BF prem baby Urgent help needed!!

[Kayzr]

I am posting on behalf of a very good friend Glaskam who is a regular on MN but can't get on at the minute.

Her DD2 was 8 weeks prem and was due 17th April so she has caught up with her due date. She currently weighs 4lb 15oz and was 4lb at birth. Glask was expressing while they were in hospital and she was having that. Then when her DD2 was strong enough she was BF normally. She has been putting on weight but only slowly so she was told by the SCBU nurses to give her 1 bottle of formula a day and to express away the foremilk before each BF.

Now she has been told to give 2 bottles of the extra calories formula milk and Glask said her supply has halved, she is really struggling to BF. Less than an hour after a BF her DD2 is hungry again, so the SCBU nurses have told her to give 3 bottles a day.

She really doesn't want to give anymore formula milk and would really like to try and exclusively BF if possible. She has BF her DS and DD1 with no problems so is really at a loss.

Any help is really appreciated. Thank You!!

Oh dear...what a shame she can't find someone on the spot to help her achieve her aim of bf

2 formula bottles a day is going to have an effect on her supply - no doubt about that. You don't say what the volume of these is, but in a baby under 5 pounds, 2 bottles could be, proportionately, a good chunk of what the baby can take in per day. 3 bottles is adding to this scenario

Wanting to feed an hour after a bf is fine - we should be shouting 'hurrah' as the issue with teeny 4 and 5 pounders is often that they are too sleepy to take in the calories they need.

The expressing away the foremilk is fiddly and (I would tentatively suggest) really not necessary. This little baby may need no more than just lots of direct access to the breast, many, many times day and night, with kangaroo care to encourage this...but we can't be sure, we are not there, and all I would say is to suggest she asks for good reasons why kangarooing, frequent bf, and feeding two, three or even four sides at a time would not be good for this baby's health, growth and weight.

Hope this helps.

Thanks Tiktok. The nurses aren't being much help at all, the practically bullied her into giving the formula and she was made to feel like she was neglecting her dd2.

She is having between 2-3oz of formula twice a day. She is doing some kangaroo care.

She needs to know that's a lot of formula.

If the baby was fully formula fed, she'd be having (rule of thumb) about 12 fl oz in 24 hours. Giving 2-3 oz x 2 a day (let alone x...) doesn't leave much room for breastmilk, so no wonder she feels her supply is down.

She needs to discuss all this with someone knowledgable in real life - my concern would be to rescue her milk supply now

Hourly feeding is not abnormal at this stage and in most cases is not an indication of bfing 'failing'. If she wants to then she should offer the breast as often as feasibly possibly, she should explain that she would like support in this from the hcps and reassure her absolutely that she can get her supply back up but she will need to feed very often indeed.

It's always hard to know exactly over the internet whether we have all the information.

Do send our best wishes won't you?

I mean let alone 3 x (ie three times, which is what is being suggested).

She has said she is going to see what happens when she stops giving the formula. The nurses are only interested in her weight and not how she is fed. I've told her to ask if there is a BF counsellor at the hospital.

My DS was born at 30 weeks and we had all sorts of probs with BFing at first. In the end, for him to gain weight and for my supply to meet his demand we feed every 1-2 hours for up to an hour at a time for the first month or so after we came home from hospital. I literally did nothing but BF. I also needed a lot of help with his latch as he too had been bottle fed which caused nipple confusion and meant his latch to me wasn't too good- in the end to make the switch to 100% BFing we resorted to using nipple shields, which would allow him to latch for much longer.

It was very hard work at first and if I hadn't had good support from family and a BFing counsellor I think the bottle feeding would have won. It is soooo hard after expressing for so long to maintain an adequate supply, so my first bit of advice would be to express whenever her DD2 has a formula feed, to encourage her supply to "keep up" in the hope she may eventually be able to increase the BFs again. Also if she's having trouble with her supply I really recommend the herbal supplement Fenugreek, which helped me enormously. There is also a drug called domperidone which her GP can prescribe to boost her milk supply.

Basically she needs a lot more hands on support from a well experienced BFing counsellor if possible, and support from others so she can spend as much time trying to increase her DD2s feeds.

Bfing a prem is often very hard work, but if she can keep going it will work out- both my DCs were prem & I managed to BF them for 10 and 12 months each- but I do remember the start being incredibly tough.

Thinking of them lots x

Ds2 was almost 6 weeks prem and I had a similar experience. I ended up having a massive argument with the m/ws about formula. They "told" me to give him some and I was adamant that I wanted to b'feed him; I even explained to them about the effect it would all have on my supply and they told me I was talking rubbish .

Can Glask find a b'feeding counsellor nearby? I found one and she came to visit me in hospital and helped me hugely and we did it. It was hard (he didn't have a sucking reflex at first) but well worth it.

Good luck and breastfeeding vibes to Glask.

Hi Kayz (say hi to Glask for me)
I think my instinct would be to feed, feed & feed again with BM. It certainly sounds as if she has been made to feel guilty about her BM and the fact that her teeny Dd2 is not gaining weight as fast as they would like

The weight issue is a hard one but I do think they need to take into account that she was very early and is actually gaining weight, albeit slowly.
Prems are likely to be 'behind' in stature, weight etc until around 2 years old when they pretty much catch up with their peers.

I would be inclined to continue to BF her eery couple of hours whether she is asleep or not and through the night too. I know she's tiny but co-sleeping helps to give good night feeds to me, but not everyone is comfortable to co-sleep, I understand that.
I would babywear her too during the day

I fully agree with Tiktok that she needs to contact a breastfeeding counsellor who can help her face-to-face.

I hope she can rescue the situation.
hth

Thanks everyone.

Jumping, I am going to post her some fenugreek as she can't get to a shop.

Sorky, I think they are co-sleeping occasionally. But she is a bit worried becasue Ruby is so little.

Firstly thanks to Kayz for kindly posting this for me... its nice to come on to advise than posting asking for it and not having time to get back and see the responces!!

Bit of background to add to what Kayz put for me...

DD2, born 8wks prem, started breastfeeding for herself on day 9, came home on day 17 fully breastfed, was very slow to gain weight, but was gaining about 0.5-1oz a week, at around 3.5wks old she got ill and was in hospital for another 5 days, lost the weight she'd gained and was then static for a week, then she started to gain again, allbeit slowly, but the Neonatal outreach (special SCBU) nurses said it wasn't good enough and that if i didn't introduce formula she'd not get enough calories for her brain and body to develop fast enough...

So i introduced a bottle of formula very reluctantly, a week later she'd put on 140g and the nurse still wasn't happy so wanted me to add another bottle, since then my supply has almost halved daily! This morning when she had her bottle I expressed only 10mils from each side. Over the last 48hrs after each time i feed her (and her draining each side) she's starving and wanting more but gets very frustrated when i dont have a single drop left for her.

Phoned the nurses and asked to loan an electric pump, and over the day have decided that once my supply is back up i'll go back to 100% breastfeeding and just feed on demand as i was before introducing the bottle.

IMO adding the bottle has just delayed her growth even more, as she's been getting the extra calories from the formula but getting less milk from me, so its not doing any different to what just BF would. And i'm almost certain that if i'd not introduced the bottle she'd have started to gain more and more weight each week if just left to BFing!! I fed both my other 2 DC's until 12mths and didn't have a single supply problem, so IMHO i think the bottle has caused the problem and done the opposite of what they wanted!!

So after a very long post, and a read of advise i'm going to be demand feeding, and pumping after each feed aswell to increase supply, will attempt co-sleeping but will see how it goes on that front, am getting lots of skin-to-skin with her... and as soon as my supply is up to about 2oz every 3hrs from one side i'll stop the formula and just breastfeed!!

Thanks for all the advise, its good to know i'm not the only one who's had problems!!

My DD1 was also born at 32 weeks and spent a month in NICU where everyone was very helpful re BF but focused on her weight. She also weighed 4lb at birth. Everything was complicated by a G3 Brain Haem.

Alongside nipple shields, domperidone and kangaroo care, I carried her in a sling a lot. I also felt like a cow as I was either feeding or expressing. We co-slept, sometimes with her in our bed, sometimes with her in a cot attached to our bed.

She moved into her own room aged 7 months (uncorrected) by which time she was sleeping through the night.

She is now 2.7 yo and perfect! She is the same as any other child born at the same time (but term.)

DD2 arrived in Dec at 35 weeks. Same troubles with BF - used same strategies to cope.

Persevere with whatever feels right for you. NICU/SCBU are more focused on weight gain but once discharged from NICU to consultant care you don't have to 'put up with them' - after all, they just want what they think is best for your baby to be healthy.

Hope all else is fine with your L.O. and two years from now the prem issue won't be an issue!

Glask - do you live close to Kayz? If so, I can recommend a fab BF support centre in Bridlington (if there isn't one closer to you). I can email the details to kayz, if this is in your locality.

Best of luck, you sound very positive

Thanks Zoe, but she is in Blackpool!! I'd love it if she was near us so I could see Ruby!!

Not having read the whole thread, there is an injection that you can have in this sort of circumstance that ups your milk supply....my friend had it when her baby was in ICU for a month and her supply then kept up with the increased babe to boob time.

Support in Blackpool

You may want to consider the various alternatives to the bottle as well if you do find she needs some supplementing or topping off. SNS will be best at it will allow for her to be at the breast providing much needed stimulation, plus she will associate the breast with feeding.

Hello there. Just read this and although my baby wasn't premature, she was 5 weeks early and only weighed 5lbs (2.5kg), obviously dropping a fair bit after that (and because I didn't read books I wasn't prepared for that).

The breastfeeding support here in Singapore (where b/feeding is sometimes viewed as old style/hippie behaviour) wasn't fantastic. Lots of dive-bomb latching techniques and shrugs of shoulders and suggestions of formula top ups.

She was SO sleepy and jaundiced and never a strong sucker (though a good latcher) and didn't even really do that proper suck - pause -suck until 6 weeks (she had put on weight though so something was being sucked in)

I topped up half-heartedly for a week but knew deep down it would lead to supply issues so from 6 weeks on I have basically fed my daughter whenever she's hungry and whenever she isn't. Basically I feed her all the bloody time. Babymoons, domperidone, fenugreek, fennel tea, oats, feeding both breasts (starting again from the last one fed from) and making sure she fed well in the night (ie not trying to resettle without feeding).

She's 6 months today (yay!) and still exclusively breastfed (planning BLW in a few weeks) She weighed last month about 6kg but I don't weigh her regularly. People still comment on how small she is but I'm so pleased we've got here and plan to continue until she doesn't want it.

I just wanted to say I empathise with your friend with a preemie/sleepy/topped up baby. It will take persistence and intensive feeding but there's no reason (that I'm aware of, of course) that she can't lose the top ups and get down to exclusive breastfeeding. But she'll have to have some nerve when it comes to weigh ins (perhaps avoid them?), and I can't overestimate the importance of getting a proper breastfeeding coach to check a whole feed. Even though I was doing it right it was really reassuring to have someone check on latch/holds all that stuff.

Best of luck to her and her little one!

i found breast compressions helped us too - more calories with less effort. i've not seen that mentioned yet so it might be worth a shot ?

We had pressure to top up, ds was a 27 weeker and dropped through the centiles when we were first discharged. it took couple of weeks but he got better at bf and started putting on more weight, 8oz one week. The Dr made me feel like a failure at the start and the nurse saw right though my 'can't get him to take a bottle' excuse when i decided that i wasnt going to give him top ups but in the end it was ok, I think scbu staff are so weight orientated they can't see the bigger picture sometimes.

How is Glaskam doing now Kazyr ?

Hi everyone, again thanks for the extra comments since my last post.... we've had some massive improvement already. The evening i last posted DD2 was feeding every 20-30mins and still starving after every feed... I ordered some fenugreek which i'm hoping will arrive today, and ordered a ring sling to kangroo hold as the premaxx i currently have can't be used like that, hopefully the sling will arrive today too.

Anyway on tuesday night something clicked with my supply and she was starting to get much more settled after a feed and going longer and longer between feeds. She's still only going 1.5-2hrs between feeds but its obvious that my supply is going back up again.

She was weighed yesterday morning (can't be avoided as the SCBU nurses only really come for that!!) and she had put on 4.5oz in 5 days!!!! thats amazing, and the most she's every put on in one go!! And that was living on mainly the formula for 2 days out of the 5... so i've reduced the formula to just one bottle in an evening and BFing on demand any time during the day or night, and hopefully if she's still gaining weight well at her next weighing next weds then i'll drop the formula and exclusivley breastfeed from then onwards.

The morning Kayz started this thread i honestly thought my supply would vanish and i'd be left with no option but to bottle feed, and it started to turn around overnight... shows what persistance and positive thinking does!!

I know i still have a bit of work to get my supply up to what it was before introducing the bottle, but hopefully within a couple of weeks i'll be complaining about how much milk i have again!!

Thanks for all the advise and support- its times like this you know you can turn to MN and find a friend!!

Glad to hear things have turned around...your persistance paid off....well done....