Exclusively expressing for newborn in intensive care. Advice??

[BebeBelge]

My baby is due in 5 weeks. I already know that he will be very ill when he arrives and will immediately be whisked away from me and rushed to intensive care where he needs to be ventilated. All being well he will receive an operation after a few days which will allow him to eventually be weaned off the ventilator. But could be in hospital for a long time.

So, initially, he will be tube fed and on drips and may not be well enough to even have breastmilk at all.

I have been told that I will be encouraged to express which is great and I 100% want to do this. I was just wondering if anyone has been in a similar situation and has any tips? Is it the same as breastfeeding a new born in that I should start asap after the birth and express every 3 hours or so day and night? Will my nipples get sore the same way they might with an actual baby latching on?

I think I am a little daunted at what lies ahead and would appreciate any practical advice/tips.

Many thanks in advance!

I'm also wondering about the logistics of expressing so frequently whilst sitting at my baby's bedside and having 2 other children to look after. I am guessing that the hospital will be used to this and will have somewhere for me to go and equipment to use?? Aaarrgh! So much to think about!

BebeBelge, have you talked to the midwives about this? At our hospital there is an infant feeding co-ordinator, specifically to help with issues like this.

Hello there

My DS was in social care for 10 days after his birth and was taken away straight after he was born because of complications during the birth. I managed to express for him and he was fed through a tube at first and then by bottle.

His first feed at only a few hours was formula unfortunately but I asked for help expressing and was shown how to hand express and collect the colostrum with a syringe. I then moved on to pumping and pumped every three hours the whole time he was in special care. I also visited him in the unit and breastfed but found there was little help inside the unit as they were more concerned with helping him than helping me.

As far as I can remember I didn't get sore from the pumping but my milk did come in very soon after the hand expressing and I did get very large full breasts within a couple of days, at which point I began using a big pump on wheels. I was in hospital for 3 days and then was given a smaller electric pump to take home.

Practical tips - make sure the midwives/other nurses etc know you want the baby to be breastfed and ask for help to hand express colostrum. I had several midwives grappling with my breasts but it was really important to me so I wasn't embarrassed by it.

Get pictures of your baby and keep them near you as looking at them will help your milk flow/production.

Be determined - I set an alarm for every three hours and pumped. Make sure you have a good book and some snacks nearby and try to relax. I found the electric pump really good.

Ask your hospital for a pump. we had to pay a £10 deposit and were able to take one home. They provided bottles for the milk which were sterilised and in bags so no need to sterilise them at home.

Will you be allowed to stay in the hospital with the baby and have skin to skin?
Hope it all goes ok for you both. Myy DS is 16 months old and is still breastfed - as soon as I got him home I phased out the bottles (With a lot of help from people on here) and he was soon fully breastfeeding :)

RE having somewhere to go - in the hospital I was at the neo natal unit had a room for breastfeeding/expressing but had I had any other children they wouldn't have allowed them into the unit because of the risk of illness.

Do you have someone who can look after your children in the early days?

Hi Bebebelge, it might be worth re-posting this on the premature birth thread as well for more advice but here is my experience:

1. Hand express the colostrum, I stupidly attached myself to the massive electric hospital pump straight away every 2 hours and was massively engorged and slightly ill when my milk came in.

1. Check the hospital has the practical support available if you are staying in for a bit- what sterilising facilities are there for the storage bottles and for the attachment that fits the breast pump if you are using hospital pump. If using hospital pump, check they have enough decent pumps to go round, if you are having C-section they can be on v heavy trollies that have to be wheeled in and out of your room if they haven't got enough for one each. Also if you have big boobs you might need a bigger funnel

1. Frequency of expressing - the most important thing for your supply is never to forget the night ones, that is what will keep your milk going. So I was told something like aim for 8-10 in 24 hours, don't go more than 5 hours without expressing.

1. Do both sides and keep the pump going for a bit after the milk stops going out. If they've got a double pump, even better. Look at a picture of baby and try to really relax whilst you're expressing.

1. Shouldn't hurt at all unless you've got big boobs and the funnel is too small.

HTH.

cairnterrier the midwives have all been a bit vague so far and just say, don't worry about that now... Not too helpful but I will try and find out if there is a feeding coordinator as that sounds like the best person to advise. Thanks!

duellingfanjo thanks for the tips! I think I will be able to stay in the hospital or at least take it in turns with DH to stay overnight but no skin to skin at first as he will be on ventilator and hiked up to ask sorts of machines and then recovering from surgery.

BebeBelge I exclusively expressed for DS2, born prematurely, for about 3 months. Took his own sweet time to get the hang of breastfeeding but got there in the end.

Not much to add as previous posters given lots of good advice. Make it clear to nurses that expressing is what you want and make sure you have lots of support from your family.

I also had 2 older children and managed but it is definitely the harder path to choose on top of all the worry and stress of a sick baby.

I will kind of have childcare but not 24/7. Only on certain days at certain times etc. so DH and I will have to try and be at home as much as possible for the other 2 dc. Also don't want them feeling abandoned.

I have to run now but will check back later tonight. Thanks so much for all the replies so far!

Agree with EyeoftheStorm - it is the harder path. You have expressed for at least 30 minutes, sterilised all the crap, put the milk in the fridge, and yet you still haven't actually fed your baby. Having said that, it is the best feeling in the world that your very sick baby is getting better and gaining weight purely on what your hard work has provided for him.

When I was in hosp the infant feeding co-ordinator was on maternity leave and hadn't been replaced so the feeding / expressing advice was a bit hit and miss. However one very nice healthcare assistant went on and on about how special the milk was for premature babies (how the hell your breasts are supposed to know you had the baby early I don't know) but she really supported and encouraged me to carry on with it.

BebeBelge - no worries, the infant feeding co-ordinator is different to the midwives but they should know about whoever holds the role. Might be worth contacting your head of midwifery services also to find out if there is someone with a role like this? It might be a different job title in different hospitals.

Hope all goes well for you x

My parents came to help and DH's work was really good. He used to go in the morning and I'd spend time with older two. Then he'd go to work and I'd stay for afternoon/early evening. We were about an hour away from hospital and I'd get back to spend time with older 2 before bed.

I expressed through the night - I hired a medella pump and hospital provided sterile bottles. I'd take them in to the hospital and they froze them. The babies don't drink much in the beginning so you can get a bit of a store up for later. At hospital there was a room to express in with all relevant equipment.

As an aside, I took the line 'who needs me most at the moment?' It was clearly DS2. DS1 and DD1 were happy and secure with their grandparents and though it must have been a bewildering time for them, almost 3 years on, they never refer to it and they love love love their little brother.

Combines post is really comprehensive but i'll just add that used to try to mimic evening cluster feeding by plonking myself down infront of the tv for a an hour or 2 at about eastenders time with the pump turned right down. It seemed to work as I was properly pro at expressing when my DC were eventually discharged :)

There are medications you can be given to increase your milk supply should you find you need it.

I wish you and your son a speedy trip though his treatment. It is a special kind of scary to be expecting a child you know will need a lot of treatment, I hope you are coping alright :) x

I fed DS1 with expressed milk for a week in the neo natal ward. All the advice above is great. The staff in the neo natal unit were brilliant and they had a special fridge for the milk. I could express the milk and store it there and knee that he could be fed as needed on my milk. I have 40DD boobs and found the funnel that came with the pump was fine.

Looking at pictures really helped.

I found that my hands were really swollen after my c section so had to ask for help to manually express into a syringe.

When he was ready to try breast feeding they let me know the times of feeds so I could be there to try.

Pm me if you have any more questions x

I echo all the above advice. My DTD was in special care for a week and I expressed for her while feeding DTS. The midwives were great at helping to hand express colostrum and in fact DH got very good at this too! It might be worth asking about donated bm if you don't express enough for whatever reason (they gave my DTD formula without asking me first). Best of luck and hope all goes well

Good idea about the donated milk ceeveebee, or you could try some colostrum harvesting before your baby comes. (if he's not premature obviously, I can't tell from your post if he's coming early).

Really hope all goes well for you both.

Bebe - are you still in Japan?
How are they over there about breastfeeding in general?

DS2 was 10 days old when he was in intensive care (heart op, not diagnosed antenatally). I was referred to the breastfeeding co-ordinator by the ICU nurses, there was a place to pump and store milk etc. I also made sure I got up during the night to express - advice given to me by a friend who had a 32 week premie.
The nurses were great at helping me with the practical stuff, storing bottles, finding me labels for the bottle etc.
DS2 is now 20 months, still breastfed and fighting fit.
We had big issues with DS1 and breastfeeding (although he was perfectly healthy) and I became a dab hand at expressing colostrum - ask an experienced midwife to show you how and make sure your DH sees too - mine is very proud of his colostrum harvesting skills. Good luck and I hope it all goes well for you.

Thanks everyone for the replies. It is very encouraging to hear that other babies do eventully take to the breast too. I have been worrying that he might never get the hang of it if he is in intensive care for weeks on end.

DuellingFanjo No, I am not still in Japan. Loooong story, but basically, my husband's employer (who covers our medical expenses while overseas) refused to pay for treatment in Japan and insisted we come home to get it on the NHS. So poor DH is still in Japan as he simply has to work but is aiming to come over here around the 38 week mark (I am 35 weeks now). We are crossing our fingers baby doesn't come early. So I am here with 2 dcs staying with my MIL (whole other thread there!), trying not to think abut the fact that my baby might die, and if he doesn't could be seriously ill. It all happened so quickly too. I was diagnosed at 28 weeks and within a week we were on a plane back here. So we have been without DH for 5 weeks now and it is really, really tough. I feel so helpless. So, I'm concentrating on what I can do rather than what I can't do. I can find out as much as possible about expressing!

Thanks again everyone for the tips (especially about the colostrum and hand expressing - I hadn't thought of that). Also, I have emailed my midwife to see if she can put me in touch with the feeding coordinator, if there is one.

EyeOfTheStorm I think that I am worried about being torn between the children too so your question 'who needs me the most right now?' will probably turn into some kind of mantra for me! Ds is 20 mo and is a bit unsettled after the move and missing his Dad and is quite clingy at the moment so I feel particularly anxious about him feeling abandoned. DD is 3.10 and is much more confident and I've talked to her about how the baby will be sick and will have to stay in hospital etc. but again i worry for her. She was really happy in her nursery in Japan and had lots of friends but within a week was whisked away to the other side of the world without her Dad for so long. I just hope me being at the hospital so much won't tip her over so to speak...

I agree with what one of the other posters has said that colostum harvisting while you PG would be a very good idea. Breastmilk is so important for sick babies if you can't express for some rasion do push for donor milk.

Bebe you are carrying so much at the moment and sound incredibly calm and strong. I hope you have some people you can really lean on. If I could do anything differently it would be to be more open about hard it was and not put a brave face on for others.

DS1 was just 5 and DD1 just 3 when DS2 was born. I tried to be truthful but not emotional about what was happening and they did visit him once at the hospital (it was the time of swine flu and only parents allowed in NICU). DS1's eyes were out on stalks but it was definitely in the exciting category for him rather than the worrying.

I just tried to be present for them when I was with them and make sure everything was as normal - trips out, parks, soft play etc - when I wasn't. But it is like leading two parallel lives for a while, neither of them being where you want to be.

DS2 had complications due to his prematurity and needed an operation at 5 months. It was a long time before we knew everything would be OK so I do understand the uncertainty you are living with at the moment.

Hi Bebe, you have got some really comprehensive advice here; I expressed for 6 weeks when my dd3 was born - she was brain-damaged at birth and went straight into intensive care. I had already expressed for dd1 who was premature, so I knew to ask for photos to look at while expressing, and also to ask that when she came off the drip, to only be fed by naso-gastric tube, so that I didn't have the bottle to breast struggle. The hospital let me store the expressed milk in their freezer, and I ended up taking a load home with me when she left hospital - as breastfeeding was established I defrosted it to use in her first solid feeds at 6mo.
I came home after a week, but would spend most of the day at the hospital expressing, skin to skin etc - luckily my neighbours all rallied round for dd1 and2 who were very young. When I got home I dropped the middle of the night feed, expressing at midnight, then 7am, but when dd3 came home I picked up that feed for actual breastfeeding.
I ended up sending dds to grannies for a week when dd3 came out of hospital - they thought they were having a treat, but it meant I could concentrate 100% on getting feeding fully established. (She came home with ng tube, mixed breast and tube feeding). Best wishes to you and your little ones.

Thank you again for the replies. I'm afraid I don't feel brave or strong. I'm on auto pilot really just waiting for the birth as that is when everything will happen.

Thanks for the support everyone. I will try and post back when i have given birth and let you all know what happened. I'll probably have a ton more questions by then too!

oh I forgot to say, I hired an electric pump from local NCT to use at home as I was getting a lot more using an electric one than a small one from Boots.Your local NCT branch will almost certainly have a breast feeding advisor who can come to your house, and the pump hire person can probably deliver too - I used to be the local pump hire person :)