Any tips to successfully breastfeed a premature baby?

[Cheeser]

Hi

My DS was born early, at 30+1. He's now 8 days old and I've been expressing for him and he's fed exclusively on my milk. I'm expressing about 300ml a day which is gradually increasing just in front of what he's consuming, so good so far.

I really want to be able to breastfeed him once his feeding tube is removed. The midwife I spoke to said his suck reflex won't come in until 33 weeks (so another 11 days or so) and that they usually try them on bottles first before trying them on the breast. Is there anything I can do in the meantime to make sure I can feed him myself without any bottles further down the line? If bottles are introduced now will that make it harder to get him to exclusively breast feed?

And any tips for increasing supply? I am expressing every 3-4 hours, including an express at around 4am, and sometimes I get more milk than others. I am dual expressing at home late in the evening and through the morning and using the hospital single pump during the day. When using the double pump I pump for a few minutes after the milk has stopped coming on each side. On the single pump I try both sides twice, making sure they are as empty as possible.

Am I on the right lines? Is there anything else I can do to make breastfeeding work? Any hints and tips gratefully received.

Thanks in advance

Oh my goodness, it sounds like you're doing a fantastic job! It sounds to me like your milk supply's pretty good, don't think i ever got that much. As far as i know there's nothing you can do to increase supply except trying to keep well nourished hydrated. I think every 3-4 hours expressing is plenty and I'm very impressed at the 4am effort!
We had slightly early but very small baby (pre-eclampsia) who didn't need tube feeding but did get supplementary bottle feeding of formula and expressed milk. We actually found it really helpful in the longer term that he always took a bottle- I have friends who had a lot of difficulty when it came to stopping breast feeding or even going out for the odd evening. The other thing I might mention is that with all the feeding we ended up doing ( a 3 hourly cycle of breast feed, expressed milk and formula) our son did end up very 'suck dependent' for sleeping which have have found difficult to break, perhaps try to not feed immediately before naps if that's something you think might be an issue.
As regards breast feeding I just let my son suckle even though I'm sure he wasn't getting much. The rest seemed to come naturally but the midwives/ nurses should hopefully be able to help if not. Failing that there are breast feeding support nurses who can give advice even over the telephone and I found quite good.
Finally, please don't wear yourself out, I found the whole thing pretty exhausting and didn't feel I could ask for help. The longer your baby the better but don't feel guilty if you want to add in some formula later on, you have already done a fantastic job for your baby by having been able to express so well early on.
Well done and good luck!

Wow, - you're doing amazingly. And yes, you sound like you are well on the right lines.

Not sure about the bottle trying before breast. That seems a bit unnecessary to me tbh. Why not just go straight to breast? There can't be any reason for the bottle thing except a lack of confidence in the hcps of your breastmilk and perhaps an inability to measure intake but that is really no sensible reason.

Wow, congratulations!! My DD was born at 26+5 and I expressed until trying to breastfeeding around 30 weeks but my supply was terrible and I found expressing a horrible experience. I am a bit confused about the bottle first, the hospital we were in cup fed if a baby was going to be breast fed but refused to bottle feed a breast fed baby. Might be worth reading up about it, I'm not sure of the reasoning TBH but they were very adamant about it. Also, the breast feeding nurses I spoke to said that although the suck reflex might not be developed it is good to put them to the breast and hand express a little on to the nipple to let them lick and taste it. Perhaps you could ask the nurses if that would be OK? It would also be good for increasing supply (not that you necessarily need to).

Lots of the mums I spoke to had a similar problem to me in that supply dropped around 5/6 weeks (just mine dropped to around 80ml a day, that wasn't common) so don't feel as rubbish as I did when that happened, it improves :)

Good luck, and congratulations on your DS.

You are doing brilliantly with the expressing - my DS was born at 32+0 and had to be supplemented with formula until day 8 when my milk came in! Keep it up and I'm sure you will have plenty to feed your baby.

Suggestions to help breastfeeding;

• Lots of kangaroo care (skin to skin) and let the baby 'nuzzle' at your breast, you can express a drop of milk onto his lips (check with nurses but you could prob do this now).
• The tube doesn't need to come out before you can breastfeed - when he is able to suck properly (usually around 34-35 weeks) he can breastfeed and be 'topped up' with tube feed (they just tend to get v tired at this stage)
• Make it clear to the NICU/SCBU nurses you wish to breastfeed - can't see a 'need' for bottles but every unit is different! Ask about cup feeding - my baby did this overnight when I wasn't there and he was being breastfed - apparently better than bottles as more similar to breastfeeding (but harder work for nurses I think!!)

Good luck!

Thank you both - lovely to hear you think I'm doing well it's tiring getting up at 4am (feels like I've got the shitty end of the stick, getting broken sleep without even having my baby at home with me) but it makes me think I'm doing something for him.

Starlight I was also unsure about why a bottle is tried before breast - I too assumed it was so they could measure intake. When the time comes I will ask more about it and see if I can just put him straight on the breast. Unless there's some other reason I'm missing. Although I can see, like Workschmirk says, that it would be handy for him to be able to take a bottle occasionally.

There is one breastfeeding specialist in the unit, she showed me how to express manually on day one, who is nice, perhaps I'll hunt her down tomorrow and ask her a bit more.

Am watching with interest, only 23 weeks pregnant with triplets but very aware they will be early and am very keen to get at least some breastmilk into each of them every day. I also thought they tried to avoid bottles for the first 4 weeks to avoid nipple confusion, at least that is what I was recommended when EBF DS. Good luck. Your supply sounds great

Ooh, crossed posts with a few posters. Thanks for all the congrats Good to hear there are others questioning the bottle first. I will also ask about giving him a little expressed milk on my nipple, that's a really good idea. On the second day the breastfeeding specialist encouraged me to use a pipette to put a few drops of colostrum on his lips which was nice. I've not seen her since though.

Great tips Babyson, thanks - I'm doing the kangaroo care, for around 3 hours a day on average. He was having phototherapy for jaundice up until a few days ago so it was difficult to have him out of the incubator but now whenever I'm there and he's not too sound asleep I'll ask to hold him. He seems to really love it Can I ask Babyson how much your DS weighed at birth, and how long he was in hospital until you could take him home?

Also interesting to hear they can try breastfeeding with the tube in, I'd not considered that possibility.

Hello, my dd was born at 33 weeks and she was tube fed until we established bfing. Not sure why they'd suggest bottle feeding first. I'd query that. Once she started rooting I used to put her to the breast while she was being tube fed, so she associated boob with food.

Keep going with the pumping. It is a hassle but worth it in the end!

Thanks Jolly that's reassuring How many weeks was she when she started rooting? And did you check with the nurse before putting her to the breast? I know he's my baby but I feel like I have to ask to do things as he's still so small I'm worried I'll get something wrong and hurt him.

cheeser congrats on the birth of your son. Firstly it sounds like you are doing a wonderful job! My DS was born at 30 weeks but got NEC so was on TVN for nearly 3 weeks. However we still had plenty of cuddles with him positioned next to bare boob with a little "spilled" milk - nurses thought it may help with food associations He was then tube feed although before each tube i was helped to put him to the breast - tbh he played. He was discharged at 36 weeks with EBM in a bottle and it took me a further 2 weeks to get to be fully breastfed. It was hard work and i will never forget those mornings of having a screaming alarm clock instead of a baby BUT when i did have the baby it was soooo worth it. Good luck

Hi cheeser, congrats on your ds!

My ds was born at 31 weeks and after many ups and downs we managed to bf for 9 months. Sounds like you are doing everything right - but I'd second(third?!) what others have said about the bottle - our nicu would cup feed bf babies not use a bottle to avoid confusion. Maybe speak to the bf specialist at the hospital?

My tips (for what they are worth!) - don't worry to much about the quantity you manage to express dipping - it did for me and I panicked big style, which made expressing really stressful and probably didn't help. I ended up taking some drugs to increase supply (can't remember what!) and it did help until ds was bigger. Looking at photo of baby when expressing at home helps too!
Start putting to breast as soon as you think he might be ready during your kangaroo care - I did before the nurses thought was typical, and he was certainly ready (was giving typical feeding cues!).
Also - definitely keep expressing at night and every three hours. Really important for keeping up supply. When you get him home () be aware that your supply may struggle a bit - mine did as my body hadn't had the cluster feeding preparation and hence we needed a top-up of expressed milk in the evening (had lots left over from the hospital!). I probably should have done lots of skin to skin to increase supply but wasn't really aware of what I was doing.
lots of luck and well done on the fab job you are doing so far - it is an emotional rollercoaster having a prem baby so be good to yourself, eat and drink loads (crucial for your supply but easy to forget in the hospital) and rest when you can.

She was 10 days old I think. I'd been trying from her being a week old so 34 weeks but it took lots of attempts to get her to latch on. I was advised by the nurses to start by trying one bf a day. They felt she would get too tired if I did it too often. It felt as though it took forever to get her bf exclusively but we were discharged after 20days so it didn't take long. When you are apart from your baby any amount of time is too long.

We had little set backs along the way. Good feeds, then ones where she wouldn't wake up but once they get it, you are on cloud nine! We were discharged 2 days after her tube came out.

I haven't had a prem baby but have bf four, and I do think women need to be kind to themselves when trying to build up supply. Eat well, sleep as well as you can, and drink lots of water, and don't run yourself ragged on things that don't really need doing, and it all helps in the end.

Hi, my DS was big (!) 4lb 12oz at birth, went down to 4lb 2oz, back up to 5lb 2 oz at discharge aged 25 days. He also had jaundice a couple of times but otherwise was fine. Would second the emotional rollercoaster - I remember being really upset when he reached 35 weeks as had heard some babies came home at 35 weeks and we seemed SO far off that. 2 days later he took his tube out yet again but this time it wasn't replaced and he came home 2 days later exclusively demand breast fed! Oh and be prepared to do nothing but feed your DS when he does come home - my DS only ever cried for food for the first few months - after going through all possibilities many times (he can't possibly be hungry he's just fed for 3 hours or whatever!) he did just want feeding and it was easier just to offer him milk! He's just turned one and still bf but thankfully only twice a day now!

Hi. It sounds like you are doing all the right things. I would definatly question the feeding from a bottle before the breast. As a NICU nurse myself that is something we would never practise and bottle feeding is something that is introduced much further down the line once breast feeding is established. Your baby is not too young to try the breast now even if he just has a few licks, it's all practice for you both. Good luck and try not to worry about the volume of milk you express..also looking at a picture of your baby while you express can really help.

Congratulations cheeser
I have had two prems, 31 and 32 weeks. Now 12 weeks and 2 years respectively. Have toddler climbing on me at mo and baby making waking up noises so apols for any typing issues.

Sounds like the expressing is going well but if you need to up quantity I'd suggest expressing at least every three hours for me personally it was too long to go four hours between sessions. I mimicked cluster feeding in the evenings and got up twice in night. Just because I needed to increase my supply.

Both DDs are/were breastfed. Both on bottles first then onto breast once home. Everybody is different but for us I wanted them home ASAP and they were able to do the bottle feeding a few weeks before they learned to breast feed.

If you do decide to bottle first then I am happy to share what we did to get the move to breast.

Baby just woken screaming must run. Lull the best. xx

Just to politely disagree with the last post! Some babies also struggle to bottle feed and are not always home earlier. This was the case for someone we were on the neonatal ward with. I think it all depends on the baby.

Wow, babyson, that is an impressive weight! Mine was 4lb 6 at 33 weeks.

Just to clarify Im not Intendung any sweeping statements about all prem babies. All i meant was as I said my two 'got ' bottle feeding before they worked out how to breastfeed.

I think all babies are different. All nuns different. All family circumstances different. There's no one size fits all.

But bottle feeding neednt be the death knell to breastfeeding is all I'm saying. My hospital (and sounds like ops one too) do bpte feeding not cup feeding with the prems and I know/ know of many people who gave moved from bottle to breast with a prem.

Hope that makes sense. Am attached to DD2 who has been cluster feeding since 7.30. Joy!

I found videoing my dd's 'hungry' cry and rooting on a smartphone and watching it whilst expressing helped my production. Also having a blanket or something that smells if her.

Dd born prem, at 34 weeks, and was tube fed for 2 weeks we git her bf with the help of a fab hcp who specialised in getting prems bfing.

She suggested putting her on the boob during the tube feeds to get the association of boobs and food.

We were also allowed to take dd home with the tube in place once we got 50% of feeds by mouth.

Congrats BTW.

Ps we still going at almost 2yo.

Hi am just marking place will do a proper reply or PM you tomorrow. I have BF a 27 weeker and do peer support at local neonatal unit.

Congratulations, and you are doing fantastically well. No reason not to BF before bottle, def seek out BF specialist again or see if there is peer support in your unit. You can try with tube in, CPAP etc. You can put to breast after expressing if baby is not ready to take milk orally and this is good for you both. Keep up the night express. If your amount drops a day expressing by hand can help.

You are really doing brilliantly. Keep going, soon you will have your BF baby at home.

My twins were born at 34 & 3 in the beginning they were so sleepy that they wouldn't suckle effectively, so for the first 2 weeks I would put to the breast, they would suck twice, fall asleep and I would then bottle feed expressed milk and then formula top up by literally squirting it into their mouths, it was hard going initially. Lots of expressing using a double pump. Gradually my milk supply increased, and they could stay awake for longer periods. After 2 weeks I fully BF and continued until the girls were 12 months, wishing you the best of luck

Thank you everyone for taking the time to comment, it's really helped.

I overheard one of the mums talking yesterday and it seems as though they let the babies home quicker if they take most feeds via bottle first - this mum was planning on switching to exclusive breast feeding. Wonder how difficult that is.

Will read through again and post proper replies tomorrow, I'm too tired atm. Thanks all

Hi again Cheeser, hope you and DS are having a good day.

Once again you are doing fantastically well, and sounds like you are doing all the right things. One thing I have learnt recently is that to establish a full supply you should be aiming to pump 700ml a day by day 14. I realise that sounds huge, I never got near that and still managed to BF, but I just wanted to give you the info. Kellymom.com has useful info here and is generally a really good source of info. You need to try to express at least eight times in 24 hours and keep the night time express (sorry!). I gave up expressing at night too early and it did affect my supply.

Re. going home, in my experience babies can go home when they are taking their feeds orally and putting on weight, whether those feeds are by breast or bottle. My DS was able to feed several weeks before he came home (had other problems that kept him in) and what we did was give bottles of EBM at night and I breastfed him on demand during the day. I was really nervous about the bottles but he managed to switch between the two with no difficulty. I did make sure that I spoke to a nurse I trusted before we introduced bottles so we could keep it under review. I don't know if daytime demand feeding would be an option for you when you get to that stage.

Does youe unit cup feed? Perhaps they could cup feed rather than bottles when you can't be there. Also if he does come to have bottles it's worth asking what teats are available, DS had some that were supposed to be for BF babies and more similar to feeding from a breast.

When DS was finally ready to go home we roomed in for two nights and ditched the bottles. He put on weight thank goodness and so we were discharged fully BF.

In the meantime there is no reason you can't put him to the breast after you express for 'non-nutritive sucking'. Hopefully you are already having lots of skin to skin which will help your supply too.

I would have a chat to a nurse you get on with to ask about what your son has to be doing to get home, explain you want to exclusively BF and ask for support with that. Ask if the BF specialist can come back to see you, there were a couple of nurses with an interest in my unit and they were really helpful when it came to putting DS to the breast.

We continued to feed until DS was 18 months, and it was so worth it. Despite a rough start he is hardly ever ill and I like to think it's at least partly down to breast milk!

Sorry that is a bit of a ramble and not very coherent!

Oh also, if your supply does dip it can help to go back to hand expressing, and/or pump every two hours for a day or so.

Double pumping is really good for your supply, and can increase the fat content of your milk, can the hospital pump be adapted to double pump? It's great you are doing it at home anyway!