Breastfeeding a prem

[WorzselMummage]

Any hints and tips ?

Ds was born at 27 weeks and is 6 weeks old now (34 gest weeks on fri) and just starting to root around now and has had a little go at BF. I have been trying every day a couple of times and he seems to know what he's supposed to do but because he he's mostly tube fed ( my ebm - 20mmls every 2 hours ) he doesnt really get hungry so either isnt interested or is interested but falls asleep after a while which is understandable, he's only a little bit still.

I know its going to be a long slog, i am determined to do it as i never managed it with dd but i am already worrying about the logistics of it while he is in hospital still, it feels like i am practically going to have to move in which isn't going to be easy with a 4 year old at home.

Has anyone managed exclusive BF of a 27 weeker, the hospital said its possible but not many people manage it.

you need Aitch and Sparklygothcat

Bumping for you

sorry i have no experience or advice but just wanted to say good luck

and to bump this for you

oh gosh WELL DONE for expressing this long, that's a marvellous achievement in itself.
dd was born at 33+6 and i am SHITE at bfing cos my supply is chronic but i still battled away for nearly five months. sparkly's the real success story on here, she's still going and i think her wee boy must be coming up for a year. plus he was earlier still.

i know what you mean about a slog but really, if you've got milk there and can get him interested i'm sure it'll click for you.

surely it's great that he seems to know what he's supposed to do, have you maybe spoken to the staff about coming in just before his tube feeds? or is that what you've been doing?

Tinkerbellesmumandfifi2 exc bf Tink who was tiny and 28 weeks I think - in fact she's tandem feeding now - Fifi was prem too.

DS was a 35 weeker, but tube fed to begin with, and what they did was to get me to put him to the breast at tube feed time so that he was having a go at it, and then fed his feed whilst there.

Once he goes to 3 hourly feeds he should be hungrier and more willing to have a go for longer

of course, tinksmum as well, she's very good on this subject too, how could i have forgotten her?

Hiya Worzel,
I'm afraid I can't help from a mother point of view as am just expecting my first next month! But I'm a neonatal nurse so have to deal with this on a day to day basis (though may just be re-itterating what nurses have told you already?!).

It's certainly possible to fully breastfeed a preemie, but does take more work than feeding a term infant, particularly since most units aim for discharge at 35-36 weeks. Don't let yourself be presurised into giving a bottle unless you want to yourself. If you have enough milk when you express, you should be able to feed and most of the time it just takes patience. I know that seems so obvious, and it must feel like he's been in hospital for ages, but he WILL get there, he just needs to get there in his own time. I hosnestly think that in some respects, this time for parents is the hardest as before when babies are sick they can see a efinete improvement every few days in their babies condition. They come off ventilation, then CPAP, they're tube feeding instead of having TPN, they can take a bit of milk orally, they're transferred into HDU or nursery and put into a cot... etc etc and then all of a sudden the only thing connecting you to the unit is a nasogastric tube!

At almost 34 weeks he sounds like he's right on track for his gestation tbh. Does he have to be 2hourly fed- is he still having resp problems, vomiting etc? If not, could they try 3hourly feeds for him as while he's being fed every 2 his tummy won't have a chance to empty. You will probably notice a big difference in his energy levels after this change. Try putting him to the breast every 6 hours, and leave him sleeping soundly for 'rest time' in between. If his weight gain is good at the end of the weekend/ beginning of next week, ask the nurses if they can give him a reduced feed the time before you put him to the breast to see if that makes a difference. Eg, if you're coming in at 10am to feed and he's usually having 20mls 2 hourly, ask if at his 8am feed they can just give him 10mls and see how he feeds after that. You're right that very often babies are 'over fed' to help with weight gain in the early days and becuase of this they don't get hungry. If he still feeds poorly at the 10am feed, you will know it's just a bit soon for him and can try the reduced feed method again in a few days.

Other than that it really is a waiting game at the moment! Does he latch on and manage to stay latched on, even for a minute or so when he feeds (even if he's not continuously sucking during this time)? Once he's feeding for 5 or 10 mins fro you they can start givng reduced top ups and it is at this point you may need to come in more to establish the feeding, but this may not be for another week or two yet.

I hope this was of some help, have been folowing your story, can't believe he's already 6 weeks old!

Bloody hell that's long!

Just bookmarking this for later, off on school run now

My tiny baby was not prem but induced at 37 weeks due to IUGR and tube fed for the first few days. I tried to BF at the same time as tube feeds and wore myself out trying to be at the SCBU so often. It did not work anyway as my DD never had the chance to get hungry though she had 30mls every 3 hours.

In the end I just pumped as much as I could for her tube feeds and when we were able to try without the tube started to feed her by cup as reccomended. This sometimes worked but it is impossible to cup feed a sleepy baby who is not hungry and I was given the choice of using the bottle or having her NG tube put back in to ensure she got enough. I hated seeing the tube inserted so went for the bottle option.

It was only when I got her out of the SCBU that I started to wean her off bottles. I think it may only be possible when the baby starts to get hungry and want to feed, and I was under strict instructions never to let her go more than three hours from the start of one feed to the start of the next. Fortunately she now likes to be fed every two hours, night and day and is exclusively BF.

Thanks Aitch I think the only think enabling me to express this long is Domperidone really. Expressing it shite, i HATE it, i seem to spend 3/4 or my life attached to a machine or thinking about attaching myself to a machine.. rubbish rubbish lol

Firstontheway thats a really good idea about adjusting his earlier feed, i will suggest it later. He's only on 2hrly feed now because he gets reflux but thats improved so much in the last week that i should imagine they wil change it soon, he's on BMF due to slow weight gain so i dont know how willing they will be but its worth an ask. I know he manage to feed from me yesterday as when i checked his tube it was undigested milk, about 4 ml and he only fed for about 10 minutes.. well he was latched on for that long, his sucking was intermittant.

Its such a lovely feeling when he does have a go, it makes me sad that i never out more effort in with dd ( she was a 32 weeker ). it makes me really determined

Do you think its worth saying i dont want him having any bottles ? They have mentioned it a few times and some of the nurses told me babies can Bf and bottle feed but my instinct says that he shoulf only have BF, what are your view about it ?

it is amaing that he's 6 week already, i dont know where the last 3 months have gone i really dont !

I think that if he can manage without bottles, then it is for the best. Especially when they are tiny and tired easily the bottle is sooo much easier to get milk from, the chance of rejecting thr breast is going to get higher

There seem to be two schools of thought on the bottles.

You might find yourself choosing as I did between tube and bottle. I felt at least with the bottle she had to open her mouth somewhat and swallow.

I think cup feeding is even easier for the baby than bottle feeding...

Remember as well that the 4mls you managed to aspirate from his tube is probably only part of what he fed... the NGT is often sitting at the tip of his stomach (esp when has just been inserted) and there may well be more milk toward the bottom. A better indication will be when he starts to wake up or stir before his feed times and you can give reduced top ups and see how he goes- if you're in the unit anyway it doesn't matter if he hasn't had quite enough, he'll just wake up early and you feed him early. It's all trial and error.

To be honest, at only 34 weeks tomorrow, I wouldn't offer any bottles yet. He's still mini bless him, and he's likely to get there in his own time. The nurses are right in that some babies are more than capable of taking bottle and breast (and often these babies go on to exclusively breastfeed when they're at home and the pressure's off them and mum) but if you're gut instinct is not to offer one, don't. Remember you're not signing yourself up to anything, take it on a day by day basis. If at 36 weeks he's still a bit slow you could re consider and perhaps offer a one off bottle to see how he does, but you'll probably find he picks it up quite quickly once he starts and you'll see a dramatic improvement. Never feel pressurised into offering a bottle, if anyone mentions it, just say you want to stick to the breastfeeding for now and will review it in a few weeks if needs be. Doctors and nurses often get so used to discharging babies early that they forget they're dealing with individuals who will get there in their own time. A few months ago I was speaking to a consultant who used to work in a unit in Australia. He was saying that over there breastfeeding is so 'aussumed' and common that 95% of preemies go home breastfeeding- but very few are discharged before 36 weeks. Over here there seems to be a mentality of trying to discharge babies as quickly as possible, which isn't very benificial. So, try to be patient and have confidence in your ability to feed him

Having said that... similarly, don't feel guilty if you do decide to introduce a bottle or two in the coming weeks- what you're doing is amazing and triple feeding (pumping, breast then top up) is exhausting. And as I said, it's very common for babies that go home mixed feeding to end up exclusively breastfed- SCBUs, no matter how nice they are, or how 'relaxing' the nursery environment, are often not conductive to breastfeeding. When you 'room in' or get home and can lie down with your baby in private, do things on your own schedule rather than clock watching, give cuddles and kangaroo care all day and just be with your baby, things may well click into place, even if they don't beforehand.

Upwind its nice to know that even if he does have to have a bottles that it doesnt mean there is no chance to bf. With DD the scbu gave her bottle even though i expressly asked them not to and she was never interested in breastfeeding so i kind of assume it was one or the other. I have more faith in the scbu ds is in, they seem much more on the ball and i trust them to do as i ask but it's definatly nice to know that i could change things when we are discharged.

Firstontheway, he really is tiny, he's stil only 3lb4 so i am probably getting abit ahead of myself.It's just that I can see that the end in in sight now so i am getting excited

thanks for all the advice

i just popped back to see if the OP had any replies(!!!) and I've been reading all your stories and find it very moving. .....just wanted to say " respect" to you all [admiration emoticon]

I meant to add - my DD is thriving on exclusive bf & is nearly 5 wks

Lovely

I bet your well chuffed !

Hi W, really nice to see you here . You know a bit about our history, so rather than recapping all of it, I would second all that firstontheway says. DD started feeding at 34 weeks but was still below cot weight (1.8kg) so we had some breathing space to get feeding sorted. We too had the waiting for hunger issue, a bit different from yours as although dd was on 3hrly feeds they were mahoosive at around 60mls. We didn't really crack the feeding cues thing until she came out of the incubator and off the sats monitor and I could feed her on demand in a more relaxed environment without the will she/won't she stress that you get when it's all tied up with the "set" feeding time. Looking back, there was about a week or so when her behaviour was like George's and it was absolutely nervewracking, as tbh I had no skilled help and were it not for the ladies on BLISS would not have had a clue. Were I to go through it again I would have more faith and to our SCBU's credit they largely left us to it - good in that no-one was trying to rush or hurry us or shove dd on to me.

One of the things I did feel was that with the best will in the world hospital staff did sometimes prepare you to fail, with comments like "not many people manage to exclusively bf premies" or saying that your milk would dry up as if it was inevitable.

It's definitely a different ball game once you are home. But let's talk about that when you get there.

at forgetting original point of post.

Yes, you can excl bf a very prem baby - dd is living proof. No formula until 6 months plus.

Worzel - i exc bf my 27 weeker - like you was told that not many do manage it and tbh that was my experience in SCBU - i was the only one of my contemparies who came out fully (if at all) bf. hard work but completely manageable if you're prepared, and able, to put the time in. i have 2 older dcs so it was a great juggling act - but in essence, put to breast as often as you can, especially at ng feed times. in all honesty it wasn't until the week that we came home that it all clicked (so J would have been 37/8 weeks corrected), when we moved to demand feeding. also she was bottle fed ebm in the night - and in our case it made no difference - i know there can be a preference to cup feed if you're trying to bf - but J was a very messy cup feeder and split more than she got down her.

DD was 33 weeks so much bigger then your wee man but hope this will be some help.

Was told by our SCBU that babies either had to be fully BF or fully bottle fed for 48hrs before taking the NG out - ie would not let you cup feed .

So we left SCBU when she was 3 weeks old with her totally bottle fed (EBM) as she just couldn't manage to latch.

Persevered with exclusive EBM until she was about 9 weeks old when suddenly she got it!
Managed to BF until she was 15 months.

DS was born at 31+5, only stopped tube feeds at 33+2 and he took at least 5 days of being put constantly on the breast before getting the hang of it (plus I was a very fretful mum and worried he wasn't actually getting any milk). Babes do develop the sucking reflex at slightly different rates so stick with it (and lots of cuddles).

Go you and George!

WEll done Worz for your tenacity. I agree- it is definitely possible... DD was born at 34 weeks, but was really tiny as well (3lbs 9). I started BF as soon as possible. I also worried about the bottle issue when she was in hospital - eventually I agreed to them giving her 1 bottle at night. She came home at 3 weeks (4 lbs) and I exclusively BF. She then started losing weight, so I had to start topping up with bottle after feeds. I agree expressing is such a pain and SO time consuming, but it was worth it in the end. IT was a nightmare, but I was determined and after about a month I was back exclusively BFing. I am very lucky as she will happily take a bottle of expressed milk if DH wants to do a feed or give me a break. I understand that preemies are very good at taking both bottle and breast.

Similar to wuglet- one day she just got it! It was so exciting, but I must say I had lost hope before. I also had to use a shield so it felt so awkward- but when she got it we were off and running and I'm so pleased we stuck with it.

Good luck!

Worsel, I think the reason I successfully bf my DS for 6 months + is because of the wonderful support I received while he was in SCBU.

He wasn't anywhere near as tiny as yours, but born at 34+6 and I pumped manically for 12 days whilst attempting about 3 times a day to bf him whilst he was tube-fed and experienced the same problem as mentioned before - a baby who wasn't hungry enough to latch on.

I found some of the nurses almost pushing the bottle on me which I refused but some were pro-bf and offered amazing support and above all patience, so watch what advice you are given - with the right guidance bf is absolutely possible I'd say.

Just as I was giving up trying to bf as DS was so uninterested in the boob, thanks to a great neonatal nurse who stretched DS enough between feeds, eventually hunger got the better of him and he miraculously latched on and away we went, even though I'd literally just gone out to get some formula as I was so frustrated.

Don't give up is my advice, and if they don't offer you the chance to feed a hungry enough baby ask them if you can try spacing out the feeds a bit more. You will get there with enough determination!