Premie Not at Breast yet, how do i help them learn and transition? UPDATE: suscess in 1st step...

[~Adorkable~]

i have newborn twins 36 weekers (my first children, first time nursing), currently 1 week old. after loosing quite a bit of weight the first few days they are now just barely starting to gain weight again and are hovering just below and above 5lbs we have been home now for a few days

they thankfully are drinking but not from my breasts, i am also thankfully pumping really well, i dont seem to have any supply issues, though i have no idea if my rate of flow is normal or how different it is with a babe rather than a pump. I dont seem to get a classic feeling of let down, but am getting 8 oz out of each breast in a pumping, so something is working.

the two parts of the system that seems to be the breakdown is

• 
  
• 
  them opening up their mouths large enough or long enough to let me get my nipple in there, 
• 
  
• 
  and when on the slightly larger of the two do manage to get it in his mouth, i dont think he gets milk fast enough to encourage him to stay on. he sucks for a 2 or 3 sucks and then goes slack and i slip out.
• 
  

so currently we are using bottles , for the first 2 days i was finger feeding hoping to avoid bottles and the issues with that. but we just could not get enough in them and they were really dropping weight. so we are on bottles and so desperately want to get to the breast. 

So my questions are

• 
  
• 
  how do i encourage them to open their mouths wider, i feel like i have done all the normal things, maybe not?
• 
  
• 
  how do i keep them on as they learn to hold their latch? my nipples are just not long enough to stay in once they are all wet.
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  what things can i do while they are still getting bottles of my milk to help them make a most useful transition to my breast?   
• 
  

i would love to hear what has worked for others that have maybe gone thru similar things 

mods, if this should be elsewhere, im sorry, please move if you feel like it

Edited by ~Adorkable~ - 1/5/11 at 9:53pm

[NP2B]

I don't have any advice, just wanted to say that I'm in a similar situation.  My twin girls are about the same gestational age as yours.  (My EDD was 1/21, but they were born 6 wks early)  They were 3 lbs 14 oz and 4 lbs 9 oz.  I cannot get the smaller one to open her mouth big enough to latch on.  I keep hoping it will get better as we get closer to their due date, but I'm concerned that she is learning bad habits from the bottle. 

[~Adorkable~]

Well get thru this together how about? You were due only 3 days before me.
Have you seen day to day changes or improvement in them giving better hunger cues or better rooting? What size are your now? Mine are 4lb11oz and 5lb 2oz as of Sat.

One really great nicu doc that I really adored visited me a few times and talked me down off my ledge about using a bottle, he was soooooo pro breast it felt better to hear it from him. He mentioned that he felt babies did really show huge learning leaps when they got to whatever would have been term, for twins he felt that happened between 37 and 38 weeks, so we are both getting close!

[mixplatemommy]

i dont have twins, but with my firstborn, i had latching problems after the milk came in. i started pumping to relieve the engorgement, and then got into a vicious cycle of bottle feeding, which caused me some serioud PPD... but thankfully i have a strong support system. my friend who had a preemie used a nipple shield (a silicone nipple sheath that u can put over your own breast to give your nipple some length as well as protection - medela makes em). she was able to latch on to it almost immediately! we used it exclusively for a little while, then i started taking it off after she'd established a good latch, and offer her my breast alone... sometime it worked, sometimes not, but by the time she was 1month old, she had the whole nursing dance down, and was able to happily nurse on just my breast all the way into toddlerhood :) good luck mama!

[MeepyCat]

I don't have twins, but I did have a baby in the NICU, so I know *something*...  well, sometimes.  This is probably more encouragement than advice.

Eight ounces per breast per session is *awesome*.  Mama, that is some hardcore output.  It's great that you are pumping so well.

My DD was born at 32 weeks, and was in the NICU for 32 days.  There were days when I was sure that she'd be on nothing but the breast *tomorrow*, and days when I was ready to chuck it and exclusively pump.  You can expect some roller coaster on this. 

Don't worry if you go home from the hospital using a lot of bottles - breast feeding often goes better when you are in your own home, with all the comfort and privacy you can have in your own space.  (And feel free to arrange more comfort!  The thing I didn't have when I was pumping that I really wanted?  One of those mini-fridge/microwave combos for my bedroom - I could have stored freshly pumped milk and sterilized parts without staggering downstairs, and I could have kept a stash of snacks.  I realize that this doesn't sound like it's about breast feeding at all, but it is!  Really!  Self-care is so important, and nursing can leave you tired and *hungry*.)

Nipple shields might help, and time might as well.  As the babies get more vigorous, they will get better at this. 

[LM96]

I was going to suggest maybe a nipple shield also--is there an LC you can work with?  Does the NICU have someone to help?  Our NICU has an Occupational Therapist on staff and that is who I would call first to try and find resources if needed.  Also, I don't know if this is different for late-term preemies, but our NICU encouraged use of the Soothie pacifier to help my preemies learn to suck.

8oz per breast is awesome output!  As a reference, I pumped 8oz total in the morning (after not pumping all night) and then 3-5oz total each time throughout the day.  Also, just as an FYI, I never felt a letdown until DS came home.

I've also heard that things often "click" for babies once they reach their due dates so hopefully that will also make a difference for you!

[Kaydove]

Hi Adorkable! Beautiful babies!

I learned that in my Postpartum Doula classes that bottles with a wide base and slow drip are the most helpful for transitioning between bottle and breasts. Avent bottles are supposed to be really helpful because its shaped similar to a breast nipple and the baby controls the milk flow in the bottle just like in a breast. Here's a link to their site with some more info. Sounds to me like learning to control the milk flow is Daxton's issue? Not sure if that helps but had to mention it.

The other thing that might be helpful is watching a few breastfeeding videos. Here's a link from Dr. Jack Newman's website who's a renowned doctor and author on breastfeeding. (His books are on my required Doula reading lists.) This page on breast compression during a feeding session, to help with milk flow into baby's mouth, might be really helpful for you.

I hope that info helps and that you're enjoying new being a new mommy!

[~Adorkable~]

Originally Posted by mixplatemommy 

 my friend who had a preemie used a nipple shield (a silicone nipple sheath that u can put over your own breast to give your nipple some length as well as protection - medela makes em). she was able to latch on to it almost immediately! we used it exclusively for a little while, then i started taking it off after she'd established a good latch, and offer her my breast alone... sometime it worked, sometimes not, but by the time she was 1month old, she had the whole nursing dance down, and was able to happily nurse on just my breast all the way into toddlerhood :) good luck mama!

thankfully i do have a great support system and a lot of help right now, my dh is so wonderful with it all and bringing me stuff while i pump and deal with things and my mom is here to deal with a lot of the house to lighten our load.

thanks for the info on the shields i had seen those in the store and thought they might be just the gateway step we needed, im going to go get a pair ASAP today and work towards them.

 

Originally Posted by MeepyCat 

This is probably more encouragement than advice.

Eight ounces per breast per session is *awesome*.  Mama, that is some hardcore output.  It's great that you are pumping so well.

You can expect some roller coaster on this. 

I realize that this doesn't sound like it's about breast feeding at all, but it is!  Really!  Self-care is so important, and nursing can leave you tired and *hungry*.)

encouragement is such a big part of why we all come to MDC, thanks for it!

yeah i had breast surgery about 15 years ago so i have been terrified that i would have low supply, boy i dont think that is ever going to be an issue! i do need to pup more often though i think i go too long between pumpings, might as well have way to much right now and have them grow into it, then ever have to catch up with them

self care is huge, i have bought a few things that seemed like luxury items, but if they make even a few minutes of our day smoother and more relaxing then with all i have on my hangs it is definitely worth it!
 

Originally Posted by LM96 

I was going to suggest maybe a nipple shield also--is there an LC you can work with?  Does the NICU have someone to help?  Our NICU has an Occupational Therapist on staff and that is who I would call first to try and find resources if needed.  Also, I don't know if this is different for late-term preemies, but our NICU encouraged use of the Soothie pacifier to help my preemies learn to suck.

8oz per breast is awesome output!  As a reference, I pumped 8oz total in the morning (after not pumping all night) and then 3-5oz total each time throughout the day.  Also, just as an FYI, I never felt a letdown until DS came home.

I've also heard that things often "click" for babies once they reach their due dates so hopefully that will also make a difference for you!

im so glad we had no NICU time, that kind of stress is so much more than i am having, hugs to those that do deal with that.

while we were in the hospital (mostly regualr post pardum wing) we did have a nicu doc overseeing us and he was super amamzing and super pro breast and everything we are doing up till now and that susess has been duw in large part to him and his dedicatin to talking with us.

he said no paci, since they do have sucking down well, heck they can nearly pull a finger nail off when i let them suck on my finger, its just getting something in there to trigger them to start that is catching us up.

they sent me a LC but she was gruff and told me a few things i knew not to be true, so it kinda undermined my trust in her, but she is hte one that talk me how to finger feed the first day, so i thank her for that. i am going to call the main LC there now and set us a follow up with her, i have spoken with her before giving birth and she seems like a angel!

thanks for the info about your let down, i feel ok about it since i seem to get so much, but i was wondering.


 

Originally Posted by Kaydove 

Hi Adorkable! Beautiful babies!

I learned that in my Postpartum Doula classes that bottles with a wide base and slow drip are the most helpful for transitioning between bottle and breasts. Avent bottles are supposed to be really helpful because its shaped similar to a breast nipple and the baby controls the milk flow in the bottle just like in a breast. Here's a link to their site with some more info. Sounds to me like learning to control the milk flow is Daxton's issue? Not sure if that helps but had to mention it.

The other thing that might be helpful is watching a few breastfeeding videos. Here's a link from Dr. Jack Newman's website who's a renowned doctor and author on breastfeeding. (His books are on my required Doula reading lists.) This page on breast compression during a feeding session, to help with milk flow into baby's mouth, might be really helpful for you.

I hope that info helps and that you're enjoying new being a new mommy!

thanks for the links, of tp read them in a sec. yeah the nicu doc said the same thing about the nipple and we are using dr browns wide base for that reason, he also mentioned that advent as well but i liked the vent system in the dr browns so went that route, since i have a medela pump (hospital grade rental) i had no other reason to lean towards the advent for compatibility.

oh and thank you for reminding me about breast compression, i've been doing it to relive my lumpyness while pumping but kinda forgot it might get milk into there mouths in a more inspiring way as well.

Kaydove, i just want to hug you and say thank you for coming on and responding. im so glad to see you on mdc again and started crying when i saw your post (hormones are strange) all the love in the world for you and your dh

[Asiago]

Congratulations!

Skin to skin contact encourages latch on also.

Baby's senses are stimulated and therefore quietly alert. Also wearing your twins and having them in close proximity to your breasts encourages frequent feeding throughout the day. Gentlle motion such as bouncing, dancing and swaying also encourages latch and feeding.

 If you google twin/ tandem babywearing you'll find info rearding wearing two babies.

Best wishes!

[NP2B]

Originally Posted by ~Adorkable~ 

Well get thru this together how about? You were due only 3 days before me.
Have you seen day to day changes or improvement in them giving better hunger cues or better rooting? What size are your now? Mine are 4lb11oz and 5lb 2oz as of Sat.
 

The bigger baby (E) seems to have gotten then hang of breastfeeding.   She was 4 lbs 14 oz at her last checkup (almost 2 weeks ago).  The smaller baby (A) was 4 lbs 6 oz at her last checkup. 

I try several times a day to get A to latch on, but it is so difficult and time consuming.  She doesn't open her mouth very wide.  The LC told us to come back for a visit closer to their due date if she doesn't get the hang of it. 

[~Adorkable~]

played with the nipple shield thingy today, i think it will work i got my boy to nurse on it for a bit, but i dont really see how i am supposed to get my nipple a bit farther into it, does anyone know how far my nipple should go in? im surprised that there is no picture or diagram for proper positioning.

[elus0814]

I've had babies at 34 weeks, 32, 35 5d, and 36. All of them nursed from just a few moments after birth and never had a problem nursing. I will say that the nipple doesn't go in very far just because their mouth is so small. I did, however, use a supplemental nursing system for a couple days to give extra pumped milk to my 32 weeker when his weight stagnated. They wanted to give him milk fortifier but I refused - they didn't even ask me, I found the open box on his isolette and told the doctor no. Watch out for things like that, they will not ask you or even tell you important things like that, they just do it. Be there as much as you possibly can, the nicu my first two kids were in had a couple rooms parents could stay in overnight. They would just wake me up to nurse. My 34 weeker never once had a bottle. The 32 weeker only had a few when I had to go home to be with the first. The other two were never in the nicu. I think a SNS would be best, the baby will still be nursing but will get a bit extra if they get tired and are unable to nurse long enough. Nurse a few minutes first without it then add it. The nicu might have some to give you but you can buy one yourself, they are about $50 if you have to go that route. You can also try expressing or pumping a minute or two first which will mean the baby will not have to stimulate the let down themself plus they will be getting the higher calorie hindmilk.

[~Adorkable~]

I guess I have not made it clear in the first post, I am not in the NICU, we are home after 4 days in normal postpartum rooms. They are "late term premie and although they worried and " threatened to take them to the nicu if I did not gett some type of feeding system in place,( that's why we finally went to bottles)
We have now been home for almost a week.

[lalemma]

We didn't have twins, but I did have a pretty little preemie (under 4 pounds), and I have huge boobs. I remember well the weird feeling of his tiny mouth and my giant boob - it was so daunting! You've gotten great advice, but two things that worked for us:

The LC taught me to wait for him to open wiiiiide before pulling him onto the nipple. I also learned that thing where you push on their chin a little bit to get them to open up, and then pulling them onto the nipple, but I found it easier to wait for him to root and open wide by himself.

Second, nipple shields. I know some people are pretty down on them, but we had no downsides and they made direct-from-the-boob eating possible when he was very small and his mouth just wasn't big or strong enough to keep my nipple elongated. We weaned off of them after a few weeks. It was fine. I would totally do it again! Anything that made it possible to breastfeed instead of the extra step of pumping and then feeding from a bottle was a sanity saver for us.

How are you using the nipple shield? To be graphic, the NICU nurses taught me to, uh, "perk up" my nipple, wet the nipple shield (on the inside, where it touches your skin) and put it on. It should almost vacuum onto your boob. The nipple won't be all the way to the end. I think it helps the baby by compressing your nipple into a manageable size (when their mouths aren't yet strong enough to do that themselves), and because milk pools in the empty end, so there's always some milk there. Also, I would hand-express a few drops first, so it was right there when he started sucking.

Congratulations on your little ones!

[Kaydove]

Originally Posted by Kaydove 

Hi Adorkable! Beautiful babies!

I learned that in my Postpartum Doula classes that bottles with a wide base and slow drip are the most helpful for transitioning between bottle and breasts. Avent bottles are supposed to be really helpful because its shaped similar to a breast nipple and the baby controls the milk flow in the bottle just like in a breast. Here's a link to their site with some more info. Sounds to me like learning to control the milk flow is Daxton's issue? Not sure if that helps but had to mention it.

The other thing that might be helpful is watching a few breastfeeding videos. Here's a link from Dr. Jack Newman's website who's a renowned doctor and author on breastfeeding. (His books are on my required Doula reading lists.) This page on breast compression during a feeding session, to help with milk flow into baby's mouth, might be really helpful for you.

I hope that info helps and that you're enjoying new being a new mommy!

thanks for the links, of tp read them in a sec. yeah the nicu doc said the same thing about the nipple and we are using dr browns wide base for that reason, he also mentioned that advent as well but i liked the vent system in the dr browns so went that route, since i have a medela pump (hospital grade rental) i had no other reason to lean towards the advent for compatibility.

oh and thank you for reminding me about breast compression, i've been doing it to relive my lumpyness while pumping but kinda forgot it might get milk into there mouths in a more inspiring way as well.

Kaydove, i just want to hug you and say thank you for coming on and responding. im so glad to see you on mdc again and started crying when i saw your post (hormones are strange) all the love in the world for you and your dh

I was thinking after I posted this, that it doesn't really matter so much what type of bottle because its the nipple that matters. So its sounds like you're all set.

I hope the breast compression helps. Its sounds like the nipple shields might work!

Mdc has been so helpful and I'm so glad you told me about it. Its made such a difference this past month. :)

Give a hug to your DH, kisses for the babes. All the love for you guys!

[~Adorkable~]

so my boy had latched on 3 times today, usually for less than 5 minutes and he seems to get pretty tired, but each time has been a bit longer, and he is clearly getting milk, who knows how much. i guess this is where the measuring ends and the on demand/ intuition starts...

im going to start working on my daughter tomorrow
 

Originally Posted by lalemma 
 You've gotten great advice, but two things that worked for us:

The LC taught me to wait for him to open wiiiiide before pulling him onto the nipple. I also learned that thing where you push on their chin a little bit to get them to open up, and then pulling them onto the nipple, but I found it easier to wait for him to root and open wide by himself.

Second, nipple shields. I know some people are pretty down on them, but we had no downsides and they made direct-from-the-boob eating possible when he was very small and his mouth just wasn't big or strong enough to keep my nipple elongated. We weaned off of them after a few weeks. It was fine.

How are you using the nipple shield? To be graphic, the NICU nurses taught me to, uh, "perk up" my nipple, wet the nipple shield (on the inside, where it touches your skin) and put it on. It should almost vacuum onto your boob. The nipple won't be all the way to the end.

yeah my boobs are so large right now (not small to begin with) i think they weigh more than my babies!  i am sold on the nipple shield, i see how they could be a crutch, but for us they are doing just what we needed. he seems to need to feel something and have a goal before he really ever opens wide enough and i just dont have enough hands to hold him, my boob and direct the nipple in a mouth that usually clamps down too fast the moment something hits his gums. but with the shield i can get it in fast enough it seems to work. it also stay in during his frequent rest periods while on the boob without it slipping out.

yeah i am perking up as well, kinda a must do. i wish somewhere in the instructions it would mention that my nipple would not go to the end, it was driving me nuts trying to make it and not until i went online looking everywhere did i read that there was always going to be some air space.  i wonder how much more gas bubbles this causes?

Originally Posted by Kaydove 

Originally Posted by Kaydove 

Hi Adorkable! Beautiful babies!

I learned that in my Postpartum Doula classes that bottles with a wide base and slow drip are the most helpful for transitioning between bottle and breasts. Avent bottles are supposed to be really helpful because its shaped similar to a breast nipple and the baby controls the milk flow in the bottle just like in a breast. Here's a link to their site with some more info. Sounds to me like learning to control the milk flow is Daxton's issue? Not sure if that helps but had to mention it.

The other thing that might be helpful is watching a few breastfeeding videos. Here's a link from Dr. Jack Newman's website who's a renowned doctor and author on breastfeeding. (His books are on my required Doula reading lists.) This page on breast compression during a feeding session, to help with milk flow into baby's mouth, might be really helpful for you.

I hope that info helps and that you're enjoying new being a new mommy!

thanks for the links, of tp read them in a sec. yeah the nicu doc said the same thing about the nipple and we are using dr browns wide base for that reason, he also mentioned that advent as well but i liked the vent system in the dr browns so went that route, since i have a medela pump (hospital grade rental) i had no other reason to lean towards the advent for compatibility.

oh and thank you for reminding me about breast compression, i've been doing it to relive my lumpyness while pumping but kinda forgot it might get milk into there mouths in a more inspiring way as well.

Kaydove, i just want to hug you and say thank you for coming on and responding. im so glad to see you on mdc again and started crying when i saw your post (hormones are strange) all the love in the world for you and your dh

I was thinking after I posted this, that it doesn't really matter so much what type of bottle because its the nipple that matters. So its sounds like you're all set.

I hope the breast compression helps. Its sounds like the nipple shields might work!

Mdc has been so helpful and I'm so glad you told me about it. Its made such a difference this past month. :)

Give a hug to your DH, kisses for the babes. All the love for you guys!

sadly the bottle im using because it has such a wide base, only fits on its own bottles, i kinda hate how each brand locks you into buying a lot of their stuff and then never wanting to change over and start again. mine i think still flows too fast, it has one step down, but not in the wide base shape, so that is irritating.

breast compressions have really made the difference with the nipple shield, he needs to get some milk pretty fast to keep inspired, so i was slipping a syringe tube in there at the very beginning and then doing a lot of compressions for the rest of the time.

im so glad MDC had been able to be there for you, we are here as well, love and warm thoughts...

[~Adorkable~]

After an amazing string of sucess last night and this morning where my boy latched on and nursed 3 times, I let my smaller daughter give it a go. Wow she was a champ, seemed to give me a look while she sucked away like " what's all the fuss about, this is great!" and has nursed twice this morning!

The shield is working wonders and compressions are still a must to keep them focused and rewarded for all the effort. They clearly seem tired after their short sessions, but they are getting longer so I have all the thrilled confidence in te world that things are moving right along,

thanks ladies, your advice and support as always has been great.

They would have been 37w4d if born today, getting closer to that full term age, so it is nice to see that what folks have said about them figuring it out around then is probably very true.

I now have a lot of questions on how to balance short nursing sessions with bottles and pumping to keep a stash and relive my engorged breast and keep supply high. But since I feel these issues are more general and other folks can benefit from the talk I will post something in the general breastfeeding area.

Thanks again.

[indymom82]

I was going to suggest a nipple shield too, just to get them transitioned from bottle to breast.  A lot of moms of preemies use them until their babies mouths get a little bigger and can stay latched on correctly for long periods of time.  I used a nipple shield for the full year I breastfed my first son and am on the same track with my second (8 months old) since I have inverted nipples.  It is possible to wean off, I just never had the patience for it, and since my milk supply was fine I just let them use the shield :).  When I occasionally try to feed my 8 month old without it he just look at me like, "no, really...where's the nipple?".  So I just use the shield every time :)  I use the Medela brand - they seem to be the most popular based on what I've heard from other moms.  There is also a case that I have to keep mine in called a Shield Shell.  I have one for each shield and I keep one in my diaper bag and a couple around the house where I nurse most often.  They are great because they keep my shields clean, and they are easier to find since they are brightly colored vs. the clear silicone shield!  They also stay safe from my dog and two-year-old, so the shields don't get chewed up or lost.  I ordered mine at www.shieldshell.com.

[~Adorkable~]

hahaha those are rebranded retainer cases that orthodontists use!!!  i so remember have them!

but yeah they definitely need a case, i was looking around for this one  but it seems like it is usually just offered outside the country, too much hassle for something that i hope to stop using very soon.

i have a retainer case laying around somewhere, im going to go dig it out and use that!

oh and i got them tandem nursing for just a sec tonight, that was a bit too much logistics wise, i will have to wait till i stop with the shields i think, just not enough hands

[Ky-Momma]

I have not had multiples, but I have had three preemies, 32wk, 34wk and 35 wk and with the two earliest ones, they definitely were just plain too weak to nurse at first.  I used an SNS from Medela and when absolutely needed a break we used BreastFlow bottles.  They have a two nipple system which requires the baby to work the tongue and jaw muscles like when they are nursing rather than just sucking, like a normal bottle which can cause bad habits.  The closer we got to their respective due dates, the better they got and with both just after their due date they were 100 percent on the breast and stayed that way beyond infancy.

It sounds like you are on the right track.  It really will get better the larger and stronger they get. :)

Oh, and the nipple shield really helped our 32weeker but my DD (34wk) wouldn't touch the thing.  Weird girl, that one. :)  Good luck mama!