In the NICU day 11, pressure to start bottles...

[meadow123]

My daughter was born on February 6th at 34 weeks 1 day, she weighed six lbs. 1 ounce at birth. We have been in the NICU since. She is doing really well and having no problems other than eating. She latched on right away and has been breastfeeding, but does not have the strength or energy to finish her full feeding. She has an ng tube and gets pumped breastmilk through that. We have tried a variety of different schedules, and are now doing one feeding at breast then one through gavage to give her a rest since the breastfeeding takes more energy. She is getting Neosure for two of the feedings via gavage.
So that bring me to my question. We are starting to get subtle pressure from the nurses and the doctors to consider bottle feeding, with lots of comments about how we could go home much faster if we would introduce a bottle (of pumped breastmilk). I have a 20 month old daughter who I nursed until she was 14 months old, and my nursing relationship with her was very important to me. I am terrified that if we introduce a bottle to this baby so early that we may not be able to continue breastfeeding. The hospital is saying that they will hang in there with me for as long as I can hang in there, but I am wondering if my expectations are too high and that I need to give in and introduce a bottle. I guess I am looking for advice, reassurance, experiences, anything??? I should also say I am staying in the NICU all the time including at night, and that it is getting hard because I have my 20 month old and husband at home (I know you all know about this). Thanks in advance for any input you can give me...

[woodchick]

I didn't have a premie, but my DD1 was in the NICU for two weeks. Because of her condition we couldn't even try nursing until day 12. She was fed expressed breastmilk via tube and then bottle until then.

We had issues going to breast from the bottle, due (I believe) to nipple confusion as well as sore throat issues from her intubation. I was only able to get her to latch on while using a nipple shield. I didn't want to, but I was determined not to need bottles. We left all the bottles at the hospital on day 15 and I nursed exclusively from then on. It took a couple months to wean off of the nipple shield, and that was hard work.

DD1 is still nursing, and she's almost four!

I know the situations are different, but I wanted to give you our experience. Good luck!

[woodchick]

double post. sorry!

[AustinMom]

This is just my understanding, I wasn't able to BF my son, but in my studies of Doula training, I have come to understand a lot more on BFing. A really good book is THe Ultimate Breastfeeding Book of Answers. It has a section you can flip to and read first on BF a special needs baby, like preemie, and babies in the NICU. You may want to check out that book and take it to the hospital with you and show them. The author, Dr. Jack Newman, is a BFing expert and has a BFing clinic in Canada for forever now. Nurses and Dr. are rarely experts on BFing.

I guess I don't understand why they want to use a bottle so bad. If it's due to flow of milk, you have a lot more options that are a lot less strenuous on the BFing relationship. It's my understanding that a breast is easier and less trouble for a preemie to latch on to because it's soft and more mailable than a hard touch bottle nipple. Another option you have, is finger feeding with an SNS tube attached to your finger. This has shown to be less confusing to a baby, and easier to go to BF after you are home. Or, you can try cup feeding. Yeah, I know, I had never heard of it before, but it's simply using a medicine cup (like the ones you get with cough syrup) of BM and, well, cup feeding.

You have many other choices than bottle. Maybe ask to have the SNS system attached to your breast so milk flows more easily, and you still have the BF going on, just slowly ween off the SNS system.

Personally, I'd stay away from nipple shields and bottles. My experience was when we used the nipple shield, it caused him to latch on to the nipple and not the breast, therefore not stimulating the milk in the right way, so my supply was very quickly diminished.

[Tofu the Geek]

I saw this in new posts and just thought I'd paste a link to a recent study about breastfeeding and bottlefeeding using the same amount of energy in case it might be helpful to you http://www.thedoctorschannel.com/vid...l?specialty=19

[moaningminny]

First off, congratulations on your baby! Also, it sounds like you're doing a fantastic job.

I can only give you suggestions based on what I went through.

My 31 weeker was gaining weight fairly well, and we ended up going from gavage to bottle to breast - something that I wouldn't recommend.

Since she had to be able to get all her feeds via bottle or breast before she was discharged, it almost seemed like a race to get her off the gavage feeding, and bottle feeding seemed to be the easiest way to do it.

In the end, sure, she could go home but I was still going back and forth between pumping, formula feeding and breastfeeding. Due to low supply and severe PPD I was able to continue breastfeeding/pumping for 11 weeks until I had to stop.

It sounds like the hospital is being fairly supportive, which is great, and it also sounds like your breastfeeding relationship is very important to you. I would try to keep going as you are - I know I blame the early introduction of bottles for part of my struggles.

I wish you the best of luck, also, have you seen a lactation consultant?

[lalemma]

My son was born at 33 weeks (and ps, your child is HUGE! That's awesome. Mine wasn't even at four pounds!) and pretty much ate BM in bottles until he came home a couple of weeks later. We'd try to nurse once or twice a day (with a nipple shield), but at first he was so little and so easily tired that we didn't push it. The important thing to me was that he was eating breastmilk, not how he was getting it. So we'd practice nursing, he'd get a little bit, and then I'd feed him a bottle of expressed milk.

People (not the nurses, the nurses were awesome) tried to scare the crap out of me about nipple confusion, nipple shields being terrible, how I was going to have low supply... you name it, I was warned about it. But that stuff just wasn't my experience. When he came home, we pretty much switched over to full-time breastfeeding over the course of three or four days: first with nipple shield, then without. And now he nurses like a champ.

[mama2soren]

Congratulations on your new baby!

I want to encourage you... if you do decide that feeding EBM out of a bottle is what your baby needs, that it doesn't necessarily mean failure. My guy, a 31 weeker, had a very tough time latching on, and didn't have any successful feeds at the breast for over 5 weeks. He could take a bottle of BM, and we did a few of those a day in the NICU. Now, at nearly 24 months old, he is still nursing like a champ. In fact, he decided at 4 months of age not to ever have a bottle again, much to my frustration, as I was a pumping, working mama! He's never had a drop of formula.

I don't want to push you to do bottles if you are not comfortable with the idea. I just wanted to share a success story from someone who's been in that same difficult place as you are now.

[LaughingHyena]

Congratulations, having your little one latching and feeding straight from the tap is a huge success already.

DD was also born at 34 weeks and it took us till day 8 before she latched at all. She kept her NG tube till 48 hours before we left the NICU.

Our NICU was very supportive of not using bottles, they were aiming for baby friendly status. http://www.babyfriendly.org.uk/ maybe there is some information there that you could show your team if you would prefer to avoid bottles.

Even with that they were quite attached to thier schedule, I guess they needed it with lots of babies to feed. However while DD was a sleepy baby and would probably have slept 3 hours between feeds there was no way should would take in the amount of milk they were recommending at once. Even when it was via her tube she just spit most of it back up again. Shorter more frequent feeds defiantly suited her better but it was hard to get them not to top her up after the 3 hours.

There is also some infromation in this thread http://www.mothering.com/discussions....php?t=1181653 about bottles n
ot being easier for premmies.

I guess the short version of this post is you have other options if you don't want to use bottles, however I know it's tempting if using a couple of bottles a day can get you home.

[pauletoy]

I personally did what I needed to do to get my little one home with me ASAP. I decided to alternate nursing with bottles of EBM in the NICU and work on full-time nursing once we got home. I needed my precious boy at home with me a whole lot more than I needed to keep bottles away from him. In the end, it worked out perfectly.

This is just my experience, you have to do what feels right to you.

[Bokonon]

Originally Posted by pauletoy

I personally did what I needed to do to get my little one home with me ASAP. I decided to alternate nursing with bottles of EBM in the NICU and work on full-time nursing once we got home. I needed my precious boy at home with me a whole lot more than I needed to keep bottles away from him. In the end, it worked out perfectly.

This is just my experience, you have to do what feels right to you.

This was my experience as well. No one in our NICU ever even mentioned an alternative to bottles; I simply didn't know there was one until after DS (32-weeker) was home.

He was in the NICU for 6 weeks. It took a couple of months to get him fully on the breast once he got home, but he did, and we nursed to 22 months. No formula.

DD (34-weeker) was in the NICU for 10 days. Honestly I didn't nurse her there as much as I could have, because I was afraid she would start having oxygen desaturation (which happened frequently with DS in the NICU while breastfeeding), and I wanted her home quickly. She was a 34-weeker and after her jaundice cleared up, she just needed to start gaining. Fortified EBM gave her more calories than just BM, so I was ok with that. Once she came home, she gained like crazy and we didn't have to fortify. Within a week, she was exclusive breastfeeding. Both kids stopped taking bottles within a month of EBF!

You have to do what feels right for you, but introducing a bottle does not automatically mean the breastfeeding relationship is destroyed.

Good luck, and I hope your baby is able to come home soon!

[justKate]

Originally Posted by pauletoy

I personally did what I needed to do to get my little one home with me ASAP. I decided to alternate nursing with bottles of EBM in the NICU and work on full-time nursing once we got home. I needed my precious boy at home with me a whole lot more than I needed to keep bottles away from him. In the end, it worked out perfectly.

This is just my experience, you have to do what feels right to you.

This was our experience too. DD was full term but refused to latch and did not void her bladder for 24 hours, so to the NICU she went. Then wouldn't eat...long story short, we FF, did everything they wanted, and it still took 3 weeks to get her home. The day we got home she latched for the first time and hasn't let go since. She's 12 mos. now. Just want to give you some encouragement--do what you gotta do to get your baby home!

[sbrinton]

When we were in the NICU, we introduced breastfeeding first and then eventually let the staff fed Zeph 2-3 bottles a day so we could get the NG tube out and I could get a break. This was after breastfeeding was well established and I don't think Zeph had much nipple confusion.

If anything, he never liked bottles and still doesn't like anything but my boob (at 15 months!).

We did find that using a nipple shield was very, very helpful at first. Not sure if you are doing this, but it allows preemies to stay latched more easily so they don't have to work so hard to eat.

There are some studies out there saying that breastfeeding is easier than bottlefeeding for preemies too...

[Mama Shifra]

I am really sorry about the pressure the people in the NICU are giving you. Unfortunately, I can relate. The people in the NICU that my son was in 5 years ago also made me feel uncomfortable (and mind you, I had a medical background and spent time in NICUs before); so much so, that I only came into the NICU for feedings. The rest of the time, I hung around the hospital or the hotel room that I was able to get near the hospital.

Breastfeeding Your Premature Baby (published by La Leche League and The Premature Baby Book are the best books on the care of premies that I know. They not only give you lots of information about what you should be concerned about, but they also tell what the hospital staff may be concerned about.

You may want to see if the staff will cup feed your baby. The hospital my son was in was very breastfeeding friendly, but they still wanted him to get more milk in (and they had a policy of breastfeeds only every four hours for no more than 20 minutes at a shot so as not to tire the baby). They had me pump and they fed him 20 ml after every breastfeed every four hours. They used a little medicine cup (like the kind you would give a small child tylenol in) to have him sip the breastmilk. If the nurses are not willing to put in the time to cup feed (because it is time consuming), you could do it, if you feel up to it.

So I would breastfeed every four hours and two hours after the feeding I would pump, so as to empty my breasts every 2 hours like you normally would with a full-term infant. I did this when I woke up (at about 7am) until I went to sleep, close to midnight. I did not wake up in the middle of the night to pump, figuring that I needed my rest and to keep up my strength. I did not have supply problems when my son came home.

[justmama]

my middle child was born at 34w 1d and weighed 5lbs 3oz. Your baby is huge! Great job growing that little one!

Since I didn't know I had any other choices, we used the NG tube until day 8 of life and then did bottles and occasional nursing tries. She came home bottlefeeding and refused her first bottle feeding at home in favor of the breast. She never took a bottle again, and weaned at 22 months. For us, it wasn't possible for me to be at the hospital around the clock for 24 hours in order to do every single feeding(required to nipple all feeds for 24hours to come home) because I had another child at home so I had to let them do bottles to take her home.

[odoole]

Mine was 34 W 0 days, 5 lbs 4 oz, was in the hospital for 5 nights. We did pumped milk in a bottle the whole time, though we "practiced" at the breast a few times a day. Honestly, I didn't know there was any reason not to do bottles, so I was totally fine with it. And it was hard enough to get him to stay lively enough to drink from the bottle, the breast would have been impossible. My main concern was just that he would eat and get fat; it's hard to see your tiny baby get even tinier as the days go by. You just want them to eat, eat, eat!!!

I was also anxious to get out of the hospital as soon as possible (the 5 day stay alone cost $25,000, of which we paid 20% -- 6 months later we're still dealing with the bills). Besides the cost, there's always the risk of nosocomial infection, etc. Even knowing what I know now, I'm not sure I would have stayed more days just to establish the nursing relationship there. I would have still aimed to figure it out at home, just as we did.

I know all babies are different, but we had no problem at all switching to breast once he got home. We did breast + bottle for another week then was all breast after the 2nd week home. Looking back, I'm actually glad we started the bottle that early so he could learn to go back and forth from bottle to breast without any problem and it gave me a little break so DH and family could feed him from time to time.

[SilverFish]

i'm dealing with a similar situation right now. i just delievered my 35wk 3 day baby... she's 5lb10oz and currently under the lights for jaundice. not only do i have the stress of being in the NICU, we're in quebec and i'm anglo, so communication is a huge problem. personally i'm trying to breastfeed once or twice a day, (we're on day 5 right now) but we've only had one successful feed. really though, i just want her home as soon as possible. and since i was a midwife transfer, my midwife is totally comitted to helping us work out the breastfeeding issues after we get home, but has her hands somewhat tied while my baby's in the hospital.

i just don't think i'm going to get the consistent and comprehensive help i need at the NICU. there's one nurse there who always makes a strong effort to help us out, but a lot of the others just walk away while i'm holding my tiny crying infant. i just want her off the gavage as soon as possible... i think the bottlefeeding (which she actually has NO issues with... gets down her full feed in about half the time of gavage even) is the easiest was to do it.

i feel like breastfeeding won't really work until we're in a comfortable home setting. trying to feed in a busy NICU wtith their tight schedules, with wires attached, my breasts squirting everywhere while everyone walks around me, sitting in a hard chair at 5 days postpartum... none of these things are condusive to a good breastfeeding relationship anyway.

anyway, i just wanted to say thanks to those who have shared their experiences... i had a rough day at the NICU today, and it's good to be reminded i'm not the only one going through this.

[USAmma]

It may be that your baby is not ready yet. When I was in the hospital with my baby (not NICU but she was sick as a newborn), I was not aware of all the resources that could have been availble to me if I had asked the right questions. Have you worked with a speech/feeding therapist yet? They can be very helpful to answer questions and break things down into small steps so you don't feel overwhelmed. You can also ask for a social worker who can help to coordinate some of these services for you.

It's good to get started in the hospital and then request ongoing help at home. Your baby probably qualifies for state funded feeding therapy, and you can arrange that now for when you go home. I found feeding therapy to be extremely useful to getting my child eating better. We first did it through out patient services and then I learned that the state pays for therapy in the home! I did not know about that service for some reason, until I learned of it from another mom. Most states have it and preemie/nicu babies qualify pretty much automatically.

[boobs4milk]

my baby was 35 weeks 0 days, 6lbs 7.9 oz. and we fought to bf her and eventually gave up and gave her bottles to get her home. we were ebf 3 wks after release.

here's a post i wrote to another mom when millie was 6 wks old...

wow...your post sounds eerily familiar. my son (11) was 30 wkr and had feeding issues. he didn't take solid foods until almost 3 yrs old.

my youngest lo is 6 wks old and was born at 35 wks. she was 6 lbs 7.9 oz 19 1/2" lost down to 5lbs 14 oz in the nicu. she was in there for 17 days and didn't even get to attempt feeds until day 7. she was a lazy nurser, whether we used bottles or the breast, and sometimes she would have negative outcomes on the breastfeeding! we would weigh her before feeding, feed her, weigh her again only to find that she either didn't gain or lost a few grams. it was all very frustrating.

then we were told that she had risk factors for osteopenia of prematurity (aka rickets) and were literally guilted into fortifying her breastmilk with human milk fortifier and eventually neosure infant formula. i was told things like 'your milk just isn't enough' and 'you are doing things all wrong' when i would insist that my milk was good for her and she would tell me when she needed it and how much. when we weren't there at her bedside, she was gavage fed while laying in her crib. we had asked that she not get any nipple besides mine, but she was given bottles during the night one night.

we fought tooth-and-nail with those people until we finally relented and decided to play there game in order to get them to release her. we had thought about checking her out ama, but were threatened with cps/dhs so we just gave in and bottle fed her ebm with the fortifier.

she came home at 2 1/2 weeks on all bottle feeds. a few days after she came home, i started introducing the breast. she was still lazy, so we used the SNS and the nipple shield. i found that that did nothing to increase her suction or her hunger as she would just sort of lay back and let the milk drip in.

i decided to try her with the nipple shield and eventually she got hungry enough to latch on to the shield and nurse. i don't know how much she got, but she had milk on her lips so i knew she was getting something. she burped, latched back on for a few minutes and then slept for a few hours until i woke her for another feeding.

i was then nursing her with the shield on the right side, pumping the left side, and then every other feeding topping her off with the ebm fortified to 24 calories. she was (is) getting the vitamin drops and vit d supplements as well. it was, to say the least, exhausting, confusing and frustrating. at least i could take comfort in the fact that dh could help feed her when i felt like i might drop? nope. he could feed her but i still had to pump.

we went to the lc at the health dept. about a week later. she was 4 weeks by this time and we had slowly started weaning from the shield. i would latch her with the shield, get the milk flowing and the nipple drawn out, and then unlatch her, remove the shield and latch her again. she was getting very frustrated with this arrangement. the lc said to pump for a few minutes until i felt letdown and then try to latch her.

we did this and it seemed to work, so then we started working on her latching onto the left breast with the nipple shield. she would fight it, but eventually she got the left breast to actually release the milk! i would feel letdown every time and sometimes it would spray her at first, but she just wasn't strong enough to get the milk to come out after the initial spray (that would usually choke her and/or make her vomit!). meanwhile i was still nursing her on the right side, using the nipple shield on the left side, pumping after every feeding, and topping her off with the ebm with fortifiers.

it took us about a week longer to be able to ditch the shield on the leftt side but i did it the same way as i had the right side. we ended up only using the sns about 6 times because i didn't feel like it helped stregthen her any. when she was about 5 wks old, we got to about 80% breast feedings, with the bottles thrown in when i was exhausted (daddy feeds) and for her vitamin supplements. i just watched her during her feedings and afterwards to see how long she could nurse at one time and how long she could go without needing to nurse. i also could feel her suction getting stronger as time went on and knew that she was strong enough to pull milk from my breast. she was sucking the bottles down in gulps and in record time by then, so that was another indicator that she was ready to start nippling at the breast.

then the sore nipples returned. i was sore in the beginning from the pump, and now i am sore again from relearning to breastfeed. i honestly believe my left breast was 'stingy' because it was used to the pump and i am one of those cases where the baby wasn't being as effective as the pump.

we also ended up with vomiting and green poops. i asked my ped about them and she said to just pump and bottle feed or switch her over to all formula to straighten her out (GRRR). we decided to try block feeding and after a few days we are seeing bright yellow poops and the vomiting has decreased significantly. i believe wholeheartedly that she was OVER eating due to the over supply and the spraying letdown. she was also getting huge gas bubbles at first and then her tummy would hurt so she would comfort nurse and get more milk and then when we would lay her down, milk would literally run out of her mouth!

anyway, sorry for the novel. i was hoping that by typing this all out you might be able to mimick what we did or at least try some of the things we did. my best advice would be to watch your lo and see how she responds to all bf. you are amazing for pumping for so long for your son! i only made it about 6 months and then put him on the medical formulas. don't give up!

[Bea]

My son wasn't a premie but was slow to nurse effectively, we used one of these we got from the hospital a couple of times.

Foley Cup

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