Feeding questions — The Bump
Preemies

Feeding questions

Hi,

My son was born at 32 weeks and is 9 days old.  The doctor told me that he will likely be moved to the level 2 NICU today... and one of the major steps towards getting him home is to work on his suck/swallow reflex.  Can anyone walk me through the steps I should expect and a general idea of timing (although I know every baby is different)? He's been doing well with his gavage feedings, and I've been told that we may start on a bottle by Friday... how does introducing the bottle and the breast work?

On a related note, I had an emergency c-section due to HELLP syndrome (totally out of the blue)... my numbers were bad enough that we couldn't give the baby more time... and my doctor and the neonatologist consulting the day of the surgery emphasized that I shouldn't feel bad if I couldn't produce breast milk at all. I'm doing much better, but I'm still recovering. I've been pumping 6-7 times a day, but I gather I need to be hitting 8 to 11... it's been hard because the NICU isn't well set up for breastfeeding (we have to move a bunch of screens, there's no surface where I can clean the pump, etc.), and we don't have much ready for our son around the house. So there's a lot to do. Can anyone tell me what the actual target volumes are for production?  I'm trying to figure out how much I need to ramp up my production. I'm at a point where I may be capable of waking up to feed, but I'm torn between recovering more quickly for when he gets home, spending time with him and increasing my supply. I'd like to get a feel for whether my supply is actually a problem... the NICU nurses make me feel terrible for not hitting 8 times a day, but I'm totally exhausted by my current schedule (and my abs are incredibly sore at night). I've been working under the assumption that my son needs me around more than anything... although the more I learn about preemies and stimulation, the more I realize that my presence may be more about me than him.

 Thanks.

Re: Feeding questions

  • Congratulations on the birth of your son!! How much is he currently taking via gavage tube? They will likely start him out on about the same amount, then build up from there. Although every baby is on his own timetable, just to give you an idea, when my baby was discharged at 38 weeks (he had been born at 29 weeks), he was taking about 60 ml every three hours (which quickly increased once he was home). 

    Please don't beat yourself up for not getting in 8 to 11 pumps. If you're not getting enough rest and taking care of yourself, that will hurt your milk supply more than a slightly lower pumps-per-day. While Jack was in the NICU, I always had more than enough milk (by the time he came home, both his crate in the NICU freezer, and my freezer at home, were full of milk), yet I usually only did 6-8 pumps/day at this stage, and yes I had a few 4 pumps/day days (though I don't recommend that because that caused my supply to tank). Yes, it's ideal to do at least 8 ppd, but not if that 8th pump is causing you stress and lack of sleep. Our LC's told us to get at least a 5-hour stretch of sleep every night.

    As for your son needing your presence, he definitely benefits from kangaroo care, so if you're only able to spend a few hours a day with him, he'll benefit from skin-to-skin for those few hours more than, say, 8 or 10 hours of just your sitting next to his bed. (Skin-to-skin will also greatly boost your milk supply, as I'm sure they've told you.) Don't feel like you have to live at the NICU if it's too difficult recovery-wise and as far as getting in your pumping (i.e. if it's causing more stress than it's alleviating).

    Best wishes to you! Although I didn't develop HELLP, my pre-eclampsia was severe enough that I came close to stroking out a few times... I know it's no fun recovering from that (as if recovering from an emergency c-section isn't bad enough). You've got the worst of it behind you, though, so please keep your chin up and know that any amount of milk you can produce is doing amazing things for your son!

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  • I understand you feel like you should be there more, but really just can't. DS was my 3rd and born via C/S 17 days early (he only developed 32-33 weeks). It was a struggle to get him to 5 ml because though he was a 37 week baby, he wasn't really. At 32 weeks eating isn't something they should be doing (not like a normal newborn) so it takes time to figure out. I definitely agree with PP, skin to skin is major, if you are there (and situation allows it) hold him as much as possible. DS was on an NG tube to feed him and so we could check what he wasn't digesting, which was his problem. He wasn't digesting food so he wasn't hungry, thus wouldn't eat. He was born 8/6 and we were hopeful to have him home by Labor Day as he also couldn't stabilize blood sugars which made it difficult to eat. One day he just started eating and we took him home at 9 days. It will come, babies work at their own pace, but he may surprise everyone (DS's doctors were in complete shock). Good luck, and I promise the stress of pumping too much will hurt your supply just as much and not pumping enough. Lack of eating or sleeping to get extra pump sessions will not help either of you.
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  • Thanks - the responses are very helpful. He's up to 13ml a day by gavage feeding and seems to be tolerating it well. I'm probably up to 15 ounces a day in production... one of his doctors indicated that they may insist on using some formula for the added calories. She said my breast milk was not caloric enough... but other nurses have talked about breastfeeding... I feel like the signals are totally mixed.
  • DrRxDrRx
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    image Trillian46:
    Thanks - the responses are very helpful. He's up to 13ml a day by gavage feeding and seems to be tolerating it well. I'm probably up to 15 ounces a day in production... one of his doctors indicated that they may insist on using some formula for the added calories. She said my breast milk was not caloric enough... but other nurses have talked about breastfeeding... I feel like the signals are totally mixed.
    They can add HMF to your breastmilk that you pump to give it more calories.  My daughter had 2/3 of her meals as BM and the other 1/3 with Neosure because of the extra calories.  Actually, she was on a type of formula that had 24 calories per ounce and then was switched to Neosure before we were discharged since Neosure is much easier to find in the stores.  While in the NICU she also got MCT oil as a source of extra calories.  You could ask your neo about adding MCT oil and some of his feeds as formula so that you can still BF.
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  • First off congratulations on the birth of your son. When DD#2 was in the NICU I would try and pump at least 8 times a day. When I was home I was power pumping, ever two hours or so, but at night I would try and get five hours of sleep, per the neo. (yes they seem to really care about the mom's too).

    Is there anyway you can pump while at the bed side? I did this with DD. I would actually offer the breast first and if she didn't latch (which in the beginning she had issues) then I would feed breast milk to her. After her feeding, I would do skin to skin contact for a few minutes and then lay her down to nap. Then I would pump at the bedside for 10-15 minutes. I noticed while at the NICU I made more milk then at home. I would also see if you can either rent a hospital grade pump or just have one available at his bedside. As for washing pump parts, I would take them to the bathroom inside the NICU or if that's not available just wash the parts at the sinks. 

    Good luck! 

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