Feeding advice, baby in hospital

[WillbeanChariot]

Hi all,

I've been reading mumsnet for ideas and advice since I got pregnant, but I'm a new poster.

My son was born at 27 weeks and is now 43+4 and still in hospital, probably a couple of months to go before he can come home. I have been expressing since he was born, but my milk never really kicked in (I did frequent expressing, fenugreek, fennel tea etc) and I've been taking domperidone since week four and I'm expressing 5x a day. I get about 350ml per day.

My son is now feeding four hourly at night, three hourly in the day. He has two bottles at night and one tube feed, in the day he has two breast feeds and two tube feeds. He's fed entirely on EBM but is now on about 500ml a day so he's starting to get through my frozen supply.

Because he's post term now he's demanding oral rather than tube feeds and the nurses are putting on quite a bit of pressure for him to be allowed more bottles. Today I topped him up by bottle after a breast feed and he took the whole amount. He still gets a full top up after a breast feed even though I know he's getting some milk from me. The nurses tell me he won't settle after a tube feed and they want to bottle feed when I'm not there (most feeds!)

I accept I will have to mixed feed but I would like him to come home partially BFing at least, and I'm worried he won't take it as bottle is too easy, also because feeds are at set times he isn't given enough time to BF before top up. The BF nurse says he'll be fine cos he BFs when he's hungry but I'm not convinced. It has also been suggested that I try to BF more but I can't commit to more feeds every day for months and still fit in expressing (when he gets closer to home I will do as many as I can).

Sorry for such a long post, but I'm at the end of my tether and got really upset today when I was asked and asked about bottles. Any ideas/thoughts/experiences??

It sounds like you've done really well.

Sorry i don't have any experience of premature babies but DS1 was born with an infection that meant he was tube fed initially and took 8 weeks to manage to latch on by which time he had lost a lot of weight. We did a mix of formula and EBM and a combination of tube feeds, BF and bottle in the beginning also.

I'm impressed that your son is managing to breastfeed and latch on. Well done.

It is my understanding that breastfeeding provides much more stimulation than expressing and therefore supply is increased more. Undoubtedly your supply would increase with more breastfeeding.

The difficulty is going to be initially whether he will tolerate the bit in between while he gets your supply going and i'm sure the nurses can advise you on this.

I think your right to be concerned about more bottle feeds as it can be easier for him. DS1 developed 'nipple confusion' with all the different types of feeding. Eventually i switched to BF only and went through hourly feeds for a horribly stressful/sleepless time although it was worth it in the long run.

I don't know if this is any help. Like i say i'm not an expert just have my experience to go on.

But remember you are his mother, not the nurses and you are able to make the right decisions.

sorry if this is ignorant question, but is it feasible for you to feed him more and express less, I mean, can you drop the EBM and actually BF him for more feeds?
I totally understand how you are feeling, I know that I would be really reluctant to increase the amount of bottles given. I really struggle to understand this, I understood that the more you BF the more milk you make, but if you keep topping up, then surely you won't ever make more milk. Don't know if that is right, but I can't get my head around it.
Sorry if that was unhelpful, but I have my fingers crossed for more helpful advice, you need someone like tiktok, who knows lots about BF.

Also, please stick to your guns, if you feel strongly that you want him to be BF, don't let them talk you into more bottles until you feel sure it is the right thing to do and all other possibilitites have been tried. I know that's easier said than done!!

Thanks for your replies. I don't feel I can really cut down expressing- he needs the milk for his night feeds and top ups. His feeds are 70ml each by tube or bottle- he doesn't get any 'credit' for what he takes from the breast which is really frustrating because I express less after feeding so he must be getting it. Occasionally they suggest I demand feed for a day and they monitor his weight gain but I know it will take a while for him to settle in to BFing more and for my supply to pick up so I feel if I try that while he's in hospital I will set myself up to fail. I can try BFing anoth feed a day and I think I will start trying to do that, but it will certainly result in less EBM for his other feeds and bottle top ups. The nurses think if he will take all the top up he must be still hungry but to be honest I think he will take more than his 70ml from a bottle because it's easier and not because he's starving hungry.

The nurses tell me he's screaming for a bottle at his feed times and won't settle after a tube feed, which makes me feel terrible.

Sorry bit of a ramble. Thanks so much for support and ideas.

DS was born at 31+1 in July and spent 6wks in hospital with a mix of tube/bottle and BF. Ive had huge problems trying to keep him BF'ing as much as possible as he did prefer the bottle (and tube previously), even when raging with hunger. I was donig the same feed/express/top up and it was exhausting. Ive compromised on my preference for him to be fully BF and now do mixed feeding with some EBM and some formula and I express 1 x day. I decided to compromise and get him through the flu season with some BF rather than give up through frustration/exhaustion and dwindling suppy. He still 'strikes' about BF now and again but we have reached a kind of agreement of how much he will take from me.

I wish I had some magic answer but I think persistance with BF as much as you can if you want to continue. It is SO hard when you have the added pressure to get them to put on as much weight as possible.

Can they cup feed him? I think this would prevent him getting to used to the easy feeding of the bottle. They dont do that here so it wasnt an option for us.

The other thing is that I was told I needed to eat 3 oz of protein at each meal (basically as much protein as you can) to make good milk. If I dont eat enough I notice my supply gets alot worse but I found it really hard to get enough protein when I was dashing to hospital.

Good luck! Hope it gets easier and you all settle home soon.

I'd go for the demand feeding for a bit if he can tolerate it with regards to weight gain. And you'll find it useful to do this in a supported environment as staff will be able to reassure you. Although it will take a few days for your supply to catch up. If i remember correctly it's about 3 days.

You need to speak to somebody who really knows their stuff. What about LaLeche league or other BF advisor?

I see that Sticki has suggested cup feeding. That is what they did with ds to ensure when he could actually feed he wasn't used to a bottle.

Thanks again ladies. NeverGoogle- I wish I could demand feed in a supported environment- I feel that the nurses want to prove to me that he won't put on weight with demand BF and won't be that supportive. Also I'm not able to take my son out of the ward so I can only BF in the corner by his cot with nurses coming over every 5 mins asking what he's doing and making suggestions (all saying different things!) Not a relaxing environment for either of us.

Sticki- I may suggest a cup feed, he was cup fed once or twice but they seem to think it's more for learner BFers and stopped once he latched on and sucked.I think we will end up in a similar situation, as I'd prefer him to continue getting some breast milk for protection against infections although I think he will have to have formula too eventually.

My twins were born at 32+0 and spent 4 weeks in hospital. The atmosphere in the hospital they were in sounds very similar to where your son is - nurses hassling you, time pressure etc. meaning you're never relaxed enough to feed properly. Neither of my babies could BF in the hospital and I was only managing to express about 400 ml a day and I thought it was never going to work out, till a more pro-BF nurse said not to worry, that when I was home and in a more relaxed environment the whole thing would work out by itself. We've now been home for 8 weeks and within 2 weeks I had enough milk to feed both babies almost exclusively with breast milk. I haven't managed to actually BF both for a variety of reasons, but I BF one and give the other expressed milk, with the exception of one feed a day when both get formula. As for nipple confusion, this was never a problem, despite the fact that the babies were almost exclusively bottle/tube fed for the first 4 weeks - the one I manage to feed cottoned on to breast feeding almost immediately, and the one I'm bottle feeding would be ok if I could concentrate purely on her to sort out her feeding, but unfortunately it's not feasible with 2 babies to deal with so she's on the bottle, and doing very well too. So I wouldn't worry too much about it, because in my experience things will be much easier when you're in a more relaxed environment and can take the time to properly BF your son in a relaxed fashion, and the fact that you're not so stressed out will help with your milk production too, hopefully. Good luck!

Willbean....difficult situation and you have done so well to maintain bf across all these weeks.

Sounds to me that you would find it helpful to get someone expert involved - is there a bf specialist connected with the maternity unit who could discuss things with you and with the SCBU staff? All your concerns need to be listened to. I am not sure why you are against more bottles rather than tube - babies get a lot of comfort from sucking, and tube feeding fills tummies but does not satisfy sucking needs...as your baby gets older and obv. not like a newborn/preterm. sucking is a nice thing for him to do...especially as he is not with you a lot of the time and so does not get the closeness and snuggles he would get at home. Please don't make too much of 'confusion' - babies are capable of bf as long as they are given a chance to maintain the 'skill' of direct bf, and the extent to which this is messed up by bottle feeding is exaggerated (IMO).

5 x a day expressing is a lot but prob not enough to maintain and support a full supply long term, unfortunately, even with the 2 direct bf he has. Is it possible for you to double pump with the appropriate pump? This usually makes life easier. Yes, if you can bf direct more it would also help.

But honestly, best thing is to have a good, in depth discussion with someone you trust.

(BTW - protein in the mum's diet makes no difference to milk supply or quality and whoever told you this, Sticki, needs a spot of re-training )

Thanks all. Tiktok- very reassuring to hear what you say about the bottles, I didn't want him to have them because of confusion, and noone has really explained it to me like that. I have agreed today that he will go four hourly I will BF 3x in the day and he can have bottles 3x in the night. If he gains weight next weigh day they will try giving him half top ups after BF which helps my supply a little bit. I will try to talk to the BF nurse- she did say it wouldn't be a problem giving bottles but just didn't really explain.

I have a pump I can double pump with but find it impossible because I have to do massage/compression to get any milk and I haven't got enough hands! When he gets a bit closer to coming hime I will revive the dreaded night time express.

Firsttimetwins- you have inspired me! It's good to know that we can do a lot after we get home.

I feel very emotional reading what you are going through as it is so close to my own experience. I have come out the other side so I hope this helps.

DS2 was born at 30+5 and we couldn't get BFing going in the hospital. I BF my other DC and assumed it would all come together at some point. I expressed and tried to BF as soon as nurses said he was ready. But he never got a latch.

After weeks of trying, I roomed in and tried every feed. Still no luck.

A nurse gave him bottle and he had no problem taking it but I still held out for BF. But then I began to panic that I was delaying his getting out of hospital because he was having all tube feeds.

So I stopped trying. I expressed and he had bottles. I was sad but pragmatic. The most important thing was he was putting on weight and coming home.

He came home, we went to bed for the weekend and started BF. That's all it took - my own, relaxed environment.

So I would hold out every hope that you can do it because your DS is already BFing. Good luck and trust your instinct.

Thank you EotS, that is very encouraging. I hope that once we get home we will have a better chance of success. I have waited so long for my son to be a bit closer to home, I couldn't bear to delay it so if it takes bottles to get him home that's fine and we will work on it later.

Just a couple of quick additions from me. As someone else has said, I think, just one day of demand feeding is not really going to help him or your supply. It really needs two or three days of it to get your supply up.

My breastfeeding counsellor told me that the night feeds really make a difference in boosting your supply (something about night-time hormones etc) and I think they do recommend night-expressing - sorry! I always tried to cheer myself up about that fact about hormones when I was on my third hour-long night feed!

As tiktok has said, double expressing is also good for boosting supply, and I saw your reply to her on that.

Perhaps one thing you could try is bfing one side and expressing from the other at the same time. You'd have the benefit of 'double-evacuation' then, plus his efficient sucking on one side should help with the let down on the other. Is that possible logistically, with the help of cushions, breastfeeding pillows etc? I know that you can get (expensive) tops that you can wear while you express that hold the suction cup against your breast for you so you can have your hands free. The alternative is to do what one of my friends did and just get an old bra, cut a hole in the cup and poke the suction cup through it. Hopefully you could wrangle your little one and express at the same time. That would also free up a bit of time for you if you could do the two things at the same time.

As tiktok says, a breastfeeding cousellor or similar should be able to help guide you to the solution that's best for you all.

And can I just confirma that big cuddles in bed where everyone's topless are just the best for getting bfing on the right track.

You're doing really well and we're all on your side.