Breast/Bottle in the NICU

[nigellas]

Hi all - Not sure if you remember me - I had the thread when I was admitted to the hospital at 23 weeks. I thankfully made it to 34 weeks - My son was born on Monday.

So far he's been doing pretty well for his age - He's been breathing on his own from the start. He's got a bit of jaundice (spend one day under the lights) and a few minor A/B episodes, but comes out of them on his own.

Right now he gets most of his food via a tube in his nose - He will latch and breast feed beautifully for about 10 minutes, twice a day - the rest of the time he's too sleepy (or it's one of the sessions I miss - gah). Until now he has had a no bottle/no pacifier rule. But now that he has shown the ability to BF they want to introduce bottles (BM) to make him able to leave sooner - The BFing really wears him out and since bottles are easier for them to handle in theory he would be home much sooner if we did a combo of these things versus trying to get him home exclusively BFing.

I'm nervous about him loosing interest in BFing once they bring in the bottles... Though on the flip side we REALLY need him home, and if this makes it easier for that to happen... Can you guys tell me about your BFing experience after the NICU? Especially if BFing was established.

Thanks!

[sparklett]

Congrats on making it to 34 weeks, and I hope things are going okay for you guys.

DS (33 weeker) was fed w/ an NG tube for a week, then put onto a bottle, and then bottle/breast. Because he would desat while on the bottle, I demanded that we switch to breast exclusively, and we went home EBF. He developed breastfeeding apnea when we got home, and that complicated things a bit. Becuase he was used to the bottle, we had to use a nipple shield for 8 months and he weaned off it on his own. It was a huge pain, but that nipple shied was the one thing that allowed us to EBF. It was HARD at first and took LOTS of visits to the lactation consultant and midwife, but it was soooooo worth it in the end. DS is now two and he's still nursing like a champ.

The fact that your babe is actually latching on is fantastic! What a great start. Before you get home, have a LC picked out and be ready to ask for lots of help. Nipple confusion might become a problem, but there are many things that can help you with that- ask your LC.

The thing is, many NICUs would much rather have you bottle feed becuase it's easier for the staff. In the long run, lots of bottle feeding will be harder on you, especially if you intend to EBF, becuase of the whole nipple confusion thing. Is he being fed on demand, or is he on a schedule? When you get home, you will most likely find that he'll nurse until he's tired, and then nurse again. He'll nurse FREQUENTLY- far more frequently then he'd feed if he were bottle fed- often falling asleep at the breast and then picking up again later. You can see how this doesn't really mesh with the NICU routine, since they want him to feed on a schedule for a set amount of time.

I would do everything possible to get baby on the breast as much as possible. Ask for an SNS, if that might help. Do as much kangaroo as humanly possible. Hang in there. Get through this, get the baby home, and then really work hard on BFing. It might take a few weeks, but once you're home, the two of you can make it happen.

Good luck to you!

[Siera]

Totally agree with the above!

DD was 31 weeks and came home almost exclusively on bottles. In about a month's time, she was an exclusively breastfed baby! :

Do as much kangaroo as possible, insist on breastfeeding whenever possible and maintain that relationship. When you get home, spend days with your shirt off and your babe latched on! Co-sleep! Do whatever possible so that your baby does not lose interest in the breast, since bottles can make that happen.

Congrats, by the way!!

[Amys1st]

First, congrats on getting way way past the 23 week mark!

Congrats on your little boy. Things sound better now.

I would vote for do whatever gets him home faster. He will do much better at home and you can do the breastfeeding thing at home and he should pick it up. Once you get to full term, things will get better and even better once you pass your due date. I noticed Maggie really did better at all the above once she hit that 40 week mark. HTH!

[mommylovesra]

Raleigh was born at 34 weeks and breastfeeding was a big issue while we were in the NICU but we left one week later EBF. I did relent to allow bottles about 3 days before he came home for feedings I missed in the middle of the night because the nurses were giving me guilt trips about the ng tube. It did get him home a few days quicker because the were assured he could get all of his feedings by mouth. One thing you can do is suggest weighing before and after. We also had to spend his last night together in a peds room so they could be sure he was nursing for 24 hours without losing weight. he did not have any nipple confusion, preemies can often go back and forth without getting confused. It probably will get you home a few days faster to not fight them on it so you have to weigh which is more important to you, him never having a bottle or getting the H out of there. Be prepared that they will tell you that he will need supplemented when you get home too. FWIW I did NOT supplement or fortify and we gained just fine. They generically give every preemie mom that advice. Good Luck and hang on, he will improve and get stronger and better with nursing each time so be there as much as humanly possible and just know once you get home it will be so much more relaxed and easier.

[BugMacGee]

Congrats on making it to 34 weeks!

Babies born at 34 weeks can take a while to get the hang of oral feeds of any kind. Good that you're putting him to breast. Getting him on oral feeds, of any kind, will get him home.


Honestly, IME, preemies are better at alternating between breast and bottle. MOst of our preemies go home on a combo of the two.

You can request nurses use a slow flow nipple for bottle feeds if you are worried about baby developing a flow preference.

Babies are smart and resilient . If you keep up with the breastfeeding now, it shouldn't be an issue.


We like to help moms breastfeed their preemies. And bottle feeding is NOT easier for us BTW.

Good luck!

[sbrinton]

First of all, congratuations! You've been in my thoughts and I'm so happy you made it to 34 weeks. Amazing job mama!! We've been through breastfeeding in the NICU twice and I'm a firm believer that for most babies and moms, it is possible.

Our 35 weeker, Micah, was exclusively breastfed from day one. He had a great latch and although he was sleepy and we had to feed him almost every hour, he did fine with on-demand breastfeeding.

Our 31 weeker, Zephan, had an NG tube for a few weeks. We began kangaroo care and "practice" breastfeeding at 32 weeks. When he was 33 weeks, we began using a nipple shield and measuring how much he got at the breast. He went from getting maybe 1/2 an ounce 2x a day by breast on a Monday to getting over 1 ounce 4-5x a day on a Wednesday. It just clicked. By that weekend, when he was 34 weeks, he was taking 5-6 of his 8 feedings a day by breast and was sometimes having more than 2 ounces.

We also had a strict no bottle rule up to that point. Our plan was "boob to tube". But Zephan did not like his NG tube and he kept pulling it out. We decided to go ahead and do 2 bottles a day so that we could get the tube out. The neonatologists agreed to fortify just those 2 bottles with HMF and other than that, we breastfed "ad lib" through the rest of the day.

When we came home at 35 weeks, Zephan was supposed to continue having 2 bottles a day at home. But...we just breastfed. And he's done really, really, really well. He's grown from 3 pounds 13 ounces in November to over 12 pounds today. He's still an awesome breastfeeder.

So my thoughts...
-I would continue to breastfeed and use the tube for a few more days to see if it "clicks" and you are able to get to 4-6 of his daily feeds by breast
-At that point, I would go ahead and do a few bottles a day so you can get breaks from the NICU and the tube can be out. NG tubes aren't fun for babies and they can cause issues later, so in my opinion once breastfeeding is established a bottle is better than a tube
-When you get home, you can discuss with your pediatrician if/when you can go to exclusive, on-demand breastfeeding
-Consider using a nipple shield. This was REALLY important for Zephan. Without it, he only took very small volumes of milk and got tired. But with the shield, he was able to drink everything he needed. You can transition away from the shield when the baby is older, somewhere around your due date.

[sbrinton]

I'd second the "bottle feeding is not easier" point. This is a common idea, but something that research proved not to be true.

Bottle feeding is more stressful for preemies because the milk flows constantly. This can make them choke.

In some ways, breastfeeding is easier. The baby can control the flow of milk. Moreover, lots of studies say that babies are more relaxed, breathe better, and have a more normal heartrate when breastfeeding.

Sometimes bottle feeding is necessary, but if your baby is already breastfeeding a few times a day, I would ask for more time to focus on that. Even just a few more days might be enough!

[jlovesl]

Don't let them convince you to give bottles. I know way to many woman who gave in to the nurses about bottles and they had so many troubles once they got home to BF. Your baby should be able to feed exclusively on the breast when they come home. And some babies do lose interest in the breast after bottles because bottles are easier. But the down fall to bottles is that your supply will rapidly decrease if baby is not on the breast. I know from my own experience.Once his feeding tube was out My 31 weeker was only BF in the NICU.(With the help of a nipple shield) He got a bad case of reflux(at 3 months) which in turn we had to start BM in a bottle so we could feed him sitting up. My supply went from pumping about 10oz a session to 4oz in about 2 weeks. I had to go on Motilium to boost my supply again. I was able to give just BM for 7 months but the last 4 months were formula and BM. Then I went totally dry and could only give formula. I have never heard of a prem. finding it easier than a full term to transition faster. I think most nurses try to push it because it makes their job a LITTLE easier.( They do work hard) But if you plan on being there all the time you might a well just BF. Good luck, it's very hard being in the NICU.

[~bookcase~]

i would honestly avoid bottles like the plague and try cup feeding/ stay with ng tube/ syringe feeds or some non bottle method. as a b'feeding counsellor i see waaaaay to many babies get stuck on bottles and it is so sad and unnecessary

in the uk they will cup feed breastfed babies in mothers absence.

i'd stay on tube until your son shows more awake time for breast and then try to 'room in' as much as is possible on chairs!!! for a few days to check weight gain....or ask to go home with the tube and have good follow up with a lact consultant. my 32 week daughter took ages to come off her tube, but it was worth it to avoid nipple confusion.

[jennchsm]

Congratulations!

My son was a 29 weeker, so our situation is a bit different from yours, but I'll relate my experience anyway. I started putting DS to an empty breast at 10 days old (so 31 weeks GA), and he latched really well from the beginning. I insisted on starting with feeds at the breast rather than bottle, and though I'm glad I did, our problem was that DS did not have the strength to get much milk from nursing. We started using a nipple shield and that helped, but he still was having a hard time.

There came a point when I realized I wanted my baby to go home more than I wanted to continue to struggle with BFing, and so I let them start giving him bottles. He struggled with those as well, and could only take a whole feeding with a really fast-flowing nipple. I kept putting him to the breast before every bottle feeding, and we did lots of pre/post weighs, but he never got more than a fraction of an ounce from me. I realized then that it was going to be a while before he would be able to nurse, and that I was okay with that.

So we went home bottlefeeding, and I started what would be another 3 months of triplefeeding him - breast, then bottle, and then I would pump. When he was about 4 months old (so 6 weeks adjusted age) he suddenly started being able to get more than an ounce form nursing, consistently. (We had rented a scale.) In another month, that became 2 ounces, and I was able to drop bottle feedings. By the time he was 5.5 months old (3 months adjusted age), we were exclusively nursing.

Now he's 15 months old and still nursing! It was hard work, but definitely worth it! If your baby is nursing and getting full feedings, there's no reason to introduce a bottle. Nipple confusion varies form baby to baby, and in our case I think the nipple shield actually helped minimize it. If your baby really seems to be struggling to get enough milk, know that you can always work on that when you get home. It's harder that way, but for me it was important to have my baby home where I could hold him all the time and where he wasn't getting poked and prodded every day. It's a tough situation to be in.

Hang in there!

[sarlusan]

I haven't read all the pps, but I'll tell you my story... with my 32 weeker, they wouldn't let me bf until the day before she went home. "Nipple confusion is a myth" said the neo. Um, no. She was totally confused. It was three weeks after we got home before she got it. I had to try the breast with and without the nipple shield, then give her a bottle, then pump, then wash all the little pump thingies... every three hours or less around the clock. It was so stressful and frankly quite torturous. But, she did eventually get it. The nipple shields really helped. Also, after a scary period where I dropped pumping too fast and lost a lot of milk supply, I followed a strict schedule of dropping a bottle supplement every other day, and dropping a pumping session on the days I wasn't dropping a bottle feeding (something like that - I found it on kellymom).

With my 34 weeker, they let me bf right away (although he was in the nicu for feeding issues, so he had an ng tube as well). Of course they gave him bottles when I wasn't there. But every time I was there, we tried it, and it only took a couple of tries before he was doing it, and he went home bfing like a champ. I had to continue pumping for a couple weeks so that I could gradually bring my supply down, but I don't think I ever gave him a bottle at home.

I was very thankful that I bf from the beginning with my son. It really made things easier. It's not impossible once they have established it with the bottle, but it's harder to switch back again.

Good luck!!!

[jennasuz]

Our son was 34 weeks as well... The nurses started him on a bottle before I was even consulted. I started breastfeeding with him later that week, and we did a combo of breast, bottle, and NG tube. A few of the nurses had told me that the bottle was the way to get out fastest, so we focused mostly on that. We would breastfeed him for at least one of the feeds every day, though. We brought him home at 38 weeks, and I'm not sure if things would have been faster or slower if we had EBF. Actually, I'm positive they would have been much slower, but that's only because DS was tongue tied and we had his frenulum snipped about a month after we brought him home.

But I just wanted to say that after using the bottle almost exclusively for a month in the NICU, DS is now a breastfeeding champ and prefers the breast to the bottle.