c-section, 35 week old preemie...what to do?

[whoabethy]

hi there,
so sunday morning i had an emergency c-section. my water broke (no one knows why!) and the baby had not yet turned, so here i am. hazel is 5lbs. 13oz. and progressing quickly. she will probably be coming home monday.

i have been pumping every 2-3 hours since delivery. i have two different sized breasts - at this point the bigger one is producing what i think is breast milk. i am only getting 5-8mL during each 30min pumping session from that breast. the other breast is producing about 1-2mL per session. in the NICU they are feeding her what i pump and then supplementing with formula. i would LOVE advice on any of these topics:

*breastfeeding after c-section - how long did it take for your milk to come in?
*breastfeeding a baby in NICU - how long did it take for your milk to come in?

i had planned a homebirth so in addition to mourning the birth i want, i am physically recovering from major abdominal surgery. i refuse to fail at breastfeeding. it's the only part of this i have left. any help would be greatly appreciated.

[dogretro]

I had a scheduled c/s w/ dd ~ she was 2 days before her due date, also breech We had no problems w/ breastfeeding & my milk came in about 3 days after she was born (started coming in at the hospital).

My v good friend just had her second baby a few months ago at 36 wks, scheduled c/s b/c of previous surgery. Her dd did not spend time in the nicu & bfed beautifully from day one. She was also 5lbs something.

Other mamas on here have said that the average newborn's stomach is the size of a marble. Makes sense b/c you do not get v much colostrum out if you pump & I remember pumping at the hospital when I felt SO full & only getting probably less than an ounce, lol! A baby is much more efficient at getting milk out than a pump, although w/ a tiny baby you may find that she gets tired quicker and you may need to still pump for her in addition to nursing &/or use a nipple shield. You will find out once you get her on there I still pumped every morning after dd nursed b/c I had milk still in me.

I know many articles say that it usually takes longer after a c/s for your milk to come it, but it may be true for you and it may not be. TAKE YOUR PAIN MEDS, and keep nursing her. Also take your stool softeners ~ you may also need laxatives or suppositories for a while. That is totally normal, too. Are you able to nurse her in the nicu? That would help you both a lot & you could see the hospital's lactation consultant who will help you, esp w/ a tiny baby. Good luck, you CAN do this! Breech c/s's are annoying, but it was what it was, now it's time to absolutely adore what is!!!

[odoole]

Congratulations on the birth of your daughter! I'm sorry you had such a rough time of it, but I admire your determination to make BFing successful.

My son was born unexpectedly at 34 weeks, 5 lbs 4 oz. It was a vaginal birth, so I can't give you advice there. I just wanted to offer you encouragement from the preemie end. DS is 4 months now and is an eating champ. The nurses in the NICU were incredibly encouraging and taught me how to breastfeed and encouraged me to put him to breast at every feeding -- even though he was too tuckered out to actually feed that way initially.

I can't remember exactly when my milk came in, but I think it was pretty quick (maybe a day and a half after the birth??? He was on a glucose IV just for the first day, then did formula + my colostrum for the second day, then was all breast milk after that). And boy did it come in!!! I pumped every 2-3 hours and froze the huge excess I had, and was later very glad I did.

DS was so sleepy he didn't do much with the breast the first week. The nursing consultants at the hospital told me that they didn't think he would be able to be exclusively breast until his due date 6 weeks later, but in reality, he was all breast by week two (he came home after 6 days in the NICU). My incredibly large milk supply may have aided that process. Luckily we didn't have any problems with latching or nipple confusion or anything like that. I credit the NICU nurses with encouraging me to put him to breast. I certainly didn't know what I was doing at the time.

I hope that helps. I know this has been unexpected and traumatic, but I encourage you to cherish these first days with your daughter all the same. Looking back, I view our 6 days as a "parenting camp" in some ways (this was our first child ...)

Let me know if you have any other questions. All the best.

[limette]

I can answer the first question.

My milk came in 5 days after my c-section. I nursed dd1 pretty much non-stop during that first week. She actually gained weight on the colostrum. We never supplemented and there was no concern by anyone about how long it was taking to come in.

Congrats and good luck!

[Mrs-Mama]

My milk came in at 5 days while pumping for my 32-weeker (c-section). I also didn't pump at all for the first 24 hours b/c the nurses said that I should rest and I didn't know better so I listened. He was on all bottles until about Day 18 when he latched on for the first time. He came home at 20 days and was totally nursing at the breast (and refusing bottles) at 6 weeks.

For my DD, born at 39 weeks (also c/s), my milk came in at 2.5 days.

[Bokonon]

My son was born at 32 weeks by urgent c-section with no labor. I didn't start pumping until the following day and didn't get to try to nurse him until several days later. My milk came in around day 3 or 4 I think. I was pumping every 2-3 hours around the clock. He spent 6 weeks in the NICU, and it took another 2 months for him to get the hang of breastfeeding, but once my milk came in, he never had formula (except for fortifying EBM for extra calories for about 3 weeks). He weaned at 22 months.

My daughter was born at 34 weeks, similar circumstances as my son (both severe preeclampsia). She was in better shape at birth though, and I was able to nurse her when I got out of recovery, though she soon went to the NICU. My milk came in 3 days later, but I only pumped 6 times a day because I had a bad problem with oversupply with my son and it made transitioning to the breast very difficult. She spent 10 days in the NICU and was exclusively breastfeeding by the following week. She's 7 months now and won't even take a bottle.

If you haven't already, I would recommend talking to a lactation consultant - preferably with IBCLC designation. It is challenging but not impossible to transition a NICU baby to the breast, but having someone in person to look at latch and cheer you on can make all the difference.

Good luck and please keep us posted!

[~pi]

Congratulations on the arrival of your daughter! I'm very sorry the birth was so far off course from what you had planned and hoped for.

I had both experiences you're asking about (c/s and NICU, though DS wasn't a preemie.) My milk came in at 7-8 days. I really understand what you are saying about needing breastfeeding to work after a difficult birth.

We quickly weaned him off the supplemental formula that he got in the NICU by (1) nursing frequently, (2) using a simple SNS (just a tube taped to my breast) so that he got the volume he wanted while I got real baby stimulation, (3) pumping after every feeding, and (4) focusing all my energy on sleeping, healing and making milk. DH did everything else for the first week home -- laundry, food prep, most diaper changes, etc.

DS is nearly 3.5 yo and I am still nursing him now.

The first week or two were really tough. It felt like forever at the time, but in retrospect, it was actually not that bad. Keep at it and hang in there! It might feel totally overwhelming right now, but with commitment, support, and a little bit of luck, it will be over before you know it and breastfeeding will be a breeze.

ETA: I second the advice to take the pain meds and talk to a good IBCLC. They were very helpful to me. (The meds and the IBCLCs! )

[lalemma]

I am a clueless first-time mom myself, but couldn't read and not respond: I just/three weeks ago had a 33-1/2 week baby myself (full-blown eclampsia, emergency C-section... good times!). He spent two weeks in the NICU (no health problems at all, just gaining weight and learning to maintain his body temperature). He came home six days ago. For almost the whole time he was in the NICU, I was in the ICU myself, and for the first day and a half I was unconscious and certainly not pumping. So it was a weird start! I was pretty worried about how breastfeeding would go, even though this particular hospital is really gung-ho on BFing and has lactation consultants everywhere you look.

For what it's worth, here's my experience: I got just drops of colostrum the first day or two I was pumping, and I was too out of it and exhausted to even try breastfeeding at first. After I think three days I started to get bigger quantities of milk (so I guess that was at about day 5 post-partum), but I obsessed over it not being enough, or somehow being the wrong KIND of milk (I know, I know...)

Re: breastfeeding in the NICU: the NICU just fed him my expressed milk, and he and I would practice BFing once or twice a day. At first, the only way we could make it through a feeding was to use a nipple shield, and even that was tough. It really was practice. The nurses were totally willing to let us give it a shot, and I was willing to finish the feed with a bottle of my expressed milk if BFing didn't work out. Your mileage may vary, but I think that attitude helped me relax (and so helped my milk let down, and helped my little guy relax!)

In the beginning, I think there was quite a bit of nipple confusion for the little guy - going back and forth between bottles and boob when you're that little can't be easy.

Everyone - the LC's, the nurses, my mom and MIL - kept telling me not to worry, when he came home we would figure it out together, my supply would adjust, producing milk for a baby is completely different (and easier) than producing milk for a machine, it would all work out.

I had a really hard time trusting that they were right.

But you know - he came home late last week, and here we are, almost-exclusively breastfeeding (he gets a fortified bottle of expressed milk once a day for the time being), WITHOUT a nipple shield. We're still working some stuff out, but the basics are there. The LC's and nurses and moms were right: we're figuring it out together.

You are going to be okay, mama. PM me if I can offer any more support. And congratulations on your little one.

[henny penny]

Hang in there, mama! Congratulations on the new babe! I just wanted to say that when your wee one starts to nurse from the breast it will be sooooo much better. Does the hospital have a supplemental nursing system you can try? Nursing will come naturally after a little trial and error (hard to believe at first, I know). Pumping is totally different than having your sweet babe at your breast and I was never able to get more than a few milimeters from a pump. But keep trying so your supply doesn't wane!! I didn't have your set of difficult circumstances but wanted to offer support and tell you I LOVE your baby's name!

[BirthKathy]

Congratulations!

My son was born at 35 weeks. My water broke, too, but we were able to do a natural birth. Well, as natural as they would let me. He was in the nicu for 8 days for blood sugar, then eating then jaundice. I stayed at the hospital and pumped every three hours. They gave me all these bottles to fill with milk, but I was only getting a few ml each time for about 2-3 days.

One day, a nurse saw me pumping, and I had a part set up wrong on the pump. She fixed it, and the milk started pouring out! It also helped me to get some Medela night bras. The pump cups will hook right into it and you can pump hands free. Have a nurse check your pump set up for you.

They let me try to breast feed a couple times a day in the hospital, but we couldn't tell if he was getting much, so we fed him the (fortified) expressed milk by bottle. When we came home, I kept up the pumping and fortifying until I realized that he was able to nurse just fine and we went off the bottle at about 3 or 4 weeks. If I had another chance at it, I would have gone straight to breast only when we got home.

That first week while he was in the hospital was exhausting, but you'll make it through and hardly remember it in a few months. Good luck with everything!

[vegasgrl]

I completely understand what you're going through. I transferred from my homebirth last Friday night and had my girl via section Saturday morning. She just came home tonight after a week in the NICU for antibiotics. (She was 41 1/2 weeks, but was swimming in meconium.) I just wanted to say because I totally get it.

I didn't pump day 1, but started day 2. My milk came in days 4 and 5. However, the breastshields supplied by the hospital were WAY too small for my nipples. I pumped anyway (b/c I'm not going to fail at BFing either, darnit!) and now my left nipple is COVERED in blisters. It's to the point that I'm hardly getting anything out of my left breast, and there's no way in Hades I'm letting my girl suck on it.

So I'm continuing to pump, usually right after I feed her a bottle of expressed milk. I offer her my right breast first each time now; she nursed like a champ once and wanted nothing to do with it the next time. I figure by next week my left nipple won't be this screwed up and we can start transitioning to only nursing, but for now I need to let it heal.

Anyway, sorry that got so long; I just wanted to let you know what we're doing to get through this really crappy situation. And I really do feel your pain. I have cried so many times this week when I felt incision pain, just knowing that it's so the opposite of what I had planned.

[Swandira]

Hi, and congratulations on your baby! I haven't had a preemie, but I have had a c-section, a VBAC, and another c-section. The fastest transition from colostrum to mature milk was actually the second c/s/third baby. My milk came in after 24 hours of his nursing every 40 minutes, while I was still in the hospital. My VBAC baby's milk actually came in the latest, after about 50 or so hours, and it was about 40-48 hours for the first one, who was a c/s. It seems to me that the method of delivery probably had little or nothing to do with how long it took for my milk to come in.

Once you get your baby home, I suggest using a nursing pillow while your incision heals.

I'm so sorry about your baby's birth! C/s really sucks. It does get better, though, and there's no good reason you shouldn't be able to have a VBAC in the future if you want.

Nealy
mama to Thales, 12/02; Lydia, 2/06; and Odin, 12/12/08

[schreiberwriter]

It took me 4-5 days after a c-section and then after a VBAC. Hang in there! You're doing the right thing!

[whoabethy]

thanks so much for all the positivity! hazel is doing much better. she's still having some trouble latching on deep enough...i think a supplemental feeder is a great idea. i may have to look into it this week.

every day there is a little more milk, and it's keeping me motivated. luckily, my mom is here helping us, so all i have to worry about is BFing and sleeping.

my doctor also put me on domperidone b/c my prolactin was low. i'm sure that's helping too. thanks for all the support ladies!

[LaughingHyena]

DD was born by c/s at 34 weeks.

I remember getting just a few drops the first couple of days. We have a video of her first feed, about 1/2 a teaspoon of colostrum in a syringe and I remember how much effort it was to express that much.

I gradually got a bit more at each session but I found it really hard to keep up with her needs until she was actually able to suck herself.

She was 8 days old when she first latched on and got a proper feed (ie more than just the odd suck) and came home at 2 weeks old fully breastfed.

Drink as much as you can, I found it easy to forget how long I'd sat in NICU without a drink and I think that really affected my milk supply. Also look up breast compressions, they helped when pumping.

Hang in there, I found it very healing that my body was able to make enough milk to feed DD even though I felt it had failed by causing her to be born early. It wasn't always easy but it was so rewarding in the end.