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

Hi OP - congratulations and well done you! Sounds like you are doing brilliantly :) I haven't read everyone's replies so apologies for any repetition....my DS was born at 34 wks and I'm still BF'ing him at 17 mos so you can most definitely successfully BF a premie - you're doing it already! Just a couple of thoughts to pass along

• You can latch him on with the tube in. If you do it when they're pouring the expressed milk down the tube it will help him to associate your breast with a full tummy whether he's actively sucking yet or not.
• Doctors like bottles because they can record exactly how much has been drunk. I used to BF then top up with EBM in a bottle. My DS never had any 'nipple confusion' and once we were home I pretty quickly dropped the bottle and trusted he was getting enough. There are other signs than how many mls - weight gain, wet & dirty nappies etc. The benefit to having a LO who will take from a bottle is that you can get someone else to do the occasional feed for you in the future.
• Am pretty sure the only way to increase supply is to remove more milk - so pump or feed more often. That 4am pumping when you're at home and baby is in hospital is totally shitty but I used to remind myself that I was the only person who could do this for him and it made me feel a bit better.

Good luck, you'll be home before you know it!

Thanks everyone.

Thanks to your comments I spoke to the Breastfeeding specialist in the SCBU and I told her I wanted to exclusively breastfeed without using bottles first - and it was totally fine and that it was perfectly do-able. So once his tube feeds are spaced out accordingly (he's on hourly feeds, they're going to spread them out to three-hourly) and he's got his suction reflex at about 35 weeks then I can put him straight to the breast without using bottles first. She's said I can room in with him so I'm there to feed in the night and that it will be no problem at all. I'm so relieved! I also said I wanted to stipulate that no dummies were given (it seems to be standard practice to give sterilised dummies to babies that cry, although I'm not sure if they are dummies supplied by the mum or whether they have a stash of them - either way I'm going to state on his notes that I don't want him to have one).

She seemed happy with how often I was expressing too which was good. She also said to get as much skin to skin as I can as that'll help too. I brought in one of my collection kits from home yesterday which means I can double pump at the hospital too, so will continue doing that.

I held him for about two hours yesterday under my top (took bra off) - and when i put him back I had humungous wet patches Still, thats a good sign i suppose!

Ah brilliant, glad it went well. Just wanted to say re dummies, they are used for prem babies for non nutritive sucking (basically practice) as they would suck their fingers in the womb and they don't necessarily have the negative effect they do on BF term babies. I said no dummies at first but was advised to use on by DS's consultant, he abandoned it himself at about term age once he realised there was milk to be had elsewhere!

Hope all is well today. having a baby in hospital is tough, sounds like you are doing really well. :)

That's interesting, thanks Celtic, I'd not thought of that. Maybe I'll reconsider. And I guess by the time they reach term you can placate them with bfeeding rather than dummy. Thanks

No probs, I think as always it's best just to talk to someone you trust there, the consultant who recommended DS have a dummy was so wonderful and I just knew she wouldn't have without good reason. They are all different I guess. I used to put a bit of EBM on DS's sometimes too so he got the taste.

Wishing you all the best.

Wanted to give a quick update for those who are interested.

I managed to breastfeed my boy on Friday, and again yesterday. He was 32+3 on Friday and I had an amazing nurse who said that he probably wouldn't even have the suck reflex but I could try him at the breast while she tube fed him so he associated the food with me - well, he actually sucked, and managed to get what looked like a fair bit of milk from me. It was brilliant! He really went for it - and actually has a really strong suck. The nurse was amazed. He only sucked for about half the time he was on the breast, he takes a few sucks and then pauses, but he's definitely doing it and I'm so happy about it. Fed him twice yesterday and although the nurse checked his aspirate level after and said it didn't look like he'd got that much, at least he's doing it and is at least getting some. He fed for about 40 mins yesterday.

Hopefully things will continue in a similar direction and whatever extra I give him will help him put on weight quicker.

Congratulations keep going you are doing a fab job!

Well done Cheeser, that's so good to hear.

What a little star you've got!

congratulations and well done cheeser. my dd was born at 36 so no-where near as early as your ds, and she was never tube fed, but she wouldn't latch on or suck. I expressed and cup fed her every three hours.
They told me to have the following routine; try her on the breast then if she wouldn't suck, cup feed her with milk I had expressed earlier. Then express milk for the next time and sterilise all the stuff. This took about an hour and I had to start again 3 hours after I started, day and night. She started to feed from the breast on day 10. It was knackering but by day 10 I could express loads, too much in fact.
When I wanted to stop breastfeeding to go back to work, she would not take a bottle
You are doing brilliantly, good luck.

Hi Cheeser, I've only just seen this and wanted to say a big congratulations. My story is probably irrelevant now, but I had twins at 34 + 4 (5lb1oz and 3lb 14oz) and they were tube fed for nearly 2 weeks. I expressed milk for them, (including the middle of the night one that you're familiar with. Ifeel your pain there, I remember my FIL saying that at least I could get some proper sleep and looking horrified when I said I was setting an alarm for 2am to express!) and they had top up formula if needed via their NG tubes. They tried to suckle at a couple of days old, and I had a great nurse who spent a lot of time with me and the boys to help with establishing supply and feeding. The hospital would feed through the tube while they were at the breast, as a previous poster has said. We successfully established bf and they were exclusive bf for 6 months. I still feed them in the night if when they wake up and they are nearly 2!

You are doing a fantastic job, well done!!

That's wonderful, well done!

Brilliant! Well done you and your clever little fella :)

Cheeser, how is your little one doing? I am in a similar position, my little one was born at 30+2 he was only 3.2lbs when born and has dropped a litttle bit after birth, and I really want to breastfeed him. He's a week old tomorrow :-)

If you have any advice or any tips in general about what to do or what to expect I'd really appreciate them. Thank you

Hi Imiss. Our littles ones were exactly the same at birth! My DS was 3.2lbs also. He gets weighed in kgs so I know he went from 1.45kg to 1.35kg, and is now 1.63kg. He's being weighed again tonight and I'm sure he'll have put on again, he's definitely getting bigger, you can see it in his arms and face.

He has slight jaundice still, and they've just done an exam of his bloods to see if there's an underlying cause (usual if they've had it longer than three weeks since birth). Other than that he has no problems at all, was on CPAP for I think 3 days in total at first but is now breathing on his own, is on no medication apart from vitamins. He has a monitor for his heartrate and blood oxygen level but that's it.

THe SCBU unit he's in are quite keen on giving babies bottles before breast (for some reason, not entirely sure why) but I spoke to a few of the nurses and one of the doctors and they are happy for me to try the breast first (so they've written 'no bottles' on his feed charts). It's going well so far. I'm only feeding him myself once or twice a day - he gets pretty tired after each time, so I'm giving him one breast feed, one NGT feed, then one breast feed... then I usually have to come home. He feeds from the breast for usually about half an hour (in total, so both sides), and then we top up with a bit of EBM. Each time we do it he actively sucks for longer. He's on 31mls every 3 hours at the moment so usually we give about 15-20mls of EBM as a top-up after the bfeed, through his NGT tube. We have to sort of judge how much he would have got from the breast, it's not an exact science. Give him too much in total and he might be sick, but not enough and he could get hungry.

There should be a breastfeeding coordinator there, speak to her and tell her you're really keen to breastfeed and what can you do to make sure it happens. She should be able to tell you more about how your unit works and if you need to tell anyone you specifically don't want bottles given. I was very anti bottle and also anti dummy at first, but apparently the dummies can help encourage their suck reflex which babies only usually get around 33 weeks. 'Non-nutritive sucking' is the term to google. My DS keeps pulling out his NG tube as he doesn't like it, and the doctor this morning suggested the nurses could give him a dummy while tube feeding so he associates the suck with a full tummy, and might make him less frustrated as when he's hungry he has his hands in his mouth a lot and because they flail about, he grabs his tube and yanks it.

I've rambled a bit there! Not sure if that's any help. Happy to answer any other questions, obviously I'm no expert but am going through it all at the moment so have recent experience.

Thanks so much for the reply cheeser it's really comforting and reassuring to read all this information. I feel a bit like I was chucked out of hospital and left to it, I don't really know what to think or what I should be doing or asking.

Our little one went down to 1.312kg and hadn't put any weight on at the last weigh in, but hopefully he will have doneby the next one. He was on CPAP on day 1 but is breathing on his own at the moment, he's on caffeine for Apnea, but we're told this is quite common for babies so small.

He has a cannula for fluids, they're monitoring his glucose, and he has little sensors for his heart rate, resp rate, and a little monitor on his foot for blood oxygen.

I will definitely find the breastfeeding person and speak to them, as I'd really like to breastfeed, but as I'm producing so little milk they're having to top up with formula.

Did your little one have a scan at all?

Thanks for sharing your experiences with me, I am such an emotional wreck at the moment I can't think straight.

Imiss I just to offer you some support are you expressing regularly? Are you doing it near your baby? I was told to do it next to the baby (babies in my case I had twins) if that isn't possible have the babies blanket near you and a photo as it can help increase milk production

It does get easier

thanks LaVita I am expressing regularly, every but as I'm absolutely shattered I keep sleeping through the night time express session. I am going to invest in an electric pump, it is slowly getting better. I can't look at a picture yet, as it makes me cry (very traumatic last three weeks). But hopefully can progress to that soon.
Sorry for hijacking post Cheeser , but thanks for all the messages. They really are helping me at the moment. :)