Feeling a little pressure from the nurses to EP

reillyroowho

My boys were born at 34 weeks and have always latched and sucked wonderfully. The problem is that, although they are big on the outside (6lbs and 5lbs 2oz), they are still weak and conk out after less than half their feeds so they get fortified breast milk through their NG tubes for the rest of their feeds. At this point they are now 36 weeks (2 weeks in the NICU) and that is the only thing stopping them from coming home. At our 3am feedings my husband gives them bottles of breast milk and I pump so I can get some extra sleep and they always take the full amount. The nurses say that if I gave up the breast feeding they would be home sooner. On the other hand the lactation consultants urge me to continue and do what is best for the long haul. What do you think? Am I being too stubborn continuing to EBF or should I be patient and let them continue to progress with it? 

happyhoopla

My advice (NICU RN here):

#1: Ask to go to adlib demand feeds and continue to exclusively breastfeed. Don't supplement after they nurse, with the understanding that they will probably end up eating more frequently. Some feeds they will likely take more than others. You will need a doctor's order for this, so don't be mad if the nurses say no...it's just not their choice. (This is what I would suggest).

#2: Continue with the current plan, knowing that it will likely take at least another week before they eat a large enough amount at each feed.

#3: Agree to bottle feed for several days so that your babies can go home sooner and then switch back to nursing once they are discharged.

Now, are they doing weighted feeds or using a breastfeeding scoring system? How do they know that your babies aren't getting enough when you nurse? I hope this helps.

MrsLaurenandDan

Ditto what happyhoopla said.  I would probably choose 3, or only BF every other feed or something, though 1 sounds like a good option too.  My little guy had a similar issue.  I went to mostly bottle to get him home, and then went back to nursing.  We are still EBF at almost 6 month.  Good luck, and keep us updated. 

katie4253

What about a Supplemental Nursing System?  I think you need to get the Lactation Consultant in asap.  They should be working with you.  The NICU told us that we could use the SNS if we wanted to BF. 

That said, we went with bottles because it meant he'd be home faster.   It was very difficult to decide. 

I think it is pretty crappy the nurse is pushing you, though.  The reason the decision to do bottle or breast was so hard is because they told us it was 100% our decision.  

becketts

 It is a super hard decision. Eating was the only thing keeping DD in the NICU as well. We introduced bottles to get her home faster and it sabatoged our EBFing efforts and resulted in me EPing for 8 months. Even now, I don't know what I'd decide if given the choice again since it was so good to get DD home. Good luck!

SushiNoMore

I'll say that, even if you go to bottles to get your LO home faster, you can still BF later.  My 26 weeker came home on mostly bottles, and, with some work, I was able to EBF him for several weeks before I went back to work.  Now, at nearly 14 months old, he still BFs morning / night.  I was able to exclusively BF him until past his first birthday.

If I were in your shoes, I'd use bottles to get your LO discharged and then work on nursing when you get home.  Nursing at home is SO much easier than nursing in the hospital.  You can make it work.

You can also page urbanflowerpot.  She was able to get her preemie to nurse exclusively, too.  She may have a perspective.

TriciaandSean

My preemie came home needing bottles, but I would nurse first (with a nipple shield) and follow up with a bottle.  I was exclusively breast feeding less than a month after we were discharged.

Mrs. Alice

How long are they nursing for?  I had to use nipple shields for a while to keep my little guys latched on.  I never was forced to have to choose between EPing and BFing.  When I was visiting the NICU, I would BF as much as possible and the nurses were satisfied if they did at least 10 minutes as long as good weight gain was happening.  It took Owen until 37 weeks to nipple all his feeds.  Our discharge instructions were to give two fortified bottles daily and BF ad lib.  They were extremely slow eaters in the beginning.  I hope you find a good compromise to get those boys home soon!

vsalt31

In my situtation, we gave DS bottles of breastmilk in the NICU.  Now that we're home, we're working on breastfeeding.  It's actually going pretty well.  In a few days, I would imagine that I'll be BFing exclusively.  We use nipple shields which seems to be helping the transition.  Plus, for me, I felt that I could deal better with pumping than having my son away from me, so the decision was easy.
But, really do what's best for you & your family.  You're doing a great job.  Good luck!

haziedaze

happyhoopla:

My advice (NICU RN here):

#1: Ask to go to adlib demand feeds and continue to exclusively breastfeed. Don't supplement after they nurse, with the understanding that they will probably end up eating more frequently. Some feeds they will likely take more than others. You will need a doctor's order for this, so don't be mad if the nurses say no...it's just not their choice. (This is what I would suggest).

#2: Continue with the current plan, knowing that it will likely take at least another week before they eat a large enough amount at each feed.

#3: Agree to bottle feed for several days so that your babies can go home sooner and then switch back to nursing once they are discharged.

Now, are they doing weighted feeds or using a breastfeeding scoring system? How do they know that your babies aren't getting enough when you nurse? I hope this helps.

Great advice! We went with option #1. I nursed exclsively ad lib when I was there with a shield. Sometimes he didn't take much, but then would do better the next feed. We didn't supplement so he could better self regulate. After 3 days of wt gain ad lib, we brought him home. If the ad lib plan doesn't work you can always continue to wait it out. GL! I love nursing my preemie; it's worth fighting for it if you can.

schenkertobe

It's a hard decision. In the end, I wanted LO out of the NICU as fast as possible. We decided to focus on bottles. If I was there with him when he got an NG feed, I would try to nurse while he was being fed. In retrospect, it took DS three months before he was strong and coordinated enough to latch and get milk, so I am glad that I didn't push for breastfeeding in the NICU or he would have been there forever. We are still nursing 13 months later. Get him home, you can work on breastfeeding when you get home. Home is much more comfortable for breastfeeding anyway.

HJOHNSTON411

Such a tough decision . . . 

Because of my LO's IUGR, I had to pump for bottles and NG tube for the first few weeks.  They worked with me on BF'ing but he didn't have much stamina.  

Personally, once he was doing well with the bottles I stuck with it and didn't look back.  I was too nervous about measuring his intake, how much energy he would burn trying to nurse, etc.

The NICU is the best and worst place for them.  On the one hand, we had phenomenal care.  On the other hand, the risk of infection etc scared the beejeezus out of me.   (We had a bad NEC scare). 

So, when I was pumping around the clock, did I wish he was nursing - YES! But at the end of the day, I think it's best to get them home and then tackle those issues when they are "full term" infants.