Will my 34-weekers be able to nurse?

[annacard]

Hi everyone. I have been lurking for a while, but it looks as if delivery will be soon. Background: I am pregnant with twin boys, (my 3rd and 4th children). First two pregnancies were uneventful with un-medicated vaginal births. I breastfed my older two children until they were three.

This pregnancy has been completely different. At 28 weeks my cervix was measuring short (1.9 mm and funneling). I was put on bedrest at home and given Procardia to prevent uterine contractions. At 31 weeks my blood pressure began to rise--even with the Procardia and 24 hour urine showed mild pre-eclampsia. Now I am 33 +5 weeks and will be admitted to the hospital today. Both babies are breech and I will have to have a c-section, plus be on mag sulfate for 24 hours after delivery.

After all that, what are the chances that my babies will be able to nurse?? Will the hospital make them formula feed? My older two never had any formula. Any help about nursing or about 34 weekers in general is much appreciated.

Thanks!

[MeepyCat]

There's actually two questions here:

1. Will your babies be able to nurse?
2. Will your babies be given formula?

The answers aren't necessarily simple.

In my experience with NICUs, they are just delighted to be able to give breastmilk (especially if it can be fortified with extra calories and enhanced with vitamins), but it's unlikely that you'll be able to do all feeding by breast right away.

There is a fair likelihood that your boys will need some breathing assistance, and that they will be evaluated for heart murmurs in the first few days of life. Heart murmurs can be treated via medication in children this young, but the medication works best on a naive gut, so parenteral nutrition is sometimes preferred to nutrition by mouth. (My dd got through her first few days on a parenteral goo that had a lot of ingredients in common with the stuff they sell to hikers.)

Some preemies have trouble coordinating sucking, swallowing and breathing - in these cases, feeding by gavage tube is preferred. The NICU staff can and will help you with transitions from gavage tube to bottle or breast. They do tend to be most comfortable with bottles.

My opinion is that you should do whatever you need to do to keep your supply up and get your babies home. Home is the best place to work on exclusively nursing. (Which is not to say you should not try for exclusive nursing in the NICU, but it is easier to do and there's less of a peanut gallery in your own house.)

Good luck, mama. I hope your NICU time is short and uneventful, and that you get to bring strong and healthy boys home very soon.

[ShanaV]

What she said

(1) Yes, even after all that they will be able to nurse! It most likely won't be right away, but it will happen! It may be with a nipple shield, but hey, it's better than nothing (we had to use shields for 3-4 months, but now we're off, so I'm sure you could get off it way quicker than we did b/c there's a BIG diff between our babies' gestational ages!)

They will likely have to go immediately to the nicu; they may need help breathing, they may need help eating, but in all likelihood your nicu stay shouldn't be too terribly long. I'd guess 2-4 weeks to be conservative. (Most babies without major problems seem to be able to come home at 36-38ish weeks gestational age.)

(2) Pump in order to avoid formula! I agree with the pp, the nicu is more than happy to use BM, and in my case was very encouraging of using BM, really stressing how much better it is for babies, preemies especially. They don't eat a lot at the beginning, as I'm sure you know, so you don't need to be pumpin' out ounces at first. Drops will do. And it may take a few days for them to even be able to take anything into their tummies anyway. Mine were fed nutrients via umbilical IV for several days because their guts had to mature. (Again, they were 3 weeks earlier than yours are, so yours will be more developed from the start, so they've got that going for them!)

Wishing you the best of luck on your early delivery! It will go well. We're here to support you, Mama.

[justmama]

Great posts so far. I have to say that it's unfortunate but formula will likely be given for the first few days until your milk comes in. Usually they wait 24 hours to make sure baby is stable and then begin feeds on a trial basis and they will mix your drops of colostrum with formula until you have milk for them. Preemies can't wait for your milk like fullterm chubsters can. They are burning so many calories to stay alive that they need some put in to fuel the tanks. I had a 34weeker who had lots of problems feeding and needed the ng tube for 8 days before she was reliably nippling feeds. And I will say that she wasn't really nippling feeds, we were forcing it into her. Her head nurse knew how heartbroken I was that she was still on the ng tube so she really tried spending copious amts of time trying to get my daughter to nipple all feeds and we really came home too soon at 11 days old. She would nurse for 5 minutes or less every 20-30minutes around the clock for the first month or so until she gained more weight and woke up a little more. It was rough. But she was a VERY sleepy baby. She not only had trouble staying awake for feeds but she had issues with apnea as well that extended way past her nicu stay and even way past her due date. My 33 weeker had no feeding issues straight off the bat and was nursing effectively as soon as my milk came in, though I could only make it to 2 feeds per day being a single mom to 2 other kids. She's still extremely food motivated to this day. But she had formuula as well until my milk came in. She stayed for 11 days as well but due to other problems.



Oh and I forgot to add(and it hasn't been mentioned yet) that pumping sucks. Get a good pump. A hospital grade pump. You'll need it. Also, bringing some used clothing(seeing your baby finally in clothing is a huge milestone and tear-jerking event) or a pic or two of your baby to pump with helps big time. Don't forget the amazing benefits of kangaroo care for you and your babies. It'll bring your milk in faster and your babies will acclimate to life faster and breathe easier and have less apnea and more stable o2 sats and heart patterns. Remember that each breast will adjust to each baby's needs for temp so multi-task right from the start and place one boy on each breast if you are allowed. Our 'roo time was so special, I just absolutely loved having my girls on my chest in the rocker. When we transferred the 33weeker to a more kid-friendly nursery when she was stable, it made a world of difference. It was less busy, I could bring her sisters in to visit, and closer so I could sit for 2 hours instead of just a few minutes because I had to factor in drive-time. So don't underestimate the power of just laying a baby or two on your breasts. It really DOES help you bring in your milk and get it flowing. If you pump right after, you should get a TON more.

[*clementine*]

I just had 33 week old twins and they were in the NICU for a month. I nursed and had them get formula. It's been a battle, but I decided to trust my body and know that we could get nursing established and it's going really well. They still take bottles of formula now that we're home, but I'm transitioning them to be fully nursed slowly but surely. I lost my supply a couple of times and paniced, and the nurses tried to push the pump on me (I hate the pump) but I'd just go back to constantly letting them nurse when they could and once they got home, they're at the breast alllll the time. One of the twins COULD NOT latch on- and we've even gotten through that. It took her a month to learn how, so don't give up hope.

[mommy2maya]

My 34wk baby was able to nurse right away- well it was like 12hrs as I was all screwed up and puking from whatever they gave me in my epidural and totally out of it for a good 12hrs. My dh fed her a bottle of preemie formula in the meantime in the nicu. Anyway, she nursed no problems from 12hrs old til 2.5 without any bottles. We didn't have any nicu time further than the 12hr observation.

[Crunchy Frog]

First of all, congratulations on making it to at least 34 weeks.

I don't think there's any reason why they shouldn't be able to nurse, though as has been said, it probably won't happen instantaneously.

My twin boys were 33 weekers and they both nursed really well from the first time they tried (at around 1 wk and 1 1/2 wks). My babies were always really good nursers and the only reason it didn't end up working better was that my boobs were just not up to the challenge.

As far as whether your babies will be given formula, well it seems like each NICU has it's own policies and they can really vary in a big way from NICU to NICU. My babies were never given formula until they were both on full size nipple feeds and my boobs couldn't keep up with the demand anymore. In our NICU they started them on TPN, and then gradually phased in nipple feeds starting with really tiny amounts, so they didn't get formula early on. They didn't get any tube feeds either, which I think is kind of unusual; they probably kept them on TPN longer than most places do.

Anyway, once you're home with them you can work on the nursing as much as you want and get your own rythms established with your babies, free of interference. As long as your boobs are reasonably cooperative it should work out OK.

[Mrs.Music]

My babies were born at 27 weeks and 33 weeks. Both were nursed exclusively for several months and the earlier baby actually nursed until she was 2. My son nursed until he was 14 months.

My 27 weeker was put to the breast at 35 weeks (so she was about 8 weeks old) and we had her nursing well enough to go home in 2 weeks. My 33 weeker was put to the breast at 34 weeks, and I had him home a week after that. No nipple sheilds, supplemental nursers, bottles or formula required. And you can absolutely refuse to let them give your babies anything that you feel would interrupt your nursing relationship. I allowed both babies binkies (which they rejected after we started nursing) and the occasional bottle of breastmilk if I wasn't around but never any formula.

Justmama said something about putting the babies on formula until your milk comes in... At the hospital I had my son at, they allowed me the option to either give him formula or keep him on the TPN until my milk came in. Obviously by the time my daughter could eat, I'd developed a great supply from pumping.

Some hospitals have breastfeeding support groups for the moms of preemies, btw. You might want to look into that too. And don't hesitate to ask lots of questions.

[aikigypsy]

I had a 34 weeker (now 44 weeks!) and he was in the nicu for 7 weeks. Yes, one week past his due date. It sucked. He was almost ready to come home after 2 weeks, then he started having apnea, which went on and on and on and on. He's still on a monitor at night, but it hasn't had a real alarm since his first night home.

I have an almost-3-year-old who still nurses 3x/day, and I pumped a lot. I hated the pump, but I got free of it sooner than I expected, and I'm actually glad that this baby is able to take bottles. DH can give him a bottle if I'm having trouble getting DD to sleep, and I have the option of going out.

Anyway, he was quite old when he came home, 41 weeks, and had had no major issues with feeding in over a month (IV feed for the first few days, then gavage feeding occasionally until he was a week and a half old). 3 days later the only bottle he was getting was the one with his vitamins and medicine once a day. So, despite the warnings of the nicu nurses that it could take 6 months to transition to full breastfeeding, we were basically there 2.5 days after getting home... but if he'd come home much earlier, and had needed added calories, it would have taken longer.

Also, we used a nipple shield at first, but weaned off it about a week or two ago. The nipple shield can help them get a good latch, and IME weaning off it is no big deal. It happened after 5-6 weeks with my daughter (who was postdates) and not long after coming home with this guy. He also sucks on a pacifier every now and again.

This baby has never heard of "nipple confusion." He'll suck on anything. According to the nurses in the nicu, most late-term premies are very versatile feeders, so my advice is to keep your supply going while they're in the hospital and don't worry about bottles. Most nurses there were also very supportive of my breastfeeding efforts, and I talked to the lactation consultants nearly every day I was there.

[annacard]

Thank you everyone for your advice and encouragement.  I just wanted to update and let you know that my pre-eclampsia remained in check and I was able to hold out delivering the boys until 36 weeks!  Owen and Matthew required no time in the special care nursery and came home with me.  They are now almost 11 weeks and thriving.  Oh, and they are exclusively breastfed!    Again, thanks ladies for your time and encouragement!

[sunnygir1]

Congratulations on your sweet babes and your successful initiation of breastfeeding!  I was going to post that my babies were born at 34w6d and 35w (not twins) and they both were able to breastfeed.  Ds had a bloodsugar crash in his first 24 hours, so he got a couple feedings of fortified formula, but apart from that was exclusively breastfed.  I was going to encourage you to try the breast and pump colostrum and milk as needed.  Yay for amazing, resilient babies and mamas!

[chanoue]

I breastfed my 27 weeker when we got home. It took lots of patience- I would offer the breast first and pump for 15 minutes after each session- He loves the breast more than the bottle. I took us two weeks to get into a groove

[belacmsage]

My pregnancy was a lot like your sounds expect I just had the one. My baby was born at 33 +2 weeks and spent his first four weeks in the hospital. He had no issues other than eating. Unfortunately, when a baby is born that young most hospitals will not even let them try to nurse at first. However, once they can keep there body temp up and show some good weight gain, most hospitals are more than willing to let you try to nurse once or twice a day. They still want to tube feed them the other half just to make sure they get enough. Then it is a personal choice really. I tried to nurse but it was just too hard for my little guy and it wore him out very quickly. I decided it was more important to get him home than to get him to nurse at each feeding. The hospital would not let us take him home until he took all his feedings in a 48 hour period from breast or bottle. The bottle was easier so I pumped and bottle fed him. When we got home, I tried to nurse more but he just never took to it. So I pumped for the first three months and he had breast milk for the first four months and then we switched to Similac Neosure. 

I hope this helps you out a bit. Just remember, if you want to breast feed you need to advocate strongly for your rights to feed your babies at each feeding or the nurses will take over. And if it doesn't work, don't feel bad. It's hard to nurse a preemie let alone twin preemies.  

[Cinder]

Janelle, born at 34 weeks, had no real issues nursing, we had to fight to keep her awake while nursing those first couple months before she hit 7lbs, but that's it, she latched fine and everything.  She nursed exclusively till past 9 months when she started solids...but she didn't eat solids every day even once a day till past 1.  I tandem nursed her while pregnant with Kincaid.  When Kincaid was born she went on a complete eating strike and went back to exclusively breast-feeding for a few weeks...she ended up nursing till 4 years and 3 days old, including the entire 23 months that Kincaid nursed for.

River was born at 36 weeks and there were no issues what so ever.  He was breastfed exclusively for about 9 months as well, then started solids (table food...neither Janelle nor River (or Travis...) ate baby food/purees at all, they just had no interest)...he weaned just recently around 20 months old.

Travis, born full term at 38 weeks and nearly 7lbs I doubt I would of succesfully been able to breastfeed had he been my first kid...for the first 6 weeks it took me up to 30 minutes every single time to get him latched, and frequently he would fall off/unlatch multiple times and we would have to start over.  There were days when I seriously spent over 16 hours breastfeeding him...it was hard, my nipples bled, uhhg...but we figured it out, by 2 months he was a pro and he never did get a bottle of even expressed milk...but by far, he was my hardest kid to nurse, and he was full term and much heavier than Janelle and River were.