What to do about supply level for bringing baby homel?

[user1471515420]

Hi all,

I had my DS at 31 weeks and have spent the last month between NICU and SCBU. Currently expressing and using the occasional top up of donor BM if he needs it depending on when I get in each day to visit.

I’m currently just about producing enough to sustain him but coming in slightly short of his daily volume. I’d hoped to BF but the ward is so stressful that we’re not having much luck. He is doing well with his bottle feeds and I’m hoping to try BF again once we’re at home rather than keeping him in for longer while we try. He’s putting on weight brilliantly and we’ve been offered transitional care for this week.

I have questions regarding what to do once we’re (hopefully!) home.

1. If I’m not producing as much as he would take in a 24 hour period - would I need to top up a feed with a formula feed since there will be no more access to donor breast milk? Did anyone else have to do this, and if so which formula did you choose?

2. He only moved from a 3 hourly strict feeding schedule to cue based feeding yesterday, so do I just need to wait for him to waken unless it runs over the 4 hours in which case I’ll wake him to try him at the breast? I’m hopeful being home and uninterrupted skin to skin will mean I can increase my supply.

3. Does anyone have experience of trying to establish BF and expressing at the same time? I currently have set times for expressing but conscious that if I’m to try cue based feeds with him at home that I’m going to struggle with knowing when to express? EG - I’ve offered breast, he doesn’t take it, DH can give EM in bottle while I express, but then if he wakes again in 20 minutes to try again then I’ll have nothing to offer from breast?

4. Any experience of how to monitor volumes when it’s cue based rather than the set volumes at set times we’ve been used to? I work too hard for this milk to waste any of it - should we start with half the volume and heat more as we go each feed?

5. How did you heat your EM for bottle?

We’ll obviously speak to the staff today when we ‘move in’ and some of these questions may be obvious but we are sleep deprived and have been running on fumes for nearly 6 weeks now so I can’t see it for myself! Thank you for any advice!

Congratulations and exciting times! No advice on using formula but when our LO was finally allowed home, they lent us an electric pump that I'd been using in the hospital to express to bring my supply in. I literally just fed them on the breast as often as they wanted it and my milk just built up to meet their demands. One piece of advice we followed was to not heat the expressed / formula milk as once you start that they expect it all the time which could make life harder when you go out and about so never did (with any of our children) and never had any problems.

Once home, I expressed a little after each feed initially but ultimately all the expressed milk wasn't used as easier just to feed them myself. Enjoy having them home.

Should say it was impressive how quickly my breast milk increased once home and no pressure of the hospital environment. 🤞 It's the same for you.

My daughter was born at 34 weeks and spent 13 days in SCBU. I expressed using the hospital pump and got an electric pump for home use too but I never managed to express more than about 50ml at a time. I lost a litre of blood during the birth and was really quite unwell so I think this affected my supply.
I tried to BF in hospital but it didn't work out and the nurses basically told me to switch to bottle feeding so she could go home sooner.
When we got home I expressed for 5 weeks until it became pretty pointless as my supply didn't increase and DD was upping the amount she was taking per feed. When I wasn't even managing to express an entire feed worth in a day I packed it in. We had to mix feed from the start so some feeds she would have SMA, some breast milk. We used a bottle warmer for BM feeds.
We were told at discharge that we should feed her every 4 hours despite it having been every 3 until then. This turned out to be incorrect and we were meant to carry on with every 3 hours even if it meant waking her.
I hope some of that is helpful and congratulations!

My 32 weeker is now 10 and from memory I was pumping a lot as dd would get tired feeding which hindered her weight gain (she was borderline failure to thrive). I was pumping every 4hrs esp overnight as was told the night pump/feed was vital for establishing supply. We were definitely on a timed schedule for many weeks anfter coming home and I had a chart where I measured time at breast / mls from bottle so can’t comment on the cue feeding questions.

we did end up mix feeding, partly due to dd slow weight gain and also as I also had a 1 yr old and it was too time consuming to be feeding plus pumping. We had extended support and a specialist nicu nurse/midwife assigned when we came home at 35 weeks and she sorted the formula prescription, was a high calorie/prem baby milk but can’t remember it’s name. it came in small ready made cartons.

I had to get my supply back after a 10-day hospital stay for me when my baby was given formula. All I did was stay in bed with him with skin to skin and he got enough food to boost my supply to the point where he was then EBF until I introduced solids. I didn't worry about timings, amounts etc - if he was full he would sleep and I knew he wasn't hungry so didn't worry, and the main thing was resting and drinking and eating well to make more milk. He definitely fed hard for a day or two which boosted my supply and then we were off.

I don't know about expressing as once he was with me we didn't need to. But I would take all the advice you can from home nurses etc.

Good luck. Once you are home it will become easier. I made it clear to people that I wasn't leaving the bed, too, until I got it established. That is important.

I also had my DS early, as we got nearer to going home the SBCU nursery nurses went through everything about feeding at home so hopefully they do for you too.

There was also a feeding team to discuss all this with, do you have the same?

To answer your points from our experience:

1.Whilst we were in hospital, donor BM was phased out and switched to formula (instigated by the SBCU), we weren’t given a choice, they recommended nutriprem2 & DS tolerated it so we didn’t change.

We had it in bottles pre-made in hospital but then once came home switched to powder, on prescription (I can’t find it for sale anywhere).

It didn't occur to me but I think others were keeping some of their expressed milk at home & freezing it so had spare once came home too.

2.Cue led in our SBCU basically seemed to be 3-4hourly, and most babies were at the 4 hour mark, so think you’re right.

The best advice we had was to keep in the hospital routine - we came home at similar time to a friend who had a baby at term and whilst they were doing feeds every 1-2hours on demand, we were settled into every 4 hours and made a massive difference to my energy & sleep, getting things done & able to go out and about. Felt like we deserved that silver lining from our situation!

5.Also agree on not heating it, DS had it cold, warm and anywhere in between in hospital depending on the nurse looking after him & think it’s helped as don’t need to worry about it at home (other than making sure not too hot!).

Otherwise no advice on establishing full BF - I was expressing half of his daily feed in hospital so decided to go with bottles to get him on more sucking feeds (was fed down a tube whenever still asleep at feed time & needed to get onto all sucking feeds to get him home) & just put him on the breast to practice latching on.

Intended to build up supply once home but ended up going the other way, found harder to find time to express which I needed to do to build it up as we stuck with 3-4 hourly feeds, and preferred knowing how much volume he’d had (and that my DH could feed him too) so BF didn’t work out for us.

Good luck with it all!

Hiya, my DD was born at 33 weeks and was also fed expressed milk in a bottle. I had intended to breastfeed directly but the bottle was so much easier for her while she was tiny and as the only thing keeping her in SCBU was needing to go 48 hours without a tube feed I just went with it. Continued exclusive pumping for four months then switched to formula.

How often are you pumping? Obviously the more the better. That said, done women's breasts unfortunately just don't respond that well to pumps and those women find it difficult to up supply beyond a certain point. You absolutely should not beat yourself up if you find yourself in that scenario. Just give a formula feed and know that you are doing the best you possibly can for your baby. Remember - formula isn't poison. It's actually a really good food for babies.

As for which formula, ask the SCBU doctors and see what they say. I know there are special formulas for prem babies. As DD was four months when she had formula it wasn't a concern and we went straight to cow and gate 1st stage.

By the way, this may be the furthest thing from your mind but just in case, don't think this means you're doomed to never breastfeed if you have another child. My second baby was born at 38 weeks and was ebf straight from the breast for 6 months

@user1471515420 congratulations on the birth of your DS. Exciting to be going home.

My DD wasn't premature but I had problems getting enough breast milk. I did my own version of BF that I called on demand plus!! So I would feed her whenever she asked but I would also try to feed her every 3 hours if she didn't ask (with a fair bit of leeway).

I pumped after every feed. I appreciate this may be a judgment call for you if she is having small feeds including at night.

We did one formula feed a day which we did around 10:30 which allowed me to go to bed and get some sleep before her wake up around 1am.

The pumping was gruelling and I never got much out. 50 ml would be a dream for me!! More like 25-30 from each boob.

She had her last formula feed at 6 weeks when I realised I could feed her and she was breast fed from that point onwards.

It was hard and I don't think you should pressurise yourself to do it if you don't want to. Formula is a perfectly good alternative. I was particularly fixed on BF because I'd had IVF, Induction and then c-section so I think I wanted to just do one thing myself!!! But it's a personal decision and your baby will be fine either way as long as he gets enough food xxx

I’m currently just about producing enough to sustain him but coming in slightly short of his daily volume. I’d hoped to BF but the ward is so stressful that we’re not having much luck. He is doing well with his bottle feeds and I’m hoping to try BF again once we’re at home rather than keeping him in for longer while we try. He’s putting on weight brilliantly and we’ve been offered transitional care for this week.

It's really good that he's gaining so well!

You'll probably find things much easier when you're home. One trick that might increase the amount you can express is to put a baby's sock over the bottle whilst you express. I read recently, although I've forgotten where, that if you can't see how much you're expressing you usually express more.

1) If I’m not producing as much as he would take in a 24 hour period - would I need to top up a feed with a formula feed since there will be no more access to donor breast milk? Did anyone else have to do this, and if so which formula did you choose

Yes you'll need to top up with formula but no one formula is better than another. They all have to adhere to strict nutritional guidelines so just start with the cheapest and most readily available.

2) He only moved from a 3 hourly strict feeding schedule to cue based feeding yesterday, so do I just need to wait for him to waken unless it runs over the 4 hours in which case I’ll wake him to try him at the breast? I’m hopeful being home and uninterrupted skin to skin will mean I can increase my supply

Personally I'd wake him every 3 hours in the day and every 4 at night until your supply is established.

3) Does anyone have experience of trying to establish BF and expressing at the same time? I currently have set times for expressing but conscious that if I’m to try cue based feeds with him at home that I’m going to struggle with knowing when to express? EG - I’ve offered breast, he doesn’t take it, DH can give EM in bottle while I express, but then if he wakes again in 20 minutes to try again then I’ll have nothing to offer from breast?

I haven't had to do a lot of expressing but have you got a double pump? Some can be used as single or double so that you can express from one side whilst LO feeds from the other. I used an Ameda Lactaline which was hospital grade and had a closed system.

Don't be afraid to go along to your local BFing Groupss* when he's out and always call one of the BFing Helplines, literally no question is silly or too small and all of the Helplines are staff by fully trained BFCs.

Does the SCBU/NICU he's in now have any facilities for "rooming in" where you go and stay in a room which feels more 'normal' with him before coming home? I did that with DD1 before I brought her home and found it very useful, but that was 20 years ago...