Advice on getting breastfeeding established for my premature baby

[Von1973]

My DD was born at 32+1 due to my waters going. Thankfully she didn't need any breathing support and spent 3 weeks in SCBU prior to being discharged. I visited once a day, not as often as I would have liked due to recovering from an extremely unpleasant c-section, high blood pressure, reliance on my hubbie to get to the hospital and caring for my 21 month old DS. During her time in SCBU I tried her on the breast a few times and she appeared to have limited interest. Since bringing her home I have tried repeatedly, some days at every feed and some days barely at all as its so disheartening and both she and I get frustrated - I will admit, I'm not the most patient of people although I am very determined. When really hungry for her feed, she initially latches on well and sucks for a few seconds but then she either falls asleep and comes off or simply comes off the nipple and just can't seem to get back on, therefore becoming more frustrated so I give in and give her the bottle. I am expressing every 3-4 hours, in line with her frequency of feeding. My supply isn't great. I've been given domperidone to help boost my supply but haven't taken it yet as I'm keen to try all 'natural' ways to help first. She is now 8+3 actual, 4 days corrected. She is our last baby, so I really want to try everything to get BF established. I was unsuccessful with my DS so want to explore all possibilities before giving up. I'm determined not to beat myself up as I did with my DS, but know that breast milk is best, most especially for premies. If anyone can offer any advice, I really would value and appreciate it.

Hi Von. I though I replied to this but just posted on the premature birth thread over in Parenting by accident. I can't copy my post over from my phone.

Its tough establishing bfing esp with another young child but it can be done. You need to express much more frequently than 3-4 hours, you can't follow a premmies lead because they are much sleepier than a term baby. Dd was a 27 weaker and when she finally came home we had to feed her two hourly by day and three hourly by night, waking her if need be. You need to fit in 8-12 expressing sessions a day to maintain and build your supply. Breast massage and drinking lots of barley water will both help but really the more you express the more there will be the next day. I couldn't get on with electric or manual pumps so did it by hand, you can YouTube for how to videos. A supplemental nursing system can also really help, although I found them fiddly, but they are like a mix of bottle and breast feeding. Good luck op, did ended up feeding for two years!!

Some prems can have really high palates, meaning that it's tricky for them to get the right stimulation to feed with just your nipple, iyswim. We never would have gotten established if we hadn't been advised to try with nipple shields - these are more likely to hit the palate and stimulate the suckling action (at least, that's how I understand the theory, and it worked for us). We used them for a few months and then gradually dropped them once DD knew what she was doing!
If you're worried about your supply, the most crucial expression is the one between 12-3am (not ideal for sleep) - again, my understanding is that your hormones are at their peak at this point so expressing as much as you can at this time helps. I also kept pumping each time for a few minutes after I ran 'dry', to try to stimulate increased production for the next time (which was one of the recommendations on the info poster about expressing in the NICU when we were there, and it really seemed to work for me).
Having a pump that works for you is really important too, if you're expressing full-time. If you can afford to hire a hospital-grade double pump, then consider it seriously - it cuts expressing time in half and I found that even 'good' single pumps (we briefly used a Medela Swing) just weren't up to doing it 8 times a day. We hired a Medela Symphony for the four months that DD was in hospital and then a few months after she came home, it was worth every bloody penny.
Wishing you the best of luck.

Yes to the keep expressing for a few minutes after your supply has finished, that's great advice. It definitely seemed to help.

I was coming on to say the same as some other posters - if you want to give it your best shot, you need to be expressing far more frequently - every 2hrs in the day and 3 at night if you can bear it.

Express until the milk stops flowing and then switch sides (or if you have a double pump, switch the pump off for 1 minute) then express each side a second time until the milk stops flowing again (will be much quicker, if you get anything at all to begin with, but it helps tell you boobs that you want more milk than what they provided!).
If you can, express at the same
Times each day, though this is not essential. It is much more important to express as often as possible than to make each session long. So if you are all done in 10 min, but do that 12 a day that is much better than doing 6 x 30 min sessions iyswim.

Re getting the baby to suck, my first latched on for the first time at 8 weeks old and didn't suck properly until 12weeks, so I know all too well how grindingly exhausting and demoralizing it all is. I would suggest focusing on increasing your supply first rather than spending fruitless hrs feeling frustrated and rejected trying to get her to latch/suck. Maybe try her once a day when she is alert and hungry but not ravenous. Do it before you express and empty your breast but before you latch her, hand express or use the pump just long enough to get your let down. That way she will get a much more immediate reward for her efforts of you do get her to latch and the milk on your nipple with hopefully get her in the mood.

Lastly, I would caution you not to run yourself into the ground over this. You have been through a hugely traumatic delivery/early weeks of your baby's life and you have a toddler to look after too. It is great that you care so much about doing your best for your little one, but formula is not poison and your own physical and mental health are very important too. In my experience, knowing when it's time to stop trying is the hardest part of all.

Good luck!

Thank you all so very much for all your advice and sharing your experiences, I feared I may not be expressing regularly enough, I'm just shattered from the whole experience, but equally keep telling myself this 'newborn' period doesn't last forever, so just trying to focus on that really. It's really great to hear how you've all done it and of course, that you've all been so successful.

Thank you Eurochick, I've found your post.

Crazy, I take my hat off to you for hand expressing, that is some dedication and commitment and here's me 'complaining' (trying not to really) when getting on well with electric pumps. You are amazing to have fed your DD for two years!

Jilly, thank you, I had no idea about premie's palates, will certainly give this a go. I had been using the Medela Swing but yes, given the challenges, decided to hire a Medela Symphony - I used these in hospital and such a huge time saving and far more efficient it seems.

How long did you all express for at each session, esp when doing it every 2-3 hours? I had initially been doing 1 hour sessions when using the Medela swing (30 mins per boob) but once we got the Symphony, switched to 30 minutes per session - precious time saving.

Takestwo, I am trying not to run myself into the ground and everything you say is so very true - thank you so much, I'm much more acceptant of using formula with DD than I was with my term DS. It has its place I know however, I really do want to give all options my best shot first. And yes, you share extremely wise words about knowing when to stop. I was no near the cusp of doing that, hence posting on here and here you all are with your wonderful advice, I can't say thank you enough to you all.

DS was born at 30 weeks and he was bottle fed initially and switched to ebf around his due date. I was told not to expect him to breastfeed effectively before his due date, so you might just have to wait a few days more before your little one gets the hang of hit! She is still very small and has been through a lot, just like you!

I would try feeding her when she is not too hungry, maybe try giving her the breast for comfort when she is upset. When she is hungry, I'd express a small amount of milk beforehand so that she doesn't have to work to get the milk flowing.

As for expressing, I expressed 8 times a day, only once during the night at 2 am, with a double pump (medela symphony -don't bother with anything else!), for 20 mins max. Apparently,for maximum stimulation it is essential to express both sides simultaneously! Also, as PP have said, frequency of expressing is more important than length of single sessions.

Drink litres of fenugreek infusion and eat porridge every day.

This is what I did and DS at 10 months is still bf, so it can be done! I remember crying from frustration, thinking he would never get the hang of it!

You sound like you're doing an amazing job, particularly given everything you're juggling.
In terms of how long for expressing, I think it was about 30 mins each time, so sounds about right.
Hope it all goes well - my experience was also that it took a while (we didn't start trying to bf until DD was about 12w, and she was about 18w when the ng tube finally came out) and there were a lot of false starts and set-backs, but it is possible with a bit of luck and support. Is there a breastfeeding specialist at the SCBU your DD was in? I'm sure they'd be happy to help, even if you've been discharged for a few weeks.