breastfeeding woes

[aslmere]

Ok.  I really KNOW that our issue isn't that big of a deal. I know that it will get better. But at the same time I don't know how much to push.

DD is 5 days old and was born at 36 w 6 d (we know that theese dates are accurate) with IUGR.

They estimated her gestational age at 34 weeks, so not too bad.

She was 4 lbs 7 oz and 16 inches long. She dropped to 4 lbs by the next am.

She is in the NICU with typical 34 weeker and cesarean issues.

She is doing great now. Off all IV nutrition and on room air.

However she is still struggling a little bit to keep her temp up and eating wears her out.

She is getting every other feed through the ng.

As much as I wish I could be there for every feed, I cannot. It sucks, but I need healing and my 2 yo is a mess right now.

I get there for at least 2 and possible 3 feeds a day.

So they are giving her a bottle a lot. Which is fine. Things change when baby is in the NICU. But different nurses have different ideas about what flow nipple to use and since it is totally up to their discretion she often gets the faster flow nipple so that she can eat bbefore she tires out.

Last night I came in and went to put her to breast for the second time. And she latches pretty good, but her mouth is tiny and my nipple is not and the milk doesn't flow fast and she gets frustrated easy.

So I could see she was tiring out and I let my dh give her the rest of the feed with the bottle.

I feel bad for giving in, but at this point isn't it about getting her strong and out of the NICU? Then moving off the bottle when I can be with her 100% of the time?

I feel bad because I gave up and I feel bad because she so obviously wanted to nurse, but wanted it now.

It doesn't help when we have one of the nurses that are not as enthusiastic about the actual nursing (breastmilk is great, but breastfeeding not necessary to some of them)

I know I don't make much sense really, and I am just really emotional. I have such an empty space right now. I just want her home!

[justKate]

Oh mama, big hugs to you.  It is awful, and I'm so sorry your DD can't be with you right now. Don't feel bad for "giving in"--of course you feel like you should do anything to get your DD home asap. No one can tell you what would be best, but I say go with what works for now.  I assume you're pumping?  Just keep that up, and keep her latching regularly, and I think you'll be fine.  My DD didn't latch at all until she was released from the NICU (3+ wks), and was EBF thereafter, so it is an option.

That being said, could you talk to the docs/LC/resident about putting in an order re. the nipple to be used when she's bottle fed?  That way at least it would be consistent for her.

Keep us posted, Mama.  This is the hardest part. 

[Siera]

The previous is really good advice.  My DD and I were not allowed to breastfeed in our NICU, so I insisted on a bottle that was very similar to my own nipple, and DD really took to the bottle (as much as I hated that).  I used the Avent bottles.  Once we got her out of the NICU, then we focused on breastfeeding at home.  DD was (and still is) such an avid breastfeeder that she switched completely to nursing herself with very little help or encouragement from me.  After our NICU experience, I had virtually given up home of ever breastfeeding her.  In our NICU experience, we were made to feel that breastfeeding was taxing on my DD and therefore tired her out too quickly.  What I learned after we came home and I hired my own LC was that DD is just a lazy feeder.  She approaches nursing as an all day buffet and just takes her time, which is ok.  But, for us, it was not ok in the NICU. Hang in there, you'll be fine!

[aikigypsy]

I was in exactly the same position a couple of months ago, except that my guy really was a 34-weeker. He was also 4 lb. 7 oz. at birth. I had a 2.8-year-old (she's 3 now).

I could not make it for every feed. I couldn't even make it in every day. We lived a 4-hour trip away from the hospital, and once I was discharged I visited about 3 days/week, because I felt that it was better for my 3-year-old to be at home in a familiar environment -- not sure if that was absolutely the best decision, but I couldn't be everywhere at once and something had to give. 

I breastfed when I could, about 3-4 feeds a week.  We used a nipple shield.  I pumped a lot, and my older kid is still nursing 3x/day. They kept the baby in until a full week past his due date. He was on IV feeds for the first few days, then some gavage for another week, then all bottles for about 6 weeks.  He got home, and within 3 days we were doing all breastfeeding except for the bottle with his medicine in the morning. He didn't gain quite as much the first week he was home, but he was still gaining within a normal range and by the second week home he was gaining very well. We dropped the nipple shield a couple of weeks later.

The nurses all said that late-preemies (32-34 weeks on) are very versatile feeders. DO NOT SWEAT ABOUT THE BOTTLES. It will all be OK. My little guy has never heard of nipple confusion. None of these kids have. Breastfeed when you can, keep your supply up, and try to stay sane.

ETA: I think I talked to the hospital's lactation consultants almost every time I visited, picking their brains about pumping, positioning, etc. They were very helpful.

[ShanaV]

All great advice. Just wanted to quickly add that you might bring a bottle / nipple of your own in for the nurses to use -- so he can get used to what you would use at home (of course, in addition to the boob). Another thing we did was the OT printed up instruction and posted them by the babies' beds that said "use only slow flow nipple" etc.

[Phoenix~Mama]

It's so common.  Don't beat yourself up Mama!  The NICU experience is such a hard one. 

I "gave" in too and saw that DS was tiring really fast when we tried BFing, and he would then have to get his feed by gavage, and I just wanted him home, so did the bottles since he did much better with those.  I figured we could figure out BFing once home.

Unfortunately, when we got home, he still did not have a very strong suck and would tire at the breast.  I was so scared of him losing weight and having to go back to the hospital.  I still tried all kinds of things, the nipple shield giving him some of his feed from a bottle first to calm him and then offer the breast... he eventually stopped showing any interest in latching onto the breast at all.  He is almost three months old now and I exclusively pump for him.  I was really hard on myself at first, but we all have to make a decision that works best for us.  The NICU can change plans.  Whatever the outcome is, don't be hard on yourself!  You are doing the best you can and what is the most important in a healthy baby at home snuggled up with his Mama.

[Bokonon]

Originally Posted by justKate 

Oh mama, big hugs to you.  It is awful, and I'm so sorry your DD can't be with you right now. Don't feel bad for "giving in"--of course you feel like you should do anything to get your DD home asap. No one can tell you what would be best, but I say go with what works for now.  I assume you're pumping?  Just keep that up, and keep her latching regularly, and I think you'll be fine.  My DD didn't latch at all until she was released from the NICU (3+ wks), and was EBF thereafter, so it is an option.

That being said, could you talk to the docs/LC/resident about putting in an order re. the nipple to be used when she's bottle fed?  That way at least it would be consistent for her.

Keep us posted, Mama.  This is the hardest part. 

ITA with all this.

My first was in the NICU for 6 weeks and bottle fed EBM once he was taking oral feedings, and I nursed him sporadically.  I was just so afraid he would have bradys and desats while nursing that I felt discouraged.  But he DID latch, and I DID produce, so I knew that once he got home, I could work on getting the two to coincide!  It took a couple of months, but it worked, and he was on the breast for a long time thereafter.

With #2, she was much healthier at birth so her NICU stay wasn't nearly as long, and like you, I just wanted to get her home, and that meant having her gain weight (she literally didn't gain anything for a few days).  So I let her have bottles with EBM, knowing that if I could pull off the transition with DS, I could do it with her too.  It was a little risky, but I had the BTDT confidence and it paid off, fortunately.  She was exclusively breastfed within a week of coming home.

Hang in there - it's SO hard, and the days feel like months, but it will get better and your family will be all together in no time!

[aslmere]

Seriously thank you guys so much!!

I feel so much better.

I do know that it will be okay and chances are good that she will be on the breast 100% before 2 months are up. 

LC and I tried a few times to get her latched correctly, but ultimately we decided that she did need the nipple shield because of the size of her mouth. She was latching ok and then would lift her tongue and push out my nipple. She had good instincts when she was hungry, just poor follow through!

The shield has made a huge difference and she is latching on great and staying and drawing good milk and swallowing. She has come off the last couple times with milk face and it makes me sooo happy!
 

I get so frustrated with the inconsistencies with different nurses. One was really trying to make me feel like it was my fault she was so worn out the other day because I tried to nurse her once!

She did lose a tiny bit of weight that day and so I had a chat with the dr and she told me to keep nursing her TWICE a day and reassured me that as soon as we got home we could still meet with the LC's and add a nursing session every 5 days until we are 100% on the breast.

She was very supportive of me nursing.

I wish I could get more skin to skin time with her though. the nurses each shift are still in charge of that and it gets so frustrating when one is great one day and the next day the nurse is a control freak and will only let me touch her for a half hour total from the start of cares to the end of feed!

It is about getting her strong and home. Dr thinks that if she keeps her current rate of progress up she could be ready to come home end of next week. Of course she added that it could possible be another week after that. I want her home, and home for good so I will try and be patient.

I am still healing and although I feel pretty good most of the time I have no stamina and get exhausted easy. I have had to limit my going to the hospital to twice a day. For the 9 and 3 care/feed times. I nurse BOTH times regardless of what the nurse thinks I should do (thank you dr!!!) And then I go home and sleep :)

So I just realized I am going to have to buy some bottles and nipples soon... which ones are the best? I haven't bought bottles since my now 7 yr old was a baby and I was working pt.

[Bokonon]

Does your NICU give you bottles to pump into?  Mine did (tons of them!), and when my kids were discharged, they also gave disposable nipples that are the same ones they use in the NICU.  The consistency helped.  I found that Gerber nipples fit those bottles just fine, and were the same shape as the hospital ones.  I remember they weren't too easy for me to find, so I just bought the bottle and nipple sets.

[justKate]

Originally Posted by Bokonon 

Does your NICU give you bottles to pump into?  Mine did (tons of them!), and when my kids were discharged, they also gave disposable nipples that are the same ones they use in the NICU.  The consistency helped.  I found that Gerber nipples fit those bottles just fine, and were the same shape as the hospital ones.  I remember they weren't too easy for me to find, so I just bought the bottle and nipple sets.

 Yes!  Ask for a ton of the nipples they're using for her in the NICU.  Find a nice nurse and they should hook you up.  You can order more online if you want--I had to do this because DD did best with the ones she was familiar with.  Surprisingly, the gerber nipples they used in the NICU were really cheap--like $6.00 for a dozen or something on amazon. Not something I could find in stores. Our NICU supplied me with Snappies while i was there and I pumped into them afterwards....

[Phoenix~Mama]

If your hospital doesn't supply bottles/nipples, I found Dr. Brown's bottles with a preemie sized nipple to be the only bottle that worked with DS.  He couldn't get anything out of the Avent bottles I had from DD.

[purplepaisleymama]

I would talk with the ped who is primary for your lo, ask to have any requests that you have and they approve entered into your lo's chart.  If you

want to have more skin time they can make that part of the orders, if you want a certain bottle and nipple that can be on the orders as well.  If you

can pin the doctor down see if they are on the same page as you, you may have more luck with having the doctor order your requests.  When our

5th was in the NICU we had to have many things entered into his chart as orders, they would not let me feed him on demand and some of the nurses

did not even understand the concept of on demand.  I remember all of the times I had to go in and argue with different nurses about what we were

doing in regards to different issues.  There were many times that even though we had orders for all feeds to be at the breast the nurse on would heat

breastmilk from the freezer and I would dump it down the drain.... they were not supportive of nursing... only breastmilk.  From their position it was

much easier for them to be able to control the feeds. 

I hope your little one is home soon... hugs:)

~laura

[aslmere]

Well we have been home for a week now and although not having to go to the hospital is great,, breastfeeding is still not going well.

once in a blue moon she will latch well and actually swallow, but for the most part she gets easily frustrated and falls asleep quickly.

She prefers the quick gratification of the bottle. I am putting her to breast three times a day, but it feels like we aren't making much progress yet.

And my nipples ar sore and red and feel bruised from the pump and I cringe every time I have to pump. I am almost not keeping up, to the point where I had to mix a bottle with formula today to get volume. I just wonder how long I am going to be able to keep this up.

And my husband went back to work monday so I don't have much help with the other two and that makes it hard to pump after every feed.

I am taking her for a weight check on thursday and as long as she is still gaining I am going to add another breast session a day and call and make an appt with the LC.

I just wonder if it is actually going to work out for me this time......

[aslmere]

I really guess it isn't going to work for me this time.

I couldn't pump anything this morning, even though I felt fuller.

Beginning of the end I guess.

I am so sad about this.

I am already pumping at least 8 times a day and taking more milk special blend with goats rue and drinking gallons and eating oatmeal and

I don't know what else to do!

[MsBlack]

Oh mama....

Have you tried contacting La Leche League?  Or a lactation consultant?  Maybe you just need some support, and a little tweaking to bring things 'round. 

sending warm hugs and encouragement!

[samhope]

I just posted this to another q, but seems appropriate here based on what you are going through right now.  First my heart goes out to you.  I highly recommend the Mother Love brand More Milk plus to help increase supply.  It worked better then anything else for me (also did fenugreek and added other lactenogenic foods).  When I felt my son was strong enough for the transition (2 weeks home so 39wks) we just switched cold turkey to a nipple sheild (which he had never successfully used and at that point was completely avoiding).  We did it with doctor's okay (although he wasn't thrilled) as long as my son didn't lose weight.  The first weight he didn;t gain, but didn;t lose either and the second week he gained.  The transition was done:)  I know it sounds drastic, but the breastfeeding relationship was way too important for me to give up on without feeling I had tried everything.  Honestly if after 2 weeks it wasn't working, we would have switched to exclusive pumping till 1 yr. If you need pumping ideas, happy to help:)  A great website is http://www.mobimotherhood.org/MM/article-diet.aspx  Many blessings to you and your little one.  You are doing so much and the situation is just so hard.  Blessings.

[PixieLittle]

You can do it! I have faith in you!

My 35-weeker and I were in the same boat as you a few months ago. It is such a physical and emotional strain - I really didn't think we would make it. However, just taking one day at a time, even one feed at a time, to keep from being overwhelmed was key.

DS was a "lazy" eater and we pumped/bottled until nearly 4 months. I was constantly in fear of not having enough milk. Things that helped us that might help you:

• mixing up the duration of pumping sessions - sometimes I'd have almost no milk after 20 minutes but still feel "full" - going for 30-40 minutes when that happened would get the milk out and reduce the full feeling
• using a nipple shield to help the latch (DS couldn't stay on without it). Any amount of milk they can get from you is fantastic.
• this may not apply to you, but ultimately we had his tongue-tie clipped and he didn't need the nipple shield after to stay latched - maybe ask your doctor about that?
• doing as many "unlimited" nursing sessions in the daytime as you can handle. Sometimes this meant sleepy sucking for nearly 2 hours straight, napping an hour and starting over, and THAT'S OK. Preemies have their own rules.
• letting DH help you by giving pumped milk in the bottle while you pump and then nap - THAT'S OK TOO - you need rest, too.
• sometimes you will run out of stashed milk and the baby still seems hungry. This is so stressful, and the guilt and feeling of inadequacy is awful. But it's one feeding. In those cases we mixed a bottle of formula, and I pumped more milk for the next feeding. Sometimes it turns out that they only needed a few sips of formula and were really just overtired.

Some of it is a waiting game. Your baby needs to get bigger/stronger and that will only come with time. Just get through one more day.

You are so strong to have done so much already. Your little one is lucky to have you!

[aslmere]

Little girl is stubborn and refuses to nurse. I can get her to latch maybe once a day and she will suck for 5 minutes (almost exactly) each time and then refuse to get near my breast again.

I am feeling rejected...

frustrated, sad, overworked

I am still pumping and I will for as long as I can...taking it one day at a time. I am not keeping up with her, and due to family situation can't dedicate as much time as I need to build a bigger supply.

DH wants me to just stop altogether, but I cant feel good about that. I have to pump as long as I can.

I didn't even think this was a possibility...

it sucks.

I hate pumping, I hate washing bottles, I hate having to get out of bed!

Pumping really sucks. It takes a long time before the milk starts and I definately don't produce much for the pump. And it hurts!

I just want to nurse my little girl.

[samhope]

It is okay if this isn't right for you, but an appointment with a lactation consultant with your pump might help.  I switched to larger falanges (sp?) and that made a big difference comfort wise.  I also only pumped for 7min on each side and never at a setting which hurt.  I did pump every 2 hours though around the clock (same as baby's feeding schedule).  Other tricks for pumping are smelling your baby, massaging your breast, and using nipple stimulation 9can google techniques).  Whatever you decide your baby will be fine and loved.  Hugs mama.

[Phoenix~Mama]

Don't beat yourself up.  Do not feel like a failure.  You HAVE BEEN KICKING ASS to pump and keep up! 

This won't be popular opinion... but I know I was there... and I was tired of everyone making me feel like a heathen, because I was slowly starting to pump less and less, because DS refused to nurse, and I just could not keep up.  I was going out of my mind from no sleep and anxiety of fitting in pumping while trying to care for two little ones.

DS went to full formula last week.  I battled depression and SERIOUS Mama guilt over it and kept pushing and pushing... until I just couldn't do it anymore.

So please.  Be gentle with yourself.  Not everyone is given the best circumstances to work with.  *hugs*  It's OKAY to do what is best for your sanity, and a more sane and happy Mama is ultimately the BEST for your baby.  *hugs*