Please hold my hand as I try to get my premie breastfeeding

[KD0706]

DD was born at 32 weeks, and is now four weeks old. She came home yesterday, taking her feeds from bottles (expressed breast milk).

She has just taken her first breastfeed. She was on the first boob for about ten-fifteen minutes then her latch slipped and started to hurt, so I took her off and tried to put her back on. She was rooting around but wouldn't latch on again so I offered her boob 2 and she went on that for about ten minutes then fell off asleep.

I expressed after the feed. Without having fed her I would usually get 150-200 ml. I got 85ml. She had been taking 60-80ml in her bottles.

This all sounds good right? I'm really anxious that she hasn't taken enough. She still needs woken for her feeds so I'm anxious she won't cry if she's hungry.

I don't know whether to offer her boob or bottle at the next feed. My ideal end result would be her being ebf with DH giving a bottle of ebm at about 11pm or so before he goes to bed (so I can go to bed early).

Any reassurance hints or tips gratefully received. I did all this with DD1 so should know what I'm doing, but she was more vocal about wanting fed and with her I just gave her boob and she never took a bottle again...

Hi KD0706

It sounds like you're doing a brilliant job! DD was 33 weeks when she was born and it sounds like we started exactly the same way as you. I expressed every 3 hours for probably the first 8 days or so (though the night too) while she "learned" how to suck on me. It was like she didn't know what to do at first. She never demanded to be fed so I offered her boob every 3 hours and then gave her the bottle after each feed. It took a couple of weeks before I could feel the milk coming out when she was breastfeeding and she started to reduce the amount of EBM she was having after. Eventually I just breastfed her and didn't need to EBF. Have you spoken to la leche/NCT? I found them both brilliant. I also found the website kellymom.com a great source of information and comfort. Lots and lots of luck to you. I've got DS arriving in a few weeks so I'll probably be asking for your help then!

Hi mollysmum what you did sounds very similar to us. Except DD is on four hourly feeds. Seems mad for a five pound baby but it's what the hospital said.

Last feed wasn't as successful. She seemed really sleepy and I thought she wasn't going to breastfeed at all. But eventually she latched on to one side and I felt she took a decent feed. She refused the second side but took 25-30ml from her bottle. She wasnt sucking like crazy though, so she must have been at least a bit satisfied from the breastfeed.

But I'm a bit gutted that I expressed after the feed and I got loads out. Which makes me dubious about how much milk she took.

Argh this is all so hard. Why doesn't somebody invent a boob gauge to show how much a baby has taken!!

KD you can offer more frequently if you want as 4 hrs is a long time, I am helping care for week old 5lb twins and they feed every 2.5-3hrs day and night.

KD, congratulations on the birth of your DD. I know it is hard but well done on getting this far.

Try not to obsess about the ml, what does it tell you if you know the ml. Nothing of any use. 5lb seems a very healthy weight to me. I would try some babymooning and try different positions to get her interested, strip her off so she is cooler, blow on her, tickle her toes to keep her awake. I even resorted to pinching (very gently) Ds ears. Try to establish demand breast feeding and relax the schedule or use it as a minimum not a target.

The BF feeds will tire her more easily but try to give more of those to stimulate your milk production. What you express bears little relevance to how much she gets from a feed. Don't be too concerned as your feed of her will have stimulated you to produce more which is what you then got out.

Congratulations again and all the best.

I don't have anything really helpful to add as wasn't in your situation, but just wanted to say congratulations on your DD and well done, it sounds like you are doing brilliantly.

I found just getting into bed and letting DD lay on me with just her nappy on really helped in the early days, lots of skin to skin and a sling was great, I just fed her whenever she made a squeak of any kind! Don't know if it made a difference but she fed till 18months. It took us ages to get to the right positions etc for us, I found it easier after visiting a cranial osteopath, cause DD was breech and was all scrunched up, didn't like one side as much as the other. Your milk flow is less at night too I think? or at least they can be fussy in the evening anyway, it's highest at 1 -2am I heard, I might be wrong. So expressing can mean nothing in terms of how much she is getting, and she will take what she needs, just keep offering and tickling toes etc helps, I heard that stroking the side of te face is good, and watching for that little muscle in the jaw moving, just by the ear, to see them drinking really helps to reassure I think. Is there a breastfeeding clinic near you? I found them brilliant, at least someone made me tea and let me drink it while it was hot whilst listening to me worry!

The more you feed the better it will get, it gets so much easier every day, just have faith you can do it and take it a day at a time, she has already had the best possible start as it sounds like you are doing great.

Hi OP - first off congrats on your baby and for your first breastfeed! I struggled like mad with my premmie baby until the nurses suggested nipple shields. Amazing - latched fabulously and stayed on - no pain for me at all :) Buy the small ones - most chemists / Asda etc sell them. Honestly couldnt recommend enough :)

Hi OP - congrats on bringing you LO home :) Sounds like you're doing a great job. My DS was born at 34 wks and came home after 8 days in the hospital. At that point he was on a 3hr schedule of a BF topped up by a EBM bottle. I remember feeling a bit anxious about making sure I followed this routine - I even had an Excel spreadsheet to record time on each breast, amount of EBM taken from bottle, how much I expressed etc. etc. It took a while to relax and understand that the BFing was working just fine - and to then feed on demand, stop topping up, stop pumping etc. I think it's hard to go with the flow with a premie because of all the worry about whether they are OK and all the time spent in a medical, managed environment where other people are telling you how/when to feed. I turned a corner when I let go a bit, and trusted that my body could nourish this baby, and saw that he was thriving. If your DD is growing, peeing, pooing (once in a while!) and satiated after a feed the chances are all is well. It seems like trite advice, especially after the intensity of having a premie, but if you can feel confident and relax a bit things will start to feel more manageable. Good luck!

Thank you everybody for your lovely encouraging messages.

Fingers crossed I think things are going well with the feeding.
I've stopped offering a bottle top up after feeds because she was either not taking anything or taking a teeny amount like 5-10ml.

We have also upped from alternate breast and bottle feeds, and other than her 8pm feed is now on all breastfeeds.
She is still fussing a bit and it takes 10-15 mins of me waving my boob in her face before she will latch on and take a feed. So feeding in public is a while away!

DD gets weighed again on Friday so I have my fingers crossed for a decent weight gain, which would put my mind at ease.

My big issue at the moment is reducing my expressing. I was expressing about 150ml every three hours, but she was taking just 70-80ml in her bottle every four hours, and I assume she's taking similar from me. So I think if I just stopped expressing full stop I would end up engorged and sore and probably do myself a mischief.

Hi OP well done on doing such a great job. I was a 29 week premmie and was EBF from six weeks onwards (EBM before that) until I was 18 months old. I am the healthiest person I know. Premmies really benefit from EBF! If you want to drop expressing can you feed DD more frequently? Is she feeding to a schedule atm? I would aim to BF every 2 hours in the day and every 3 hours at night until the midwives advise you that you don't need to wake at night anymore (e.g. she can demand feeds and wakes herself).

Congrats on getting DC home and feeding - well done you!!! My DC2, DD was a 27 weeker and we're still bfing now, and she's 7 months old (four adjusted). She never ever cried for feeds either, so I had to set my alarm, and just feed her by the clock. I too think four hours is way too long, our NNU had DD on a 4 hourly schedule too, but they do it because most babies are FF in the NNU and they don't really have a clue about BFing, DD lost weight learning to BF on a 4 hourly basis, so I upped it to between two to three hours during the day, and 3-4 hourly at night and she soon started gaining... plus I added a lot more clothes to ensure she wasn't wasting precious calories keeping warm. But then she came home at 4 lbs. Anyway hope things go from strength to strength and good luck with the weigh in!

Sounds like you are doing fantastically - my DS struggled to feed for more than 5-10 minutes until at least term. He was born at 26 weeks, fully bf until weaning and 21 months later is still a milk monster...

Please, please, I'd echo the call to ignore the instruction to only feed every 4 hours - that is setting you up to fail. There is no way a 5lb baby can go that long between breastfeeds even at full term. NNUs know nothing about breastfeeding, they are entirely geared to formula - shocking but there you go! Once my DS was fully off tube feeds (later than your lo, at term), he probably fed every 2 hours during the day, and I'd set the alarm for every 3 hours at night until he was big enough to wake up himself crying for food (that came all too quickly:) )

Good luck!

I'd second all those messages about 4 hours between feeds OP. DS (33 weeker) was feeding every 2-3 hours until about 5 months when we started solids. It was only at about 7 months he ever went as long as 4 hours in the day between feeds.

The premmie stomachs are small, and on top of that, they have a lot of catch up growing to do!!! That's how I reasoned anyway - bit like one contiuous growth spurt. Hard work but worth it though of course. Also, DS only 'got' bf when he was around 37 weeks i.e. coming to his full term age - the hospital expected this.

Best of luck!

Hi. Thanks again everybody.
I have taken your advice and I'm offering every three hours. She is still so sleepy and needs persuaded to take a feed. But when she finally latches on she is taking what feels like a good feed. Usually only one side.

I have always expected the four hours to reduce once she was more awake and demanding. DD1 rarely went as long as three hours, even when she was about nine months old (she was blw and a bit slow on the uptake!)

I think I was just allowing the hospitals four hourly routine to continue because it's easier with a toddler and a baby to have such long gaps! But I know you're all talking sense!

Well done KD0706 sounds like it is all going swimmingly. Keep up the good work.
Maybe try reducing the expressing a bit at a time then you have some in reserve if you need it again (freeze it).

Good luck hope the weigh in goes okay and try not to panic to much if it doesn't. As long as she is feeding, weeing and poohing and gaining (not losing) and seems well try not to panic.

Hello I just wanted to update. The weigh in was fabulous, she had put on 9.5 ounces in the week and the health visitor was delighted with that.

She still isn't waking herself for feeds, so I am still waking her. But even with her still being so sleepy her latching on is going so well. It's now at most five minutes of faffing before she goes on rather than the fifteen minutes it used to be. And often she goes on immediately. I feel so lucky that things seem to be going so well.

Well done

I hope you're managing lots of skin-2-skin cuddles too. That will help her to get even better at all of this.

Thanks pesto
Probably not as much in the way of cuddles and skin to skin as I ought to do. I have two year old DD who often only sleeps for ten hours a day, so poor DD2 generally comes second either to DD1 or to my need for sleep!

I am trying though.

Have you got a sling? I found that invalauble both times I had baby/toddler combo. It is hard work, though, and that was with all mine being full term, so hats off to you for your great work!

ds was born at 34 wks, is now almost 6 months and going great guns with feeding. scbu had him on a 4 hourly feeding rota (was tube fed ebm until bf established), but they did tell me as soon as we got home to feed on demand, but not let him go any longer than 5 hrs in the early days. i would probably try reducing the expressing by only expressing enough milk to feel comfortable again, as i was told by scbu. i initially expressed every 3hrs while he was in hosp, but once we got going with BFing, started winding down the expressing gradually.
i;ve also been told that the amount you express is NOT an indicator of how much your baby takes. babies are better at removing milk (so to speak!) than a pump, so will generally take a bigger volume than you will express iyswim. as long as she's having plenty of wet nappies and gaining weight, she's feeding well.
DS did get much more vocal about demanding his feeds after a few weeks, and i found using a sling to be a great help too. sound like you're doing great n hope you continue to do so :)