Transitioning a preemie from bottle to breast

[LM96]

My son was born at 30weeks, 6days and is getting ready to come home.  All we are waiting on is for him to take all of his feeds by bottle which could be any time now.  I'm wondering what is the best way to transition him to breast once he comes home.  He has latched on successfully at the hospital but we have only been able to do 3 or 4 nursing sessions due to logistics.  Yesterday, I nursed him and he did great for about 7 minutes then was too sleepy to latch on well and we finished off with a bottle feeding.  He took about 30mL from the bottle and then whatever he got from me (his nurse marked him as a full feed, 45mL, since we know he did get some milk before the bottle--yay for a breastfeeding friendly NICU!).

Anyway, I'm wondering if I should just offer the breast every 3rd feeding or so and then "top him off" if he doesn't do a very long nursing session or if I should just let him nurse however long he wants and then offer a bottle at his next feeding.  He would have been 36 weeks on Dec 26, so if he comes home in the next few days I expect he will still be pretty sleepy.

My daughter was a preemie also and we were able to transition completely, but I don't remember quite how we did it!  Plus she was over 37 weeks when she came home.

[MeepyCat]

Remember that once you're home you don't have to stick to the feeding schedule!  You can offer the breast whenever you want.  You can lie in bed (older child permitting) with the baby at your side and your shirt off.  This was how we transitioned - we hung around.  I put her on the breast anytime she seemed vaguely interested, and a few times a day she also got fortified breast milk in bottles.  I took an insulated bag with a few bottles and an ice pack upstairs with me every night, and I nursed her and offered bottles when that wasn't working, and after about three weeks, I was bringing the same number of full bottles downstairs in the morning as I took upstairs at night.  It was pretty much all downhill from there.

[Mrs-Mama]

Originally Posted by MeepyCat 

Remember that once you're home you don't have to stick to the feeding schedule!  You can offer the breast whenever you want.   

When DS came home (born at 32w4d, hospital for 20 days), I offered the breast at every feed, then pumped while DH gave him a bottle of EBM (or I would give him a bottle and then pump).  Sometimes he would act very frustrated and mad if I tried to nurse him, so we would go straight to the bottle occasionally.  During the night, I did not try to nurse...just bottle-fed and pumped.  I felt like I needed my sleep for the sake of my milk supply.  We nursed a lot...not at all on the 3 hour schedule, but at the beginning, we did make sure that he got at least one bottle-feed per 3 hours.  After 3 weeks we were completely on the breast, even at night.  He just started taking more and more and was less and less interested in bottles.  We had plenty of dr appts to verify weight gain, so that was reassuring.

[Siera]

Same thing here.  Once DD came home, we co-slept (night and day!) and that's what did it.  Just being around the breast 24/7 was enough to get her to give up the bottle completely. 

[marzipan84]

I've been home with my preemie for almost 2 weeks now. He was born at 33 weka and came home at 36 weeks. My plan was to offer breast at every feeding that he was awake enough to be interested. I've had to use a nipple shield due to various circumstances. While we were in he hospital he wouldn't suck hard enough to get any milk out so we decided to exclusively bottle feed him until we got home. Once we were home it was about day two that I decided I was going to only offer the breast all afternoon. Once he was got a full feeding from the breast he quit taking the bottles at all. Even at night he would slurp air when we tried to bottle feed him. My son decided on his own that he would exclusively breastfeed. It's been great except that now he trying to use me as a pacifier...chewing and light sucking, not drawing milk. Now I'm trying to put a stop to that because it hurts too much. He's also rejected his binkys in preference to breastfeeding. Never thought nipple confusion would go this direction.

[ShanaV]

My babies were born at 30 w 5 d, so just a day shy of yours ((hugs)).  It is NOT easy. Just as a comparison, they were in the NICU for 6 weeks (42 days and 45 days), and they spent the last 3 weeks on the "take all of our feedings orally" roller coaster. Some days were great, then they'd have an apnea spell and would be set back, over and over and over again. Nursing for about 7 mins and then taking the rest by bottle sounds familiar. In the NICU we would nurse for like 6 to 20 minutes before they fell asleep, then do bottles.

They wouldn't BF on the boob either, needed a nipple shield. So you've got that going for you! So when we came home we did most feeding by nursing with the shield, I'd also pump and give them that from a bottle a few times a day in order to induce food coma so we could all get a little sleep. It was exhausting. I didn't plan out which feedings I'd do by bottle or by boob, I just went with whatever worked at the moment. As others have said, you could probably offer the boob as much as you want and just top off with bottles every few times to make sure he takes in a good amount some times. Best of luck mama!!

[LM96]

Thanks for the tips!  He came home on Christmas Eve and right now I have 2 feedings at the breast and then the rest are bottle.  I need to make a pediatrician appt for early this week (the holiday has made scheduling a bit difficult!) and I will see how he is doing with his weight and then I plan on adding more breastfeeding sessions and dropping bottle feedings.  Plenty of wet/dirty diapers, so that is fine.  Because of Christmas and 2 older kids, I couldn't completely "check out" and spend a few days in bed, but now things will settle down.  DS is pretty sleepy still, so we are keeping to a schedule--mostly because sometimes I need to wake him up to eat.  

Surprisingly, it's actually a bit less daunting now that he is home and we have had some successful nursing sessions.  It feels like it is just a matter of time before the bottles are gone.  :)

[Mrs-Mama]

Keep up the good work!  I can't imagine doing all I did with DS and having older children to care for.  He was our first, so much easier to just focus on him.  Sounds like things are moving in the right direction.  Yay!

[samhope]

My son was born at 34 weeks and was in the nicu for 21 days.  When they released him it was on the grounds that I promise to bottle feed (easy flow nipple) after offering the breast at every feed or they were going to keep him for another week.  After he was home for 2 wks (so 39 wks) and not latching at all anymore (so frustrating!), I decided he was strong enough to stop with the bottle all together (after being given the advice by a former nicu nurse turned pre/post-natal yoga teacher).  I did it with the pediatricians okay as long as I weighed my son and he did not lose any weight.  The first week was challenging and he didn't gain, but didn't lose either.  The second week he gained and the transition was done.  He used a nipple sheild exclusively until he was 5mo and now is still bfing at 27mo:)  Hope you have an easier time, but what I did worked and I feel was worth it in the long run.

[mipsy6]

I just wanted to throw in my experience and tell you not to get discouraged if you get off to a slow start with breastfeeding. My 23-week preemie came home at 38 weeks, and at first we didn't do much breast feeding because he was still so sleepy and we had to give him medications and fortify bottles of EBM. And, to be honest, he just wasn't good at it and I was so stressed about him gaining weight and getting nutrition. BUT, over time we just worked in more and more breast feeds, and he eventually really took to it. It took maybe a month or so, and then he was drinking happily and is now a total champ at draining both breasts in record time. It helps that we don't have to give him those medicines or fortify anymore, but I mainly think it was just a matter of him getting bigger and stronger. So if things aren't going well at first, don't despair. It's quite possible that your preemie just needs some time and then he'll get great at BFing.

[liz-hippymom]

i got willow (born 31 weeks) off the bottle a week after coming home- i used a scale for test weighs (rented)and an SNS. she was too sleepy to get it all by breast without the help of the sns. we used the sns for about 3 weeks. now she is 4 months old and loves her boob, and has no idea what to do with a bottle!

[LM96]

I'm happy to report that we are exclusively breastfeeding now!  We had a bit of a hiccup when DS caught a cold about 2 weeks after he came home and bottles were a bit easier for him to drink from, but after he got over his cold, his ped gave us the go ahead to drop them completely.  Woohoo!

He is 1 week adjusted now and doing great with breastfeeding so I am pretty happy about that.  So much easier to just "plug him in" than deal with the pump and bottles!

I think it took us about 1 month to completely make the transition, so not too long in the grand scheme of things.

[star*mora]

what a champ! that's great - my former 33+6 took 12wks to get from exclusively pumped milk to the breast and self weaned just before i had ds2 (a later preem at 36wks). but it took him 12wks so one month is really so great!! congrats to you both!!
 

Originally Posted by LM96 

I'm happy to report that we are exclusively breastfeeding now!  We had a bit of a hiccup when DS caught a cold about 2 weeks after he came home and bottles were a bit easier for him to drink from, but after he got over his cold, his ped gave us the go ahead to drop them completely.  Woohoo!

He is 1 week adjusted now and doing great with breastfeeding so I am pretty happy about that.  So much easier to just "plug him in" than deal with the pump and bottles!

I think it took us about 1 month to completely make the transition, so not too long in the grand scheme of things.