Help with nursing and NICU?!?!?!?

[Tenk]

So here's what's going on....

I'm not making as much as she's eating just yet. She's doing about 60ml's or 2 ounces at each feed and I pump just enough for 5 feeds. I go up there for 2 feeds and try to nurse her but she still needs formula after nursing.

Now nursing is hard work as we all know, so she nurses for around 20 minutes and then stops but is still hungry. They are telling me that she needs more calories than I'm making right now, but i know when she gets the bottles of BM or formula they are much easier, so basically she gives up and gets mad when I nurse and the longer she's there without me the worse it gets.

What do I do to get her to nurse better and not get mad when we try to nurse because it's hard work. they even want me to nurse then give formula after each feed to make sure she's getting enough calories because she's so small.

I want to nurse when she gets home and NOT give formula but she's not good at it and I'm afraid she'll start losing again, and she's way too small to lose more weight.

How do I fix this???? I'm exhousted from pumping round the clock and trying to spend 4 hours a day at the hospital, feed while there, then pump more, then what ever is next. I just dont know what to do.

[cristeen]

Can she be syringe fed when you're not there? If not, I'd bring in some of your own bottles, and get one that she has to work for... I use the Born Free, but I hear Breastflow is also good. Use the slowest flow nipples.

How often are you pumping? Are you doing breast massage while pumping? Are you getting enough calories/water? These can all effect supply. And then I'd add supps like fenugreek to help boost supply.

When you're nursing her, and they're wanting to supp, I'd suggest using a SNS or a Lact-Aid for this, so that your breast is getting the stimulation still and she's not switching back and forth with the bottle so much.

HTH

[lalemma]

Our boy was born at 33 weeks and was under four pounds. And I was in the ICU and totally out of it. So I know where you are right now.

For us, we decided that the main thing was for me to pump a lot to get my supply going as best we could, and to get our son home ASAP. We really wanted him to have the benefits of human milk, but it was much less important that he get the milk directly from the boob. So once or twice a day, he and I would practice nursing, but mostly he ate my milk in bottles. And aside from that I just tried to relax about it, and pump a LOT, both to get my supply going, and to make sure he had enough bottles in the NICU fridge.

We also used a nipple shield in the beginning. I know people have mixed feelings about those, so you will probably want to talk to a lactation consultant. But I have giant boobs and flat nipples, and he was tiny. It was hard to get him to latch on. So the nipple shield worked for us, and we weaned off it over a few days about a week after he came home.

People offered dire warnings about nipple confusion. It just wasn't an issue for us: he mostly ate from bottles in the NICU and took several of his meals from bottles when he came home (tapering off over the course of a week or so).

I'm not in your shoes, but if I were, I would try to just focus on getting her fattened up enough so she could come home. Can you pump in the NICU? I always got more milk when I was sitting there with him than when I was in the ICU. And I also got more milk, I swear, when I wasn't freaked out, so if you can, try to relax. It'll be okay. It will.

A great tip I got from the breastfeeding boards here was to pump while nursing your baby: it's awkward, but if you can pump the boob she isn't eating from, you may find it easier to let down. (I have never found it very easy to make milk for the pump.)

It's going to be okay, mama. My boy is giant and fat and healthy now, and a champion nurser. I know how scary it is in the beginning. But your baby is going to be okay, too.

[Tenk]

Originally Posted by lalemma

Our boy was born at 33 weeks and was under four pounds. And I was in the ICU and totally out of it. So I know where you are right now.

For us, we decided that the main thing was for me to pump a lot to get my supply going as best we could, and to get our son home ASAP. We really wanted him to have the benefits of human milk, but it was much less important that he get the milk directly from the boob. So once or twice a day, he and I would practice nursing, but mostly he ate my milk in bottles. And aside from that I just tried to relax about it, and pump a LOT, both to get my supply going, and to make sure he had enough bottles in the NICU fridge.

We also used a nipple shield in the beginning. I know people have mixed feelings about those, so you will probably want to talk to a lactation consultant. But I have giant boobs and flat nipples, and he was tiny. It was hard to get him to latch on. So the nipple shield worked for us, and we weaned off it over a few days about a week after he came home.

People offered dire warnings about nipple confusion. It just wasn't an issue for us: he mostly ate from bottles in the NICU and took several of his meals from bottles when he came home (tapering off over the course of a week or so).

I'm not in your shoes, but if I were, I would try to just focus on getting her fattened up enough so she could come home. Can you pump in the NICU? I always got more milk when I was sitting there with him than when I was in the ICU. And I also got more milk, I swear, when I wasn't freaked out, so if you can, try to relax. It'll be okay. It will.

A great tip I got from the breastfeeding boards here was to pump while nursing your baby: it's awkward, but if you can pump the boob she isn't eating from, you may find it easier to let down. (I have never found it very easy to make milk for the pump.)

It's going to be okay, mama. My boy is giant and fat and healthy now, and a champion nurser. I know how scary it is in the beginning. But your baby is going to be okay, too.

This is exactly what I needed to hear. I only agreed to the bottles of formula (which she doesn't get much because I'm pumping a lot!) so she could get fat enough to come home. I don't so much care that she's getting a little bit of formula because I'm pumping as much and as often as I can and she gets 5 full feeds of only breast milk and nurses twice a day but tops up with formula and gets 1 feed of only formula. I'm only really worried about getting her back to the breast when she gets home without stressing her out and burning all her calories/making her loose weight.

Thanks so much for the advice!!!

[PatioGardener]

Supplementing at the breast (after nursing) - either in the NICU or when you are home will help her to learn to nurse and should start to decrease her frustration at the slower flow of milk from the breast than milk from the bottle.

This will also help to bump up your supply as it will keep her at the breast longer (positive feedback loop, more nursing at breast, more milk produced).

Has anyone talked to you about domperidone? There is a really good randomised controlled trial that shows it helps moms of early babies to produce more milk. I know it is 'black listed' in the USA, but you may be able to get someone in hospital to prescribe it for you from a compounding pharmacy.

I hope she's home soon!

[Altair]

How many times a day are you pumping, and are you using a hospital grade pump? The yahoo group PumpMoms is great for these questions.

[mambera]

ITA on the advice to supplement at the breast whenever possible.

You might want to print this out (even the full text if you care to pay for it) and bring it into the NICU for ammunition when people tell you the breast is too tiring for the baby.

http://www.ncbi.nlm.nih.gov/pubmed/19933725