bet you're DS will be out in no time and you will be able to give him all the cuddles in the world all day long Good luck x

Thanks so much for all of the advice - it came in really handy and I had a brilliant day at the hospital yesterday!

He was being looked after by a nurse I realy like and get on well with - she asked how his feeding was going and asked about top ups - I explained that I'd been forced to allow him to be topped up the previous day and how upset I'd been about it. She immediately said that when she's seen us together he'd been 'feeding like a dream' and that of course he didn't need top ups whilst I was there - 'that's what Mummy is for...'

The nurse booked out the Mother and Baby room for us and we sat in there all day having cuddles and feeding on demand - it was amazing! My Mum came up and I was able to give her her first quick cuddle! We avoided 4 tube feeds (I stayed all day) and he's started to cry and suck his fist when he's hungry and has 'definitely turned a corner' according to the staff!

he's put on 2.5 oz since his birth last Wed and he's off his drip and heat mat so I'm really hopeful he'll be home soon!

Thanks again - the difference some practcal advice makes is unreal, I'm so grateful to you all!

Great :)

When the dust settles, write to them, thanking them for the excellent care and pointing out when and how it was undermining, and upsetting. They need to know!

Brilliant - am really pleased for you but sorry you had a bad day.

In case anyone comes across this thread. This is the leaflet I found helpful:

www.multiplebirths.org.uk/MBF_Professionals_Final.pdf

Is he on any kind of sat monitor? That will tell you how he responds to kangaroo care - one if my Dts always had lovely high Sats and went into a deep sleep post cuddle, the other started desatting if he stayed out too long, so it's not always the best for every early baby, but you should be able to see how he reacts.

Find someone senior who is pro bf and get them on side, nicu units are often a bit divided in my experience.

Well done bce! It sounds as though you are doing so well. Fingers crossed that you get him home soon.

Sorry, earlier post was a bit brusque as was twins juggling!

You're doing incredibly - to be expressing that well, and b'feeding, and standing up to the nurses, all just a week in, that's so fantastic!

Re the monitors I just meant if he is on one and sats stay fine when he comes out then you can use it as proof he benefits from cuddles, if he isn't on one then clearly he doesn't need to be monitored so closely, and even if he is on one and dips at least you can see exactly how much time out he can tolerate!