Help me bf my preemie

[NoForkNKnife]

DD2 is now 12 weeks old (1 week corrected). She's been out of the neonatal unit 5 weeks and I've been expressing and bottle feeding her. She is tiny. Currently 4lbs 11. She has an oz of nutriprem 2 formula with all but one of her feeds (she is supposed to have 2 ff a day, but the formula is so thick she can't drink it and it is near impossible to mix and dissolve. Hence making up an oz then topping it up with ebm).
She is gaining weight slowly but surely (below 0.4 centile). But I'm sick of expressing. Don't get me wrong, I'll keep doing it as long as I have to, but it's so time consuming. Plus my supply is dwindling because I keep forgetting to do it

She will latch on to the breast. And I try to put her to the breast once a day (she demands it in the evening between bottle feeds). She will be latched for an hour or more but I'm not convinced she's getting much as her latch is very shallow. She also rarely seems satisfied after, but during seems very content.

One of the reasons we started bottles in the first place was because of her size (she came home at 3lbs 5) and very slow weight gain. With the bottles I can see how much she's feeding.
Ideally I'd like to add more bf. But if I offer the breast in the day, after the feed (90mins or more) she cries for more. If I offer the bottle she has a full normal feed! Despite having the breast first. . Does that mean she didn't get anything from the breast?

Sorry. I know this is long. Wanted to add I bf DD1 for 6 months. She wouldn't latch got first 2-3 weeks. But got there in the end.

How do I know she's ready? Is it possible or should I just accept that a lot of preemies are bottle fed ( is this correct ?).

Bump.
Anyone any experience of particularly small preemies?

Hey - my little man was still under 4lb when he came home too. Have you tried nipple shields? They helped my DS to latch and i could see the milk in the shied so i knew he was getting it

Hi my ds 2 was Born in December at 24 weeks he is exclusively breast fed. I Had to express for months though before he was strong enough to suck at the breast. Have you spoken to your hv/dr about your latch and concerns? If she's taking a bottle after the feed my guess is she's not getting milk quickly enough at the breast, which maybe a latch problem? A lactation consultant maybe?
Sorry I'm probably not being of much use. Just didn't want to read and not reply. Was your nicu nurse helpful?

Dd was a 27 weeker and is still bf now at 21 months. I was ridiculously stroppy about avoiding bottles although for her first month she was on twice daily top ups. Have a google for supplemental nursing system if you want to wean her back onto the boob. It doesnt work perfectly with the thick prem formula but its a good start. Also have her checked for tongue and lip ties which are v common in prems as is the dreaded reflux whichcan make them appear unsettled/needing to feed all the time. Dd has cmpi and soya ishoos and were both still on dietary restrictions. Good luck. It is really so hard but you are doing brilliantly.And it will get easier as she gets bigger and stronger.

Thank you both.

I used a shield in the hospital when first getting her to latch. Maybe I should give it a try again?
She actually feels like she has quite a decent latch. I have an appointment with paed and dietician next week so will ask again.
The NICU nurses were amazing. With this and everything. But she's so different to the way she was 5 weeks ago their advice seems obsolete. But with a desperately slow weight gain I don't feel confident to stop bottle feeds.

She's just topped up on the breast after a bottle. She definitely had a lot as when she came off she sneezed and it flew into my face!

Knowing you made the swap to breast is encouraging. Thank you. Did you increase breast gradually?

My heart my goes out to you. I hated expressing. Absolutely hated it!

I would recommend offering her the breast both sides before every bottle

This will boost your supply. She will always get something if she is sucking even if you can't express she can still make you make milk, so don't worry about that.

Dd had a tongue tie that wasn't clipped until 4/5 weeks, she really struggle to suck as much as she needed and was basically latched on all the time yes, it was he'll! but it was worth it in the end. By about 8/9 weeks I started to see the 3hr ish feeds people kept telling me existed!

Also lots of skin to skin, hot baths etc will help stimulate your milk.

To be completely honest though I might have given up were it not do my local breastfeeding support group, go, honestly! Of all the groups I went to this is the only one I have made lasting friends at!

Well done for your determination sometimes you really need it to establish breast feeding BUT it does get easier, I promise there comes a tipping point where their little jaws get strong enough to fill their belly in mins and your sitting there thinking "done already?" And you don't have to go and wash the bottle

Congratulations btw

X-posts!

Thanks wouldbe I'll certainly take a look at your links. I can't quite picture it from your description.

I'll also ask about tongue tie and reflux poppet. She has terrible wind-very smelly recently. She has got into a routine of one poo a week since coming home and starting the preemie formula (btw, the formula wasn't due to supply issues but to increase calories).

I'm nowhere near 8 times. Today 3x plus a bf (but only on one side). I'm getting about 500-600mls a day which I know is a little low. She is feeding about 350mls a day. Do I need to increase it? Can't I wait until her feeds to up? I just don't know how with a 3yr old as well I can fit in more expressing times. I realise I'm sounds stroppy and ridiculous but I find it so annoying. and eats into my time

Herrena a bf group sounds like a great idea! Sounds obvious now you've said it. And a day out! Ha !

Glad to see you're getting lots of helpful answers. I made sure dd fed every two hours in the day at first and at least twice at night as its the night feeds that will really boost supply. And yep I offered both sides Little and often was her thing while she was small and quick to tire. I had a 2 yr old too and it certainly wasnt easy. We used the sns for as many day feeds as I could face and sometimes just resorted to syringing in hindmilk too. She struggled with bottles as she found them too fast and in the end she was down to 30-60mls a day which her consultant worked out was worth about 16-30 calories more than top ups so we were allowed to stop them. I never managed bf groups and am sorry to say but found the bfing helplines out of their depth when it came to prem bfing. Which was annoying as dds health team were prem experts but out of their depth with bfing... They suggested feeding her four hourly when she was first discharged!?!

Hi - congratulations on having your DD at home! And well done on expressing & breast feeding so far. I know how hard it is.

My 28 weeker weighed around 1.7kg when he came home and until that point was fully tube-fed. We had a day and a night to 'practice' breast feeding in the hospital before coming home. Like you, I thought he was not getting anything. He seemed to latch on, but then either fell asleep or constantly wriggled and groaned out of hunger and (as I discovered later) reflux pains.

I'm no expert beyond my own experience, so the idea of asking for help from lactation consultants is probably a good one. My HV knew less than nothing about preemies and had very unhelpful views on things - but perhaps you have a better one.

Anyway, I'm wondering: do you supplement with formula because your supply alone isn't adequate? I think I would offer her a breastfeed at most, if not all, feeds, and then top up with formula afterwards if she wants it. This way you'd make sure she has lots of practice at the (physically much harder) breastfeeding, but also gets all the calories she needs. I would expect your supply to increase as a result so that you could eventually phase out the top ups. And as she gets stronger she will be able to take more from you and will be less frustrated with the hard work.

Another thought I had was about the way you give her the formula. I was actually not opposed to bottles in the hospital, and the majority of nurses seemed extremely keen on giving my DS a bottle. But there was one nurse I really liked who advised me to say 'no' to bottles, even if it meant that the ng tube would have to stay in for longer. She convinced me that a much better alternative, for those who are serious about breastfeeding, is to use a cup. And it really is not very hard - just look for newborns fed with a cup on YouTube, they kind of do it all by themselves, lapping the milk with their little tongues. So I used a cup on some occasions when I thought DS didn't have enough on the breast, and also to give him his iron & vitamins.

Sorry this is so long. In a nutshell: I would say try to breastfeed more often (and rule out tongue ties etc by asking specialists), and think about not using the bottle for a while when your DD is still getting the hang of the breastfeeding mechanics. It will get easier, as she will grow and get stronger. Good luck! (Happy to answer more questions if you like.)

Ha, I hadn't update my browser before posting - and now see others have already said similar stuff to my post. But at least we agree

I think I was told you need to make 700-900mls a day to ensure your supply is established enough to grow with her. So you may need to express more. Sorry. I ended up preferring pumping by hand rather than machine as I felt less like a dairy cow and it was easier to stop and chase the toddler. It is so hard at this stage but once you can ditch top ups, expressing and sterilising the workload decreases dramatically

I agree, Poppet, I was told I'd need around 900ml at least, and to express at least 8 times a day and at least once at night.

Do you have a decent pump? I could never get the hang of expressing by hand, and most of the electric ones I tried were extremely painful and not very effective.eventually I hired the pump I had tried in the hospital (Ameda elite) for a couple of months - it made a huge difference.

Harriet I called LLL and the um National Bfing helpline or something like that... I got variants of the babies tummy is the size of a marble platitudes but nothing helpful about how to fill it. I used the internet to discover that preserving my supply and giving her the chance to learn to nurse were key for the early days and I realised the sns was a way to do this while also giving her her top ups too. So although it was fiddly - as if latching a prem wasnt fiddly enough - it was worth it.w

Wow. Thanks for all the replies!
I have 2 swing medela pumps (one from last baby and second I got off eBay. Luckily I had loads of hospital pipes and shields that fit). I would say I get on pretty well with them.

I want to try all your ideas but I'm scared her weight gain will slow further before her appointment. It's already a concern with them. She's doubled her birth weight if 2lbs 2 only last week (11 weeks!) and isn't really following a nice growth curve.
She won't take the formula on its own. It's too thick despite using bigger teats. So I'll have to give it mixed (I was told upto 6 months plus!). I kind of have to eventually still rely on the bottle. I mixed fed dd1 (one bottle feed a day) really successfully and really want it to work.
She's recently gone upto 90mls 3 hourly. Do you think if I give less then top up at breast it would be a good idea? I could then express less than 8 times. I've thrown litres of ebm away as I have a freezer full and it only lasts 3 months (was 6 months last time ). I can't donate as I'm a type 1 diabetic. Such a waste.

Could you not offer her the breast before each bottle? I think that would make it more likely for her to get the hang of it.

Cup-feeding would be fine for feeding formula (or your bm-ff mix), by the way - it's just that it is easy for tiny babies to get milk that way, and it doesn't confuse them when they go back to the breast.

I had a 34 weeker, who was gargantuan in proportion to you dd. (5lb 10 but awful birth injuries hence the nicu)

We did the tube feeds and expressing for weeks and although I've not got anything constructive or helpful to add I'd jut like to say a big bloody well done! What a woman!

My nicu nurses and doctors were fabulous, much better support for feeding than any midwife or breast feeding support worker was. Hopefully they will let you keep in touch?? We were there weekly after discharge and it was very good for sounding them out

Good luck!

were thank you. The nurses actually came here until this week (so 5 weeks after discharge). They were fantastic but I never asked them about bf. not sure why. Her weight has been the focus of everything and I suppose I didn't/don't want to rock the boat.

Gurke I will try offering the breast before feeds. In going to go slowly until after the appointment next week. If she loses or gains little I'm worried about what they'll say. I really don't want to substitute more BM for formula.
For some reason the cup feeding seems a faff. I did try with dd1 who wouldn't latch for first few weeks. If I do decide that nipple confusion is an issue I'll certainly try again.
Will also look into the links above. Never heard of such a device!

Thanks so much for your help. Actually looking forward to it!

Just wanted to add my support - I had a 29 weeker with reflux who was on the 0.4th centile. I expressed for him & got a good supply but unfortunately he was unable to breast feed due to chronic lung disease of prematurity.

I was told by the dietitian that babies don't catch up on breast milk alone, so DS changed to Infantrini just after his term date. He didn't tolerate Nutri-prem at all as it made his reflux worse - it's gut-rotting stuff!

I was very upset not to be breast feeding him, especially after 12 weeks of expressing night & day, but it wasn't what he needed & I tried to take my needs out the equation. But it was very hard to let go of - there were tears.

I also wanted to say that you will have been through a lot with such an early baby in NICU. For that reason, it is really, really important that you enjoy your baby, and try not to stress about feeding. I know what it's like to be "down that hole" with feeding, especially when you have invested so much in expressing.

Good luck. And feel free to PM me x