Update in reply! Breastfeeding a Preemie

edited December 2014 in Preemies
I posted this on the breastfeeding board and thought I'd throw it out here too!

Hi ladies! My daughter was born at 33wks5days via emergency c-section. She is now 2 days shy of a month old. For the first couple of days of her life she was fed only via her feeding tube since she hadn't developed her suck swallow reflex yet. After she was able to suck/swallow I was allowed to BF as much as she could, as nursing is extremely exaughsting for a premie and then the nurses would give her feedings via her feeding tube. All of which was my breastmilk as I was pumping regularly also. I made it very clear to the Drs I wanted to exclusively BF and did not want her to be bottle fed. The Drs respected my decision but it was also followed up with them saying she would be able to go home faster if she was bottle fed and that it is unlikely she will go straight to BFing from the feeding tube and all their babies go home with some sort of bottle feeding. They also "assured" me that nipple confusion is a myth. I stuck to my guns with BFing only until DD was showing signs of readiness to eat on her own. We had another long convo with the Drs about the use of a bottle and I caved.

Well the good news is that we are now home! However she is now nursing less and now only with a nipple sheild (in the hospital I didn't use one, she actually hated it) and bottle feeding more. My heart breaks as I knew this would happen. My question to you ladies is, have any of you been in this position? Of BFing a premie or getting a baby who prefers the bottle to eventually switch to exclusively BF? I plan to reach out to a LC for their help, but wanted to see if you ladies had any experience or input! Thank you!

Re: Update in reply! Breastfeeding a Preemie

  • It's possible, but likely to be a lot of work (you can do if you're truly committed, for sure!)

    My girls were born at 29w3d, and while we did try some BFing in the NICU, they were just cruddy eaters in general (they had tons of issues with choking). By the time they were discharged (shortly after their due date), I had such an excellent pump routine down, my supply was good -- so we just didn't want to mess with success. I even mastered the pump & bottle feed at the same time. We absolutely made it work. Twins were challenging enough, I just didn't feel like going nuts trying to get them to the breast. For me, it was important they received BM -- I didn't care much about the means by which they received it! 
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  • DD spent 24 days in the NICU.  She was on the feeding tube for the first 13 days or so.  Then bottle fed.  They would allow me to try and BF for 10 minutes each side before giving her a bottle.  It was super stressful but I was determined to EBF.  So once we got her home, that's what we did.  IT is definitely possible. 

    Lots of skin to skin and BFing on demand.  She managed to maintain her weight and gain some for the first few weeks.

    Unfortunately, we did end up supplementing after about 6 weeks when she stopped gaining.  BUT that was our decision.  I think if I had the support and encouragement of an LC, I would have continued.  Our ped had said it was an option to supplement and didn't tell us that we HAD to but it was up to us.  And I had gone to a LLL meeting and even everyone there seemed to think I could try supplementing.  Looking back, I think it was just because DD just looked so small.

    At any rate, I think if I had the support and encouragement of an LC, I would have continued.  I would definitely contact an LC.  And know that it is totally possible!  You can do it!
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  • I had a 32 weeker who was able to come home on bottles after only 10 days in the NICU.  I never believed in nipple confusion and just let the NICU do what they do.  Getting her to eat from bottles at home was hard enough, but we did try breastfeeding a little every day.  It was so frustrating because she never really did it in the beginning.  Around 37 weeks, she ate with the nipple shield.  We did that a couple days, with more success each day, and then, around 38 weeks, we didn't need it, and she could bf and we did it exclusively for many months.  They just don't get it and lack the strength before then.  I was unhappy and came here for advice and heard the same thing.  Be patient and it will happen sometime near your due date.  Your LO is still young and probably tired from a new routine at home so she's going the easier bottle route.  She'll get there. 

    As for supplementing,  we did add calories to one bottle of breastmilk/day.  My LO was able to take a bottle and switch to breastfeeding without issue every day.
  • I had a 31 weeker. They told me the same thing about it taking longer without bottles and I also couldn't stay at the hospital 24/7. I worried about bottles and wanting to ebf. DS nursed until 18 months. He had bottles when I wasn't around but prefered me. This became clearer as he got older. But as long as your baby is eating you need to try not to stress too much. You've already come so far and bottles aren't that bad!

    Also he just decided he didn't like the shield around 38-39 weeks and we went on without it. So that's not a forever thing in most cases either.

    Keep up the great work!!

    Our little hippo was as impatient as mom!

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  • Like PP, my daughter was born at 31 weeks and for the first couple weeks was tube fed, then they started bottle feeding her and I was allowed to try "non-nutritive" breastfeeding around the same time. For every feeding that I was at the hospital, I would try BFing and eventually started using a nipple shield. When we got home a month in, I nursed her for every feeding but followed up with the high cal preemie formula. Then I started seeing a lactation consultant, weaned her off the nipple shield, and started using a supplemental nursing system since my supply was never enough but I didn't want to bottle feed her. She's 19 months today and still nursing. It is definitely possible. They have to work harder at the breast and they often fall asleep, but to echo PP she will reach a point if you keep at it when she'll be strong enough to exclusively bf. Just keep at it!! Good luck!!!

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  • Congrats on making it home! DD is a former 26 weeker who came home with half her feeds pumped milk in a bottle and the other half breast. For a couple of weeks we kept that schedule to make sure she got a "full" feed (by nicu standards) every other time with the bottle. I pumped every time she had a bottle and after every nursing session as well to keep supply up and build a stash. It was exhausting, but once she got to a good weight of 8 lbs I stopped pumping after she ate because she was better at draining me and we started only bottle feeding when I was at work. She didn't get really good at nursing until she was about six weeks adjusted. We are still nursing once a day at 23 months.

    As far as tips:
    I always had my DH give her a bottle once we got home from the nicu. Mama was boob only!

    We found night nursing to be very helpful tip getting her to love the boob.

    Definitely let her linger as long as she wants-in the evenings we'd spend hours snuggling, nursing, repeat! Thank goodness for Netflix!

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  • One thing that I think helped us was I would pump for about half a session then try BFing. Not only did he not get firehosed, but it was also hindmilk which he seemed to really go for. Maybe that would help?
  • Just wanted to add that it's definitely possible - my twins were born at 34w and we BFed until 14 mo when they self-weaned.

    I had the opposite problem w my singleton - he refused bottles. So I wanted to make sure the babies got bottles early and often bc I work FT. We came home w instructions to half BF / half bottle and we just switched EBF. They gained and we never looked back.

    We always nursed in the same spot. I also tried to get a full feed in and would latch and re-latch. I had a very forceful let-down and you can catch the spray in a burp rag if that's the case.

  • It is certainly possible.  When we came home from the hospital my 28 weeker fast became used to breastfeeding.  It was hard at first since we had to wean from the bottle and then the nipple shield.  When I returned to work she would NOT take any bottles!  we tried so  many bottles and she didn't like any.  Eventually I found one she didn't mind so much and was able to return to work... ever since then, breast feeding was ruined for us.  She just isn't a good nurser. I've tried all the tricks I can think of, and she'll nurse for a little bit and stop. She was recently very sick and went on a hunger strike for 4 days and ended up dehydrated, so I decided to throw in the towel and pump and feed.  She is still drinking my milk, but I'm heartbroken that she's not nursing.  She latches for a split second and quits... it is so frustrating.
    I nursed my older son for 13 months and would have loved to do the same with her... but that has proven to be very challenging and frustrating. Nipple confusion is indeed a real thing.

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  • Thank you ladies for all of your stories!! They all have been so inspiring and reassuring! I am happy to say that the "light switch" went off xmas eve night and she nursed both of her feedings!! I couldn't believe it was actually happening! She did so great!! Ever since then she has been nursing all of her feeding except one morning bottle so she can get her vitamins. I couldn't be more thrilled!!! But with our latest achievement comes my constant worry of is she eating enough and getting enough milk. Ah the joys of being a parent! She's been having plenty of wet/dirty diapers, so I know she's getting enough, it's just each of her feedings vary so much in length and the intensity of her draw if that makes sense. Also, last night she wanted to eat non stop from about 7 to midnight and was really restless for the rest of the night nursing for only short periods of times. Is this what you consider a cluster feed? Her "birthday" due date is tomorrow Dec 28th and she is now 6 weeks old! Could it be due to a growth spurt? Also, one last question... Should I offer her more than just her am bottle while we are transitioning to EBFing?
  • Feeding frequently -every hour - is very common during the evening hours and is classic growth spurt behavior. She's actually working to increase your supply. There's also a growth spurt at 6w. Preemies hit growth spurts differently, sometimes at actual and sometimes at adjusted age. It's scattered.

    Have you ever looked at Fantastic resource for BFing and what to expect.

    I tried to do one bottle every couple of days bc I was returning to work and had a prob w my oldest refusing a bottle so I wanted to make sure they stayed "in practice" w a bottle. But if she's having wet/dirty diapers and your boobs feel empty when she's done feeding, and she's gaining, you don't really have to do bottles.

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