Help for a friend: preemie breastfeeding

[Hey Mama!]

A friend of mine is trying to bf her fourth kid, first one she has attempted to bf. He was born 3 weeks early at 5lbs, 5oz. She is having a hard time with it. I went over to try to help her today and he seems to be a very lazy eater, he would pop off and seem to get tired. She got an electric pump from WIC and is pumping and getting a very good amount, she has oversupply at the moment. She attempts to breastfeed him and then will give him a bottle of pumped milk. I watched him eat the bottle and he's a lazy latcher on that as well. She said he sleeps all the time except he does wake to eat approx every 3 hours. His mouth is just so tiny it looks almost impossible for him to get a good latch, and he tires really easily. She said she is determined to bf him but I don't think she'll go for syringe or cup feeding since she is so used to formula and bottles. What advice can I give her to encourage her to continue? I've talked about different holds and pumping a few minutes before attempting to feed to draw her nipples out (they're almost flat), and pumping regularly to keep up her supply. I told he to ditch the paci for now. I sent her the link to kellymom but her internet got shut off. I've been getting late night freak out texts but I feel like I'm not really helping all that much. She seems ok with pumping to feed for now but would like to get him on the breast if possible. He is 5 days old. They got discharged at 2 days and the hospital told her absolutely nothing about breastfeeding. She did not see a lactation consultant nor is his weight being monitored. Oh, and I mentioned nipple shields-never used them myself but hear they are good for flat nipples. I went to Wal-Mart to buy her some but they don't carry them here. Any advice greatly appreciated!

ETA: he drank two ounces pumped milk while I was there and was rooting for more. She said he likes to eat til he pukes, and has taken up to 4 oz at once! That seems like a lot for such a young baby.

[boobs4milk]

the bottles need to go, but that is SOOO hard with a preemie. my dd3 was 37 wks, 5lbs 1 oz (4.10 at take home) and she went to town on bf. my dd4 was 35 wks and was in the nicu for 17 days. she was a lazy latcher, both on the bottles and on the boob. i used the sns with her and she would barely suck and i had to put the thing above my head to get gravity to pull the milk down for her!

finally, when she was right around term, every thing just clicked for her and she seemed to really wake up and be hungry.

my best advice would be to just keep at giving him the boob and to pump before hand to get the nipple to pull out. she could try a nipple shield, but that would need to be followed with an IBCLC so she can be sure it's effective.

good luck!

[lalemma]

My son was born at 3 pounds, 12 ounces. He has never had anything to eat but my milk, but he got it mostly in pumped form for the first 3 weeks or so. My boob was just so HUGE compared to his tiny mouth, and he tired easily, although he was always game to give it a try.

What helped us was nipple shields (Babies R Us sells the Medela kind: the LC told me to wet it to help it cling to my boob, which really worked well) and just accepting that he needed to eat, and eating pumped milk from a bottle was still BM! My nipples were kind of flat, too: I think the nipple shield really helped there. We ditched it completely a week after he came home, and went to full-time breastfeeding, no shield, no bottles. Even after that it took us a few more weeks to really get a reliably good latch every single time.

My overall approach was just to give the boob a try every single feeding. If it didn't work, I'd move to a nipple shield. If that didn't work, we'd move to the bottle. It felt much less fraught, that way. I knew he was going to eat no matter what happened, so I would feel better about trying to get him to latch for five minutes in the beginning, even if it didn't work out for that particular time. My little boy never had nipple confusion. I was of course warned about it, but it didn't seem to be an issue.

Good luck to your friend! You rock for trying to help her.

[Mom2M]

My older DD was like this for about 7 weeks. Her weight was around 5.5 pounds and I had to strip her naked and hold a wet washcloth on her sometimes in order to keep her awake for a few minutes to nurse.
She constantly unlatched and when she was latched on it hurt!
Since she lost so much of her birthweight and wasn't regaining it for a couple weeks, the ped told me to pump and then nurse her first and give her the pumped milk.

I would nurse for a long time then go pump while DH fed her the pumped milk from the last feeding.

When she got up to 7 pounds, that's when she was able to stay latched on and awake. Then it was horrible to get her off the bottle.
After trying to ease out the bottle use, I finally had to just get rid of them and get through 2 days of screaming till she was only on the breast.
We went on to nurse for several years and it was great, ust tough at the start when she was small.

[Hey Mama!]

She says she is offering breast first, but he won't stay latched. She has anothe question-she was pumping last night and her milk is blood tinged. Can she feed it to him? I've never pumped so I have no idea if my dd's ever got bloody breastmilk or not? I told her it's probably ok but I want to make sure.

[Lil'Momma]

breastfeeding for a preemie is a lot of work. They get worn out easily though most do "perk up" and "get it" around their due date. That being said, for a lot of them, they don't always get "nipple confusion" (though some do) so much as "flow preference". The bottle is faster, they like the milk just pouring into their mouths. That can cause a problem. With DD, we used the First Years Breastflow bottles. The double nipple system can be a pain to wash, but it forces baby to work their jaw and tongue to get milk out, just sucking won't do any good. This makes them work for milk, no matter what it is coming out of... this caused DD to realize she liked the boob better. hehe

Also making sure she is offering when he is not starving helps. If baby is calm and not freaking out, a lot of times they are more willing to "experiment" with the nipple and latch more calmly than if they are rooting and going crazy and wanting something to eat NOW.

Newborn babies don't know when they've had enough... especially out of a bottle. It fills up their tummies so fast they don't know they are full until they are too full. My LC told me a newborn needed 2-2.5 ounces. Feed that, then wait ten minutes or so and let their little tummies have time to tell their brains whether they are hungry still or not. My daughter would try to down more than she needed and one NICU nurse just let her keep eating and my four pound little girl downed SEVEN ounces of fortified BM, I was furious when she wouldn't stop puking then slept for six hours straight... that nurse never came back to the NICU while we were there for some reason....

I have no idea about the blood, but I think I've heard other mothers talk about it being a blood blister, or something like that...

[Hey Mama!]

Yeah, the bottle she used seemed to just kind of steadily drip the milk into his mouth so he didn't have to work as much. I advised her not to wait until he was screaming to feed. I will pass along the info about newborns overeating. Her husband told her to wait a before offering him more breastmilk via bottle, but she thinks since he is so small she needs to stuff him full. Actually, her husband told her to start feeding him 2 oz every two hours instead of more every 3. I'm glad he's on board

[boobs4milk]

Originally Posted by Hey Mama!

She says she is offering breast first, but he won't stay latched. She has anothe question-she was pumping last night and her milk is blood tinged. Can she feed it to him? I've never pumped so I have no idea if my dd's ever got bloody breastmilk or not? I told her it's probably ok but I want to make sure.

are her nipples cracked? if so, she needs some lanolin asap! i used it every time i pumped or nursed the first 2 months and i avoided the bleeding nipples (although they were still sore!)

we used the nuk nipples, slow flow so that dd would have to work for her food.

[AllyRae]

At 37 weeks, the baby isn't really a preemie...he was full term. However, it sounds like he was born before he was ready to--was the mom induced or given an early c-section?

My 36 weeker had a lot of trouble nursing...she was very sleepy, had no suck reflex, and aspirated a lot because her swallow/breathe wasn't really on target. The no suck reflex meant that she couldn't even use a bottle (even at a year old, a bottle or binky in her mouth makes her gag...she had to be tube fed for her first couple days so I wonder if that messed soemthing up?).

The thing that worked for me was to give her constant access to the breast. She slept on my chest while I was shirtless so she could nurse in her sleep, I carried her in a sling almost every moment I was awake (or I held her on my chest), and offered her the breast every time she was awake. We didn't have a schedule...I was nursing her almost constantly for the first month and a half until she "woke up" (she was very jaundiced the first month too, so that certainly didn't help the sleepiness). She never cried to eat because she was just given constant access. It was hard because she couldn't suck at all...we had lactation consultants in the house a lot during that first month.

Just have her keep offering all the time, day and night. It took Mia about 2-3 months before she really got it...and now at 12 months old, she's still going strong.

[Hey Mama!]

Yes, he was born before he was ready by emergency c-section. Mom was experiencing a placental abruption. The hospital told her he was a preemie, I think he was just under 37 weeks.

Oh, and I gave her some Lansinoh yesterday afternoon, and told her to use it constantly to help heal her nipples.

[AllyRae]

Aaaah, yeah, with an emergency c-section early, I can definitely see where the issues might be coming in to play...

Maybe advise your friend that her and her baby should spend a week or so in bed, doing kangaroo care and just letting the baby nurse all day. That way she can heal and he can practice suckling until he's ready to be more wakeful. I ended up having to do that with my 36 weeker, and it helped us both a lot...

And you're such a good friend... :

[CalaRei]

I think the blood is normal and OK. Kepler's GI doc said that to test for milk intolerance, they usually look for blood in stool, but breastfed babies will generally pop up false positives because they normally have minute amounts of blood anyway.

Tell her to keep up what she's doing, and know it'll get better. Mine were 37 weeks, and Kepler was only 4lbs10oz and whisked away to the NICU for a few days. They were both very sleepy for a few weeks, I had to set alarms to tell me to feed them, otherwise they'd just keep sleeping. My whole day was: alarm goes off, change diaper, strip babies down, nurse, offer bottle supplement, put clothes back on babies, pump, wait 30 minutes, start over. It'll get better. Sometimes, I think it helped Kepler to get a *little* food in him (maybe 1/2 an ounce or so) before we tried nursing, so he could concentrate without being frantic.

The NUK nipples were the best for him, and yes, he was lazy at bottles, too - it'd get under his tongue and then he'd just shovel it all back out down his chin. It'd take him 40 minutes to eat 2 oz. Neither of mine ever took the breastflow bottles, so I can't advise there.