Online breastfeeding help (preterm baby)

[Merrow]

My baby is currently in NICU and I'm trying to establish breastfeeding. He was born at 27 weeks, and is now 35 weeks. He's tube fed every 3 hours.

I've been attempting breastfeeding from 32 weeks, and he's definitely interested. However I don't think he's having much success. I've not breastfed before so no idea how it should feel, but it seems he every so often gets a grip on me that feels similar to the pump, but that only lasts a few seconds and I usually only see my nipple in his mouth rather than any of the areola. The nurses are very nice and have talked through nose to nipple, positioning, things like that. However, it's understandably not a priority for them to sit down with me for however long it takes to get him properly latched on and checking if he's swallowing.

What I'd really like is a lactation consultant, but since it's only immediate family allowed then that's not an option. However I wondered if in the wake of COVID online consultations were a thing? He can't come home until feeding is established (plus a host of other things), so I don't want to wait until then as I think he'll just end up being bottle fed so he can leave the ward.

It's obviously been a pretty traumatic and horrific time, and breastfeeding is something I really looked forward to so I want to do as much as I can to achieve it, so I'm looking for help on that front rather than any reassurance that fed is best.

Is there a lactation consultant affiliated with the hospital? Ask the nurses for more support, there may even be an infant feeding team too.
To answer your original question though, yes, lots of lactation consultant’s still do online consultations! Have a google and see if there are any nearby to follow up once baby is discharged. 🙂

Thank you. There's an infant feeding person, but they're also a working nurse, so trying to coordinate when they're available and when DS is awake and interested is proving difficult. I'll keep trying with them. No lactation consultant. The other nurses are more just generally encouraging rather than offering the hands on help I think I'd really like.

Good point about finding someone online that I can follow up with when they're out - I hadn't thought about that!

Give Kathryn Stagg a message - she is on Instagram but also does videocall assessments.

kathrynstaggibclc.as.me/schedule.php

I follow her on Instagram and she's very useful and knowledgeable.

I used Kerry from Lactalove - she came to my house but also provided WhatsApp video calls and messages so she may be able to do it all remotely.

www.lactalove.co.uk/about/

I also follow Kathryn as above and she had a lot of useful videos.

Good luck - and well done for persevering, you've done so well already! Feeding can be so so tough and you've already been through so much, keep going if you can and hope you get the support you need xx

Have you tried nipple shields? I really struggled with my preemie trying to get him to latch, he was very enthusiastic but could stay on for longer than a few seconds!
Turns out I have very soft and small nipples, not that I'd realised! Still using a nipple shield at nearly a year on as he wouldn't be able to breastfeed without it! Was a total game changer

*couldn't stay on for longer than a few secs!

I don't know about online consultations but when I was trying to feed my son the UK Breastfeeding Support Facebook group really helped me. He was born at 35 weeks and I tried breastfeeding him from the beginning but he couldn't latch properly until his due date. I got loads of advice on this Facebook group.

Thank you for the recommendations, I'll look into all of those. I'm in the NW if anyone knows anyone specific to that area.

@skywalkersweetie I've had conflicting advice about nipple shields - one nurse said that if he was latching at all I shouldn't introduce them, another said that they were great for premmies! I'm going to try and catch the infant feeding person and ask for some. I don't think I have small nipples, but they might be soft? Things I hadn't thought about!

Something to consider :) I'd argue though that if you say he's only getting nipple and it's only lasting a few seconds then maybe the latch isn't great? Just sounds very similar to my experience!
Never looked back since using the shield and think it's definitely worth a try, they're not too expensive on Amazon, I use MAM

I think you need to give it a bit more time. He’s still not a term baby - mine was born at 37+0 and took a good 2 weeks even from then to manage a ‘full’ breastfeed. The priority until his due date is making sure he’s gaining weight nicely and keeping his strength up, while keeping him ‘in touch’ with the boob so he doesn’t forget what it is. I would keep going as you are, but give it another 2-3 weeks before really concentrating on getting breastfeeding off the ground as his main feeding method. Good luck!

I haven't used them myself but there are some in Manchester if that's nearby?

www.mcrlc.co.uk/ they offer virtual ones too

Yeah it's a tricky one, he is obviously still preterm even though from my perspective it has been nearly two months. I think what I'm finding hard is that he's very evidently trying, and not succeeding. And I'm not sure if that's something that will correct itself with time or if actually there's something I could do now to help him.

I think it depends if there are other health issues keeping them in NICU. My preemie was born at 28 weeks but managed to get home at 36+6 as we were fortunate not to have other health issues, so it was just breastfeeding that needed to happen before going home.
It's something that can bring a bit of hope and help them on the way to getting home!

He's likely to be in NICU until at least his due date because of other reasons, but they're planning to try and reduce his tube feeds next week (unless he takes a step back). It's not clear yet how much choice we'll have about whether that will include bottle feeding when I'm not there.

id absolutely second what @Cuppasoupmonster says. It’s early - baby is still small and lacks stamina but you will get there. I had a 33 weeker who is now 10 weeks actual and an enthusiastic breastfeeder.

It was tough at the time but I gave her bottles of expressed milk to get her home. When home, I prioritised giving her time on the breast whenever possible. There were a few mismatched days of having to express but it works brilliantly now. They’re clever little things and they love milk so they soon work it out!

I’d say the one thing that hasn’t been mentioned but was important for us: keep your supply as high as you possibly can by expressing very regularly, especially in the night. if there’s plenty of milk, baby will get there. Bonus too - you’ll end up with a freezer for a frozen milk which will ultimately mean more naps for you when you need them most!

hang in there. Breastfeeding is difficult and the NICU is a difficult place to be. Don’t underestimate that. ❤️

I found the prospect of other people giving my preemie bottles quite upsetting - especially as I’d exclusively fed my other child from birth - but I tried to think of it as every bottle taking her closer to the exit and home where she belonged. In the end she took to it quickly and we were home soon after. It’s not actually been that long but it is a rapidly fading memory.

Yes, I think I'm definitely taking an emotional rather than rational approach to this! I can't help him breathe, or make sure his eyes are fine, but my supply is good and he's clearly interested so this feels like something I should be able to achieve.

I don’t have any experience of online BF consultants but my 28 weeker came home just before 37 weeks with a ng tube and on two breastfeeds a day (and was fully breastfed within 3 days of being home, purely because I was then with her 24/7). Our hospital policy was that we could start trying to bf from 34 weeks, but it wasn’t until around 36 weeks that it seemed to click. All of a sudden every attempt at bf was better than the last, don’t be disheartened that it’s not working for you yet as I think it would be unusual at 35 weeks. It really was as though a switch had flicked overnight!

When are you offering feeds? We were tube feeding 3 hourly, so I needed to be there when a feed was due to have a chance of DD being interested in feeding for any length of time. If she had a good feed then we skipped the tube feed, but otherwise it was either a half of full feed via the tube.

Try not to put too much pressure on yourself - it’s difficult when you feel like it’s completely down to you but you’ll get there eventually!

That's encouraging, hopefully it will just click here too!

Hospital policy is that they have to be NG free for 48 hours before they can come home. While I could probably fight it DS is very likely to be coming home on oxygen, and that's overwhelming enough. I don't think I could handle the feeding tube too!

I'm around for 2 - 3 feeds a day (have another DS at home). He's usually only awake for one in the morning, and I make sure I'm always in for then. I'm not convinced he's actually getting anything so he's still getting full top up feeds even if he's put in a lot of effort.

Ah ok, we just needed to have two non-tube feeds a day to get her home (otherwise unless you stay at hospital for the 48 hours that seems like quite a difficult target!). I was also juggling other children at home, so appreciate how difficult it is trying to be there for as many feeds as possible! One thing I did find is that if we managed a half decent feed at 9, then she’d be too tired for the 12 feed and so we had more success just tube feeding that one then trying again at 3. Otherwise I just ended up stressed that it wasn’t working! It’s really tiring from them feeding orally when they’re so tiny.

The nurses also helped us out and cup fed her a few times overnight too, it’s closer to breastfeeding than bottle feeding if that’s something the nurses would be willing to do when you’re not there!

That's interesting about the cup feeding, that's certainly not been mentioned in any of the various conversations I've heard on the ward!

They have a couple of rooms for parents to do an overnight with support to hand before going home, and we've been told that if there's no one else using it we could have it for longer to help with the breastfeeding. That seems like the far distant future though.

Hi @Merrow , how’s the feeding going?

Hey, thanks for thinking of me! I tried nipple shields off the back of this thread, and that proved to be a game changer. The team on NICU are happy that when he is awake and feeding he's getting enough that he doesn't need any tube top up feeds. The more feeds I add the less clear cut that becomes as he cluster feeds and gets very sleepy so it's hard to know if he's feeding well, and his weight dipped a bit. He's getting reviewed by the consultants today so we'll see how it goes. I know it would make things simpler for them if he was bottle fed as they'd know how much he was getting, but I'm trying not to feel guilty about that!

Oh, and I found a local lactation consultant that has experience with premature babies so I'm having a home visit when we're gone (currently unknown when that will be, but hopefully by the end of the month).

I'm so happy to read this! So glad you've been able to start breastfeeding! Hope your NICU stay isn't too long now the end is in sight and your little one is home with you soon xx