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Infant feeding

Get advice and support with infant feeding from other users here.

Breast feeding a prem baby - advice please

20 replies

elesbells · 16/04/2008 07:36

I know you lovely netters will know about this

My niece had to have an emergency c section yesterday, 7 weeks early - It was quite an horrific time for her, she started bleeding v heavy so I took her to hospital. She lost a lot of blood and needed a tranfusion. She was four hours in theatre. Her baby girl was taken to scbu but is breathing by herself and okay at 4lb 7 oz.

My Niece has just called me in tears saying she wants to give the baby breastmilk but she has been told by the midwife that the baby has a formula tube and she is being fed. My niece has insisted they give her bm but they are not listening (lots of excuses like 'the anesthetic will affect the milk', 'she has lost a lot of blood and is too weak' ect)

are any of these excuses true? should she wait until she is feeling better?

She is so upset

tia

OP posts:
popsycal · 16/04/2008 07:37

She needs to keep insisting if it is what she wants. Is their anyone who can stand up for her and enforce what she wants?

elesbells · 16/04/2008 07:44

Yes there is someone who will stand up for her - me!

I just want to be sure about the 'too weak' and 'anesthetic' excuses as i'm not sure.

I know I could bf straight away after my section but I only had the spinal block - she had total knock out so i'm not 100% sure iykwim?

OP posts:
brrrrmmmm · 16/04/2008 07:51

Your poor niece, I hope she recovers quickly. Found these links on kellymom -
www.kellymom.com/bf/preemie/preemie-links.html

CantSleepWontSleep · 16/04/2008 08:39

I'm going to keep bumping this for you until SparklyGothKat sees it. She insisted on feeding Callum by breast rather than formula, despite him being born similarly early.

numptysmummy · 16/04/2008 08:43

Bf dd who was nearly 7wks early. I had a spinal and a ga and was on the breast pump as soon as i was able. Nobody told me she was too early,weak etc. Besides,even if she is too weak etc it's still a good idea to get vexpressing ready for when it is possible. Although tbh sounds like tosh.

numptysmummy · 16/04/2008 08:44

Should add,also had a pph and blood transfusion - can't see tyhat blod loss is an excuse.

slalomsuki · 16/04/2008 08:54

I had two prem babies one at 5.5 weeks early and the other at 8 week early and breast fed them both.

They will have put a tube in because the babay may not have the sucking reflex yet but there is no reason why it cannot be breast milk that goes down the tube and not formula.

I expressed as soon as I could and as soon as I was able started to put my two to the breast and eventually they got the idea. In the mean time I expressed like mad and at one point had so much milk I was giving it t the milk bank for other prem babies.

In my case I wasn't too worried about the formula aspect but was more concerned about the introduction of a bottle at this early stage so I got written the following on my notes.

Order of preference for feeding

Breast fed
Breast milk by tube
Breast milk by cup
Formula milk by tube
Formula milk by cup
Formula by bottle

If anyone did something while I wasn't there I asked for the other actions to be recorded and there sucess or otherwise noted

elesbells · 16/04/2008 09:01

Thanks for this. I knew it was rubbish about her 'being too weak'. She wants to do it and feels she's up to it, so that bit is a matter for her surely?

Does anyone know if a general anthesetic would affect the bm? I want to be sure I know what i'm arguing about when I get there.

OP posts:
numptysmummy · 16/04/2008 09:03

Not sure - like i said,i'm sure i started expressing the next day. Woman have term babies under ga and breasfeed though.

SparklyGothKat · 16/04/2008 09:09

I had Callum at 33 weeks and he weighted a similar weight, I managed to give him BM but unfortunely her milk will not be in yet anyway, and scbu will formula tube feed. She needs to start expressing ASAP, there should be a pump on scbu for her to use. The formula will be used until she has enough milk stored.The sucking reflex is not supposed to come in until 35 weeks but Callum was feeding within a week. Not sure about the other things.
SCBU will push bottlefeeding (they are not supposed to) but its easier for them, but if you manage to get a great nurse (as we did) then they can be very supportive.

cmotdibbler · 16/04/2008 09:10

My DS was born 5 weeks early, but naturally although had a pph.
He had a tube down as needed the nutrition constantly at first, but I expressed for him every 3 hours, and he had whatever I had produced, plus formula to top up to whatever his feed was supposed to be. After 2 days my milk came in and I swapped from hand expressing (much the best when just producing colostrum as it stimulates the breast more, and you catch every last drop) to pumping and was able to produce all his needs. We went on to bf exclusively to 6 months, and are still bfing at 22 months.

The GA would have left her system, and therefore her milk within an hour of coming round, and I can't believe that if she has had enough transfusion to replace the blood she'd be too weak.

Bliss have info here on bfing a prem.

Unfortunatly some places just aren't very supportive of bfing a prem baby. The most important thing is that she expresses regularly (every 3 hours at least day and night) to get and maintain her supply.

She should also ask to see the infant feeding coordinator/bf specialist to get good support in the hospital

elesbells · 16/04/2008 09:19

Ah thanks sgk - I will get her to ask scbu for the breastpump. Just remembered, When I had dd3 there was a bf nurse on the ward - I will seek her out too for support.

Why is it such a fight to get what you want? Surely it should come natural for them to help her bf? ffs, she's been through enough.

OP posts:
kiskideesameanoldmother · 16/04/2008 09:29

This is a copy of a post from Mears way back in 05.

Print it off, take it to the hospital give a copy to your niece. If you are able to speak to someone senior in the SCBU or Midwifery on her behalf, please discuss it with them too. You can ask if they hospital has an Infant feeding specialist.

Expressing Colostrum during Pregnancy

Hypoglycaemia Policy
Most babies have no difficulty in adapting to life outside the womb. However, some babies have an increased chance of developing low blood sugar, sometimes called ?hypoglycaemia?. Babies at increased chance of low blood sugar are:
Babies born early or premature ? before 37 completed weeks of pregnancy
Babies, who are lighter in weight than expected for the number of weeks of pregnancy, sometimes called ?small for dates?.
Babies who need extra help to breathe at birth
A baby who is ill
Babies whose mothers had diabetes during pregnancy
Babies whose mothers have had to take medicine for blood pressure (betablockers).

If any of the above applies to you or your baby, then we will encourage you to feed your baby as soon as possible after birth and then to feed often, at least every 3 hours as this will help to prevent low blood sugar in your baby. Your expressed colostrum can also be given to your baby after breastfeeds. Your baby will be carefully monitored and we will check his/her blood sugar regularly.

Is there anything I can do during my pregnancy to prepare for this?
Sometimes as early as 28 weeks of pregnancy, women find that they leak colostrums. The midwives will offer to teach you a very simple technique for expressing colostrum and provide you with sterile equipment for collecting and safely storing it with labels for dating it.

How much colostrum will I be able to express?
Colostrum is present in the breasts from about sixteen weeks of pregnancy onwards. Some women leak colostrum and some don?t, both are normal. Don?t worry if you don?t leak colostrum, it is not an indication that you won?t have enough milk or a reflection on your ability to breastfeed. The amount of colostrum will vary from woman to woman. It can range from a few drops to as much as a teaspoonful or more.

When do I start?
A good time to start would be when you reach 36 weeks of pregnancy.

How often can I express?
A good time to have a first practice is when you are in the bath but you can express as often as you like.

How is it Done? In 4 Easy Steps!

  1. Prepare ? gently stroke or use circular movements with your fingertips to massage your breasts, moving towards the nipple area. (It is not essential but sometimes a back massage can help. Ask someone to stand behind you with a fist either side of your spine, level with your breast and rub their fists up and down, gently and firmly).
  2. Finding the place you need to press ? You need to find where your milk collecting ducts (sinuses) are in your breasts. The best way to do this is by feeling for them. They may feel like peas or peas in a pod or just a change in the texture inside your breasts. They are often found a few centimetres from the end of the nipple or where the darker tissue around the nipple area (areola) meets the skin of the breast.
  3. Removing colostrum ? Place the flat your thumb above and the flat of your first finger below, in a ?C? shape, over the sinuses and gently press and release, building up to a rhythm. A few drops of colostrum may appear at the end of your nipple. When the drips stop move your thumb and finger around your breast to the next set of milk collecting sinuses, repeating this process of rhythmic press and release. You may need to swap hands to express colostrum from the other side of the same breast.
  4. Collecting and storing colostrum ? You will be given a package containing equipment for collecting and storing your colostrum. There will be small sterile syringes with red caps, which you can use to collect the colostrum directly from your nipple. If you chose this way to collect colostrum, carefully replace the red cap and place the syringe at the back of the fridge. Alternatively, you may wish to use the small sterile gallipot for collecting colostrum, if so when finished re-cover the gallipot and place it in the back of the fridge. If you are expressing more than once in a day then use a new sterile syringe or gallipot at each expressing. At the end of the day, you can put all of the collected colostrum into one container (universal container) and store this in the freezer at minus 18 degrees C. When you are coming into hospital to have your baby put all of the collected colostrum into the plastic bags provided, pack the bag(s) with ice. Once at the hospital give the bag(s) to your midwife who will have it stored in the hospital freezer.
elesbells · 16/04/2008 09:38

Thanks for that kkm have printed it

Will let you know how it goes.

thanks all x

OP posts:
ephrinedaily · 16/04/2008 09:52

Just a quick thought for when milk comes in - I had similar probs with my early baby. As others have said it is easier for nurses to give formula.We did all the tube feeds ourselves - that way me or DP could go and get the expressed milk from the fridge to do it. The one time I slept through a night feed they gave him formula. Not really staff's fault - shockingly understaffed. I had to push to get breast pump, storage bottles, sterilising unit, taught self how to assemble kit - bought own pump in the end as had to share one working pump with 3 mothers, 2 with twins! Good luck x

lizzytee · 16/04/2008 11:29

Just to second all that others have said. My dd was born 13 weeks early and was delivered by section although I was unwell.

I would question, firmly and politely, what you have been told by a single nurse. If there is a specific medication that contraindicates bfing in your niece's case then she should be told clearly what it is and preferably by the consultant paediatrician caring for her baby. At the very least I would approach the matron/nurse manager in SCBU and say "I have been told this, can you clarify this for me as I don't understand the explanation I have been given?"

As for whether she is too tired to express milk for her baby....that is a judgement for her, not the nurse to make.

However, if her milk has not yet come in, it MAY have been a well-intentioned but not entirely appropriate comment on the nurse's part. I could express nothing until day 3 and my milk did not come in until day 6. As many hospitals don't have breastmilk banks they do often start by feeding formula.

I would suggest that your niece ask midwives/nurses on the delivery ward to show her to hand express and not to be afraid to keep asking. I had to ask 3 different nurses before I found one who really knew what she was doing.

It's important to express at night and again this is an area were well-intentioned healthcare professionals tell you to get some rest rather than do this. The BLISS leaflet that another poster has linked to is excellent and also reflects agreed UK best practice.

Best wishes

LiegeAndLief · 16/04/2008 12:53

As everyone else has said, completely untrue. She is lucky to have someone to go in and stand up for her as it's difficult to be assertive with a prem baby and csection! My ds was born by cs at 34 weeks and I started expressing the next day with the help of the mws (they actually brought the pump to my bed on the observation ward, so much better than your poor niece's hospital). She needs to get someone to help her to express. Tell her not to be too disheartened if she doesn't get much at first - even when her milk comes in it might take some practice to get a lot out. Like others said, ideally you should express 6-8 times a day and at least once in the night to mimic the baby feeding. This is HARD when you have had a cs and can barely get out of bed, I would imagine even harder if your niece has had such a rough time. Make sure she is getting enough painkillers to manage - paractemol, codeine and morphine are all fine to take when expressing.

The baby will need to be tube fed to begin with but your niece should be able to start putting her to the breast fairly soon (and not worry if the baby doesn't suck - just being near the breast will be good for both of them), she should keep asking the SCBU staff about it as they are not always very helpful either. There might be a bf specialist attached to SCBU she can talk to.

Rascal1979 has been through something very similar recently - I'll keep an eye out for her.

Best of luck to your niece, hope she recovers quickly and the baby does well.

rascal1979 · 17/04/2008 10:43

Only just seen this - How awful of the hospital - def should make a complaint once sheis feeling better. However for now she needs to focus with your support on getting her LO onto EBM

It is your Neice's right to BF and indeed her LO's right to be BF.

I gave birth to my DD by emergency CSection under GA in Dec last year after developing HELLP/Severe Pre-eclampsia at 31 wks gestation. I was encouraged to express on CDU within less than 24hrs after giving birth - despite being on a morphine drip - has no adverse effect on milk and neither does GA.

Babyrascal was only 2lb 1oz and was having my EBM albeit very small amounts to start (she started on 0.5mls!)within 2 days of delivery and although it was a LONG journey which had me regularly at the end of my tether and on the brink of giving up after 9 weeks of attempting to get her BF my LO came home from SCBU on her due date exclusively breastfed. She is now 18wks old and after a rocky start with her weight gain she is now a healthy 6lb 9oz (small for a 4mth old but she has come a LONG way)

Your niece should insist on seeing the hiospitals BF co-ordinator as SCBU is often not the most helpful or conducive envoronments for establishing BF. Babyrascal was born at one unit then transferred after 10 days closer home. The first unit were amazing but the second was not so BF aware or as proactive at encouraging BFing. The BF counsellor however was amzing and really helped us through some difficult days and weeks on the unit.

Your neice should continue expressing at least 6-10 times in each 24hrs including during the night to keep up her milk supply, having a pic of LO or even at the bed(incubator)side is ideal to stimulate her milk . She also needs to do as much skin to skin with her LO as soon as she is upto it - this will help her milk supply and encourage LO to feed

I really do feel for your neice it is a terrible experience and she is going to need all the support she can get. However Babyrascal and I, and many other MNers are proof that it can be done!

[waves to L&L]

SaintGeorge · 19/04/2008 14:05

Had to post to say thanks to everyone who has posted such wonderful advice and links on this thread.

My friend had an emergency CS on Thursday night due to pre-eclampsia (31.5wks). She now has a beautiful 2lb 7.5oz daughter.

I promised I would check the best parenting resource in the world for info & advice on BF for her and this thread has it all .

shreksmissus · 19/04/2008 19:18

Message withdrawn

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