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Preemie won't nurse, nor wake up for the bottle

post #1 of 18
Thread Starter 

Posting on behalf of a friend. I do think her situation is challenging enough for this forum, if it's not, please move as appropriate.

 

My friend finally brought home her preemie after a harrowing tale of years of losses, infertility, surgery for Asherman's, PCOS, Hashimoto's, blood-clotting factor issues, myomas, hormonal issues, an ultra-complicated pregnancy, you name it, she had it.

 

Due to intrauterine growth restriction (it's not really known what caused this, they thought she had gestational diabetes and had her on insulin and metformin, then thought she didn't and took her off again, now they think it may have been left-over scarring from her Asherman's), her daughter was delivered some three weeks early at just over 2000 g/4.4 lb (due date is next Tuesday or so) via CS. They spent two weeks in the NICU because she wasn't breathing at first and not drinking properly. She was released with about 2400 g/5.3 lb and drinking so-so from the bottle (between 60 and 90 ml, about 2-3 oz), and occasionally getting something like 30g (1 oz) into her after prolonged nursing sessions with nipple shields.

 

My friend's been exhausted for years and now breastfeeding isn't working either! Though she says at least pumping is going well for now, so that's one cause for cheer. However, she's got a gem of a midwife who is giving out dire warnings her that if she won't nurse as well as pump her milk will be dried up by six weeks and who told her to switch from the easy-flow nipples they used in the NICU to a hard-work nipple from Medela because "it's your job to teach your child now that you have to fight for everything in life otherwise your child will end up one of those *sshole children". However, the baby has to be woken for every feeding session, will fall asleep at the breast if interested at all, and seems unable to drink enough from the bottle when she uses the Medela nipple, falling asleep exhausted again or scream (she will drink more if she uses the easy-flow nipple which the midwife has prohibited her to use is it will supposedly cause nipple confusion).

 

My friend is so tense now about nursing that she had to take a break from trying for 24 h because she couldn't take it any more. I told her to fire her midwife and find someone who can actually reassure her about things and help her relax but I do not think she's got the energy!

 

I did some research for her on kellymom and this is what I've found and relayed so far in the way of advice:

Lots of skin to skin

Just put her to the breast as often as possible, but without the pressure of her having to nurse, just having her close, sniffing the breast or taking it into her mouth is fine for now

try feeding with a syringe or cup rather than the bottle

use nipple shields if they work, for as long as she needs them, preemies do

 

Stuff that I came up with:

Drink Weleda breastfeeding tea, have some alcohol free beer or a glass of champaign to help her relax and keep production up

Feed her every four (eta I've passed on posters advice: 1-3 )hours, making sure she's taking in a real meal. I think she's still just too exhausted to nurse, or suck hard from a Medela nipple, and should be fed for now with an easy-flow nipple, just to get her to gain (my experience with my preemie was that as soon as he was strong enough, he nursed like a champ, and before that all those tricks like massage here and stroke there and put EBM in the nipple shield and pump before or pump after or whatever were totally useless).

Don't worry about milk drying up.

 

Can anyone help? Any and all advice much appreciated, and please tell me if you think I came up with total BS on my own!


Edited by Tigerle - 11/21/11 at 1:06pm
post #2 of 18

Yes all of that! Also, oatmeal is good to keep production up. If she is pumping as often as she should be feeding, every 2-3 hours or so, I wouldnt worry about the supply right now. Baby needs to be eating every 1-3 hours on cue if possible (kellymom has great information about hunger signs), 4 hours between meals is too long at this age, especially considering the complications. If she could pump wile trying to nurse baby (she will need extra hands for this now, maybe a pumping bra?) that will help with output and help get the letdowns going faster so baby doesnt get frustrated waiting for it. Her mw sounds like an idiot... :( I definately second firing her and maybe attending a La Leche League meeting if possible...news flash, baby is already nipple confused, and as you mentioned, babies tend to get better as tey get stronger so just feed the baby!

 

Get naked from the waist up and take that baby to bed, all the cuddling and time to relax will help. Make sure she stays hydrated and continues to take her prenatals (a whole food brand like New Chapter is a great option) and start off every feed at te breast, topping off with a bottle of pumped bm if possible. btw, getting baby naked will help wake her up to eat.

 

Wish her luck for me, and tell her I said to listen to you...you definately know your stuff..

 

Also, it gets easier...I promise :)

post #3 of 18

Oh, and see an IBCLC if possible...not an LC or CLC, IBCLC!!!

post #4 of 18
Thread Starter 

thank you, that was very helpful!

I think I said "at least every four hours", because my friend told me sometimes the baby sleeps for 6 hours straight and they can't wake her to feed and she can't dreamfeed with the Medela nipple. (I think I yelled "use the other nipple already!" down the phone). I will phone her to make sure she didn't misunderstand me, and that she should feed and pump even more often! There is no need so far to read up hunger cues apparently as the baby sleeps all the time anyway!

Starting every feed at the breast, finishing off with an easy-flow nipple, then pump...i think that's a good routine to follow. I hope routine helps with her frustration, because it feels like - ok, I have a plan and I am doing this right...

Nursing and pumping at the same time will be hard, as her husband would have to be home. And her mom is still working, too. I think either of them should burn some vacation time, frankly. it's just not always that easy...

post #5 of 18

We had some issues in getting DD started nursing as she was premature. She was 6 weeks early and was in NICU for 2 weeks, with a feeding tube for most of that time. Even when we got home she was still very sleepy and I had to wake her.

 

We were advised to not let her go more than 3 hours without a feed, not that she should go that long but if she was still sleeping then we should wake her. As far as I remember it was shortly after her due date when she really started feeding without so much encouragement. I would also pump/hand express a little and leave a few drops of ilk on my nipple as I latched her on.

 

I hadn't read this site at the time but the laid back position described here was one that seemed to work well for us. I actually found it quite a comfortable way to relax on the sofa with the TV and let DD take as long as she needed to feed, she was a pretty slow feeder so I really needed to be comfortable for a long time. I remember being SO relieved to get home and have a comfortable chair rather than the hospital ones!

post #6 of 18
Thread Starter 
Quote:
Originally Posted by LaughingHyena View Post

I hadn't read this site at the time but the laid back position described here was one that seemed to work well for us. I actually found it quite a comfortable way to relax on the sofa with the TV and let DD take as long as she needed to feed, she was a pretty slow feeder so I really needed to be comfortable for a long time. I remember being SO relieved to get home and have a comfortable chair rather than the hospital ones!


Weren't the chairs ever horrible in the NICU! With those rickety little stools you were supposed to put your feet up on, people traipsing through the room all the time, as there were 8 incubators in there! I remember being horribly tense with having to nurse for months, finally ending up in hospital with a slipped disk and needing spine surgery.

 

Can you tell me what you mean by "laid back position described here"? Is that a sticky or a link?

 

Interesting that had you a similar experience to ours, with your preemie needing to grow much stronger at first until you could seriously get her interested in nursing. i am still unsure how much one should try to force or encourage it until that time. It may be different in every case - I thought for my friend she desperately needed some of the pressure off her shoulders for a few days, but of course she needs to keep working on keeping her interested. Turns out her husband is off work at the moment, just wasn't home the other day when we talked on the phone and she mentioned being alone, so I think that is very hopeful in terms of her having good support. So she could actually try the routine you suggested: pump a little - put some EBM into the nipple shield - try to get baby interested - if it's not working or not working properly, hand over baby to husband to bottle-feed and continue pumping. Repeat every three hours. Not easy! I explained the suggestion of having the baby nurse while pumping at the other side but she admitted she felt overwhelmed at the thought of trying that right now.

post #7 of 18
Thread Starter 

Oh, and my friend is telling me to say thank you so much to everyone who's helping!

post #8 of 18


 

Quote:
Originally Posted by Tigerle View Post
Though she says at least pumping is going well for now, so that's one cause for cheer. However, she's got a gem of a midwife who is giving out dire warnings her that if she won't nurse as well as pump her milk will be dried up by six weeks and who told her to switch from the easy-flow nipples they used in the NICU to a hard-work nipple from Medela because "it's your job to teach your child now that you have to fight for everything in life otherwise your child will end up one of those *sshole children". However, the baby has to be woken for every feeding session, will fall asleep at the breast if interested at all, and seems unable to drink enough from the bottle when she uses the Medela nipple, falling asleep exhausted again or scream (she will drink more if she uses the easy-flow nipple which the midwife has prohibited her to use is it will supposedly cause nipple confusion).

 

My friend is so tense now about nursing that she had to take a break from trying for 24 h because she couldn't take it any more. I told her to fire her midwife and find someone who can actually reassure her about things and help her relax but I do not think she's got the energy!

 

I did some research for her on kellymom and this is what I've found and relayed so far in the way of advice:

Lots of skin to skin

Just put her to the breast as often as possible, but without the pressure of her having to nurse, just having her close, sniffing the breast or taking it into her mouth is fine for now

try feeding with a syringe or cup rather than the bottle

use nipple shields if they work, for as long as she needs them, preemies do

 

Stuff that I came up with:

Drink Weleda breastfeeding tea, have some alcohol free beer or a glass of champaign to help her relax and keep production up

Feed her every four hours, making sure she's taking in a real meal. I think she's still just too exhausted to nurse, or suck hard from a Medela nipple, and should be fed for now with an easy-flow nipple, just to get her to gain (my experience with my preemie was that as soon as he was strong enough, he nursed like a champ, and before that all those tricks like massage here and stroke there and put EBM in the nipple shield and pump before or pump after or whatever were totally useless).

Don't worry about milk drying up.

 

Can anyone help? Any and all advice much appreciated, and please tell me if you think I came up with total BS on my own!

Hello there,

 

I thought midwives are for assisting births?  What does a midwife know about breastfeeding, especially challenging breastfeeding issues?  I was lucky enough to work with an IBCLC who had a lot of experience with breastfeeding problems.  Not all of them do, not even the hospital lactation consultants.

 

In many ways, the midwife is crazy, BUT I agree with the midwife in TWO IMPORTANT aspects.  I really feel that the midwife is correct that switiching to easy flow nipple is not a good idea if you want to succeed with breastfeeding.  Also, I really feel that the midwife is correct that it is important not to let the milk supply dry up at this stage.  HOWEVER, the midwife's way is not the only way to accomplish these two goals.  I know this because I have been there.

 

7 years ago I went through a very similar situation that your friend went through. My dd was born only two weeks early, but she had jaundice, so she spent ten days in the NICU. My husband and lived 25 miles away, so we didn't go home at all during that time and slept in the NICU.  I didn't go into the birth totally exhausted like your friend, but by the time we got out of the NICU, I was exhausted.  I couldn't have been anywhere close to as exhausted as your friend, but I can sympathize because there is something about the NICU that just drains everything you've got, and my dd didn't have anything critical or life threatening, and in retrospect, it was pretty brief duration in the NICU. Once we got home, it was much better, but I was still extremely exhausted because my dd wouldn't eat.

 

Jaundiced babies are very sleepy, and my dd slept through the nearly all of the entire first three months of her life.  Our daughter would sleep for twelve hours at a stretch, not have any interest in eating, and then go right back to sleep, so there was a genuine concern about not eating. The pediatrician kept telling us to wake up dd every four hours to eat, and I cannot tell you how awful it felt to wake up in horror after eight hours and realize that we had slept through the alarm clock because we were sleep deprived.  The irony at having to set an alarm clock to wake our newborn (while all the other new parents were complaining of being awakened for frequent night feedings) would have been funny if we hadn't been so sleep deprived. And it's not like we were ever successful at waking up our dd.   I think that I would ask the local LLL leader to email you her pamphlet about waking up sleepy babies.  (I haven't read it, but it might be helpful.)  The lactation consultant suggested walking our fingers up and down the spine of our dd as one way to wake up the child, and also the application of a slightly cool washcloth, but even those attempts did not work for us.

 

It doesn't look like the midwife has been able to figure out exactly what the problem is.  For me, although my dd had this incredible drowsiness, the lactation consultant also figured out that my dd had a weak suck, and then the lactation consultant figured out that my dd did not know how to latch on.  So first, I had to teach my dd suck more strongly, which was easy to do once I was instructed how by the LC.  Then I had to teach my dd how to latch on, which was not easy.

 

SUGGESTION #1

 

I think I would have you look up suck training, to see if the baby has a strong suck or not.  The LC stuck her pinky finger into the baby's mouth to see if the baby could suck the finger.  I think you can look up Kelly's mom or youtube to see exactly how.  To teach dd how to suck stronger and at the same time prevent nipple confusion, we used a Medela "Special Needs Feeder" a.k.a. "Haberman Feeder".  You can buy it from Medela, and then I would think you can get their 800 number to walk you though how to use it correctly.  If used correctly, then you can adjust the rate of flow.  We started out pretty easy flow, then made the flow slower as dd learned developed the skills/endurance to suck harder and harder.  The way that the baby has to suck with the Haberman feeder is more like the way that the baby has to suck with a regular baby bottle on the breast.  In the NICU that my dd was in, several of the babies (much weaker than mine) were ordered to use this type of bottle instead of the regular bottles, presumably because their mothers eventually wanted to breastfeed the baby, but I didn't realize it until very near the end of my dd's NICU stay because I was in a sleep-deprived haze. After the LC spent 2 minutes demonstrating how to use the Haberman feeder, it was just as easy to use as a regular bottle.

 

With the use of the Haberman feeder, my dd very quickly (like in a couple of days) learned to suck properly and strongly, so getting enough milk was quickly solved, but she was just as sleepy as ever and too sleepy to be interested in learning to latch.  So I often used the Haberman feeder as a crutch to stay in what I called a holding pattern to get a week or two of rest when I needed it.  So during the first three months, I would try all kinds of ways to try to teach my dd how to latch on, as instructed by the lactation consultant: (not just skin to skin) SNS feeder/nipple shields/etc.  And at the end of each attempted nursing session, I would finish off with pumped milk from the Haberman.  When it got to be too much, I would just completely stop all of the (SNS/nipple shilds/skin to skin) attempts to breastfeed whatsoever for a few days or a week until I had accumulated enough new strength to go back and try again.  I asked the lactation consultant, and she said that feeding my dd with the Haberman without attempting to get my dd to breastfeed for those exended stretches would in no way delay getting my daughter to breast eventually.

 

OP, you are SO right, once you have a plan, the stress level goes down to a manageable amount.  My suggestion for your friend would be try the breast if she has enough energy, finish off with the Haberman feeder, or go straight to the Haberman feeder if your friend is too tired.

 

SUGGESTION #2

 

I do think that at this early stage, it is very important to establish a good supply.  Certainly it is easier to establish a good supply by feeding the baby frequently, but if the baby doesn't even open her mouth during the feedings, or if the baby falls asleep before the feeding even starts, then that's not going to work.  It sounds like the midwife is just giving you the standard solutions for the easy problems.  It is certainly much harder to establish a good supply by just pumping and not feeding at the breast, but I did it. When we got out of the NICU, the lactation consultant told me that as soon as I got home to pump every 2-3 hours round the clock, whether the child breastfed or not.  I was to record every single cc of milk that was pumped, and add up the amount pumped each day.  The goal was to work my way up to whatever number of ounces of formula a newborn my dd's age was supposed to be drinking per day.  And I did it!  After about 1 or 2 weeks, I was pumping enough milk.  It was hard.  I woke up every two hours without fail, while my baby was still SLEEPING SOUNDLY, to get up and pump.  I fell asleep while pumping more times than I care to admit.  Each pumping session didn't get a lot of milk, but eventually, the amount of milk over a 24 hour period was enough.  It is a matter of supply and demand.  If baby can't get up the mother's supply up and maintain it, then I found that I had to pump even more often than baby usually feeds.  Pumping sessions of long duration didn't help.  What helped was frequent pumping sessions, even if very little milk came out. Difficult, but it can be done.

 

Did i mention that it was HARD?  My husband was back to work, and my parents weren't with me at all to help.  It was just me and this baby who wouldn't wake up.  But it was a PLAN, and even though the pumping was difficult, it was much better than the NICU. I found that I could manage it, one day at a time, once the LC outlined the plan.

 

SUGGESTION #3

 

I think what helped me the most was a point-blank question that I asked my lactation consultant.  I asked her if there was a deadline by which the child had to learn to breastfeed by, and that if the child hadn't, then would the child be doomed never to breastfeed?  The lactation consultant had the experience to confidently assure me that it is no rush to get the child to breastfeed, as long as I could avoid nipple confusion.  In fact, my dd didn't figure out how to breastfeed until age 3 months.  Of course, it's better if the child breastfeeds right away, but when my dd wasn't breastfeeding at 2 weeks old, I had this secret fear that if she didn't learn to breastfeed really quickly, she would lose some sort of instinctive ability to breastfeed at that point.  Just the thought of this fear was extremely stressful.  The lactation consultant reassured me that nothing could be farther from the truth.  Just having that knowledge that my fear was unfounded gave me the confidence to persista and not give up on breastfeeding and to keep trying.

 

In fact, there is some kind of quick mental formula that the lactation consultant used.  She took the number of weeks the baby was preterm, did something to the number, and used it to get a rough idea where in the breastfeeding timeline to expect the baby to be.  No doubt you could look it up yourself.  As a matter of fact, once I did get my baby to breastfeed, the lactation consultant again plugged in the number of weeks baby was preterm, and said, "Yup, 3 months, right on schedule."  So apparently even a very slightly preterm baby starts breastfeeding on his/her own timetable that a VERY experienced lactation consultant knows about and not before.

 

SUGGESTION #4

 

OP, I wanted to give you my perspective on the suggestions that you came up with, just so that you have an additional data point to think about. Obviously, your friend's experience may very well be totally different from mine.

 

A.  Tea:  I found the tea to be useless.  Granted, I tried the Mother's Milk tea that has a strong anise taste and was probably fenugreek, but tea didn't do a thing for me.  So I think that if you counsel your friend not to be disappointed if the Welenda tea doesn't work, it will prevent her from being crushed if it doesn't do the trick.  Hydration, however, is probably important.

 

B.  Alcohol:  I have to admit that I never tried it because I don't like the taste. I suspect that it would only help if the baby is feeding well.  I would be surprised if it helps your friend.  However, she shouldn't be afraid of imbibing if it will help her relax.

 

C.  Feeding baby every four hours, and ensure a real meal.  Yes, this is important, and yes with a bottle if necessary. And yes, it is important to get the baby's strength up.  However, I don't think it's a good idea to invite nipple confusion with easy flow nipples when there is an easy alternative to avoiding nipple confusion.  That's why I suggest the Haberman feeder.  Preemies, who are too weak and exhausted to suck hard and REALLY need to eat, use the Haberman in the NICU.   If my dd had gotten nipple confusion, then I could have pumped exculsively and bottle fed in the end, but I believe that the measures that I took to avoid the nipple confusion were more than worth it, even with all of that extra exhaustion. I just think that if it is easy, it is worth it to avoid developing nipple confusion, instead of trying to deal with nipple confusion after it becomes very well established. Because pumping is MUCH harder than nursing straight from the tap, and I know that first hand because I pumped for work for three years.

 

D.  I do concur with you in that I do think the tricks like massage, etc.  were not useful to me. 

 

E.  I'm sure that I'll get kicked out of MDC for saying this, but even skin-to-skin was not useful to me.  Putting the baby on the breast often, even without nursing, didn't help me a single bit.  I'm telling you this so that if it doesn't work for your friend either, she doesn't think that she has failed. On the other hand, for many mothers, that's all it takes.

 

F.  I have to disagree with you about pumping.  I think that frequent pumping is very important if the baby is not nursing strongly. Once the baby wakes up out of his/her stupor, the baby will be more encouraged to eat if there is lots of milk coming from the breast.  Frequent pumping works (at least it worked for me) if you start pumping now, instead of waiting a month to try it. The measures that you suggest might work, but not for everyone. They didn't work for me.

 

SUGGESTION #5

 

At the risk of being redundant, I'm going to respond to midwife's comment about, "if she won't nurse as well as pump, her milk will be dried up by six weeks".  I didn't nurse and pump at the same time.  I couldn't.  All I could do was pump for the first three months because my baby refused to latch on.  My milk did NOT dry up.  In fact, I built up an adequate supply up from absolutely nothing at all with just two weeks of pumping.   It is true that unless you are very disciplined about pumping every 2 - 2.5 hours, your supply WILL dwindle.  And it is true that many mothers who try to pump can't pump that often because it's very DIFFICULT to pump that often when you are sleep deprived, and it is true that their milk supply often does dry up.  HOWEVER, it is NOT correct to say that it can't be done, because I managed to do it, so it can be done, and I am surely not the only person who has ever succeeded.

 

 

SUGGESTION #6

 

I want you to tell your friend, that I've been there, and I managed to succeed, but every single day I was on the verge of giving up.  So tell your friend that if she does eventually decide to give up on breastfeeding, she should not feel any guilt for feeling exhaustion and giving up.  That kind of exhaustion can be debilitating.  Unless you have been through that kind of exhaustion yourself, people really don't have the right to judge. (OP, I am NOT talking about you.  I'm talking about the occasional person who just blithely tells other mothers to throw away all of the bottles and eat oatmeal when the situation does not warrant it.)  When you're that exhausted, you get to the very valid point of wondering what is the trade-off between breastfeeding and actually having any kind of bonding experience with your baby.  I for one applaud your friend for every single drop of breastmilk that she has given her baby thus far. I could totally understand if your friend gave up tomorrow because for EVERY single day for three months, I came SO close to just throwing in the towel. (For me, I found it easier to say that I would try just one more day, and give up tomorrow, and tomorrow eventually never came, but that's just me.) But really, when I was deprived of that much sleep (much more than the regular newborn sleep deprivation), my judgement was impaired, and how good of a mother in all of the other respects could I be?  I thought about it everyday, and every day I was ready to give it up, and I might very well have given up, except I just never got around to giving up.

 

SUGGESTION #7

 

I'm going to respond to the midwife's comment that "it's your job to teach your child now that you have to fight for everything in life otherwise your child will end up one of those *sshole children".  I am going to get kicked out of MDC for this, but when I was that exhausted, my child was NOT a good enough reason to endure all of that exhaustion to get breastfeeding to work.  For me, it was sheer cussedness and stubbornness because I was faced with a problem that wasn't budging, and by golly I wasn't going to let it get the better of me just on sheer principle.  That's about as unmaternal a reason as you can get. So, no, the midwife is crazy.

 

SUGGESTION #8

 

A little bit of formula will be fine, if that's what it takes to get the breastfeeding to work.  My dd got almost all formula when she was in the NICU because it took like 5 days of pumping before my milk even came in, and even then very little came out until I was able to get serious about pumping until I got home.  Although the hospital staff was almost always very respectful about not giving my dd a bottle, there was one NICU nurse who gave my dd a regular bottle against my direct orders at least once during her shift.  (In retrospect, I guess my dd might have been too sleepy at the time to develop nipple confusion.) And yet, everything turned out fine in the end.  One magical day (after many weeks of fruitless attempts and exhaustion), when my dd was 3 months old, something just clicked.  My dd just started drinking at the breast with the SNS.  It was like magic!  And from that point on, she was a very strong nurser until she weaned herself at the age of 3 years old. So here is a success story for your friend.

 

SUGGESTION #9

 

I really do think that you shouldn't use the regular easy flow bottles. Not every child develops nipple confusion, but I do think it is worthwhile to avoid it.  However, even if you want to use a slow flow nipple, it doesn't have to be Medela. So although I agree with the midwife about not using the easy flow bottles, I disagree with the midwife about her insistence on the medela brand. Once we were ready to try to get our dd on the bottle for daycare, our lactation consultant said just to try slow flow nipples of different brands that we could find until we could find the one that worked for us.

 

 

 


Edited by emilysmama - 11/21/11 at 3:59pm
post #9 of 18
Thread Starter 

Thank you so much! Wow! I'll have to reread your post twice to make sure I've got everything down, relay it to my friend and then maybe come back with questions. That is such a helpful perspective - it is so great to read more and more experiences here.

I've been with my friend very step of the way and I do understand her exhaustion. I've been there in a way, but not in the "can't I ever not have to fight?" kind of way she is. thanks agian for the time you took. I'll keep youall posted!

post #10 of 18

Wow. That midwife sounds not at all useful. Your friend is doing a good job and loving her baby and that is important.

 

If she can talk to a lactation consultant, that might be good.

 

Sometimes preemies  are slow to figure out nursing. My girls were four weeks early and spent the first six weeks on bottles (Dr. Brown #1 nipples). I was devastated and frustrated to not have nursing work. I pumped religiously every three hours. The biggest thing that helped was getting them big enough to get with the picture, so it was really about getting milk into them. We did practice nurse, but the biggest thing was just getting them bigger.

 

At two months, they went over to breast during the day, and at three they went to breastfeeding at night. And now they are five months old and big and breastfeeding for all their meals.

 

Get them bigger. Don't stress them out at the breast.

 

And when we were trying to nurse, we did skin to skin time, sitting in the bath time, nursing before bottle, nursing after one ounce in a bottle, and we stopped when either they or I got too frustrated to be productive.

 

 

post #11 of 18
We're not talking about a healthy, term baby here. Your friend should do whatever it takes to get calories into her babe because right now it's a vicious cycle - baby is too sleepy to nurse and not nursing is making her sleepier.
My only quibble with your advice is that feeding and/or pumping every four hours isn't often enough - for the babe or your friend's supply. Newborns should have one longer sleep period of say four hours but despite the usual "feed every three hours" advice the typical newborn nurses more like 12 times a day. Your friend should be mimicking this pattern with her feeds and pumping.
post #12 of 18


 

Quote:
Originally Posted by Tigerle View Post

 

My friend finally brought home her preemie after a harrowing tale of years of losses, infertility, surgery for Asherman's, PCOS, Hashimoto's, blood-clotting factor issues, myomas, hormonal issues, an ultra-complicated pregnancy, you name it, she had it.

 

Due to intrauterine growth restriction (it's not really known what caused this, they thought she had gestational diabetes and had her on insulin and metformin, then thought she didn't and took her off again, now they think it may have been left-over scarring from her Asherman's), her daughter was delivered some three weeks early at just over 2000 g/4.4 lb (due date is next Tuesday or so) via CS. They spent two weeks in the NICU because she wasn't breathing at first and not drinking properly. She was released with about 2400 g/5.3 lb and drinking so-so from the bottle (between 60 and 90 ml, about 2-3 oz), and occasionally getting something like 30g (1 oz) into her after prolonged nursing sessions with nipple shields.

Hi there OP!

 

I the first time that I read your OP, I saw that the baby was 3 weeks early, but I missed that the baby was only 4.4 lbs.  My baby was 2 weeks early, also by CS, but she was pretty much full term size, almost 8 pounds and the NICU didn't really consider her a real preemie because, except for the jaundice and the not breastfeeding, she didn't have any problems to worry about and these were pretty minor in the grand scheme of things.  So I cannot say that I have exactly been there and done that, because you're friend is still at a very delicate stage.  I am certainly happy to answer any follow up questions you and your friend have about my experience.  But now I see that in this regard, I had it easier than your friend.

 

Also, although I had quite a few pregnancy and some pre- and post- pregnancy complications/issues, I had no where near the seriousness  and list that your friend has.  So I am actually amazed that your friend has had the stamina to even get this far. Hindsight is always perfect vision, but in retrospect, I think that if I hadn't had the good health that I had at the time when my dd was a newborn, I would most likely have given up before where your friend is right now.  I'm not trying to discourage your friend.  I'm just telling your friend that when baby does grow up, her daughter had better be able to appreciate every single drop of breastmilk that she has been able to squeeze into her thus far. :D

post #13 of 18
Thread Starter 
Quote:
Originally Posted by emilysmama View Post


 

Hi there OP!

 

I the first time that I read your OP, I saw that the baby was 3 weeks early, but I missed that the baby was only 4.4 lbs.  My baby was 2 weeks early, also by CS, but she was pretty much full term size, almost 8 pounds and the NICU didn't really consider her a real preemie because, except for the jaundice and the not breastfeeding, she didn't have any problems to worry about and these were pretty minor in the grand scheme of things.  So I cannot say that I have exactly been there and done that, because you're friend is still at a very delicate stage.  I am certainly happy to answer any follow up questions you and your friend have about my experience.  But now I see that in this regard, I had it easier than your friend.

 

Also, although I had quite a few pregnancy and some pre- and post- pregnancy complications/issues, I had no where near the seriousness  and list that your friend has.  So I am actually amazed that your friend has had the stamina to even get this far. Hindsight is always perfect vision, but in retrospect, I think that if I hadn't had the good health that I had at the time when my dd was a newborn, I would most likely have given up before where your friend is right now.  I'm not trying to discourage your friend.  I'm just telling your friend that when baby does grow up, her daughter had better be able to appreciate every single drop of breastmilk that she has been able to squeeze into her thus far. :D


Yes, it's a miracle that this baby exists at all and we've actually talked about that today - that compared to the years and years when she thought she'd never have a baby and had all these medical procedures and complications, what a luxury it is to be able to obsess about which nipple to use with a living yawning baby on her lap...but she's such a fighter, had to be to even get here being a mama, I'm sure she'll get breastfeeding down eventually or keel over trying. Hope the former!

I think what is really important and helpful about your experience is that with sheer cussedness, yes, you can pump that long, and yes, you can take time off from practice nursing if you just can't take it any more and yes, some babies just take their time until it just magically clicks - and sometimes nursing works only after three months, so don't give up. I sure hope that your experiences will be alike in that this magic moment happens for them. And if not - she says pumping is still working very well and she is filling the freezer with EBM like there's no tomorrow so I am sure she will get at least 3 months worth of breastmilk into that baby, and that's already a great start.

 

This is so important:

Quote:
Your friend should do whatever it takes to get calories into her babe because right now it's a vicious cycle - baby is too sleepy to nurse and not nursing is making her sleepier.

And this:

Quote:

Get them bigger. Don't stress them out at the breast.

I am happy to report that the baby is now spending more time awake, waking up on her own a lot of the time giving hunger cues, taking the Medela Calma nipple well most of the time and managing up to 4 oz with it. So she is hoping she can soon retire the easy flow nipple altogether and just use the Medela Calma which is supposed to be the absolute closest thing to the breast. (Though I am rather suspicious about any silicone appliance supposedly "feeling just like the breast" to the baby, I have to say the Medela Calma at least looks very impressive - total space age nipple. Great design. Hope it does its job.)

 

She is now pumping and feeding and practice nursing according to the plan we worked out, emphasizing on the feeding and taking it one step at at time. And her DD apparently is gaining and today even tried to nurse twice, only she does not appear to be able to get anything from the breast at the moment. It sounds like there may be more issues that just the sleepiness, which seems to be slowly but surely getting better. Today would have been her due date!

 

I also found her an IBCLC lactation consultant in her village and she'll phone her for an appointment tomorrow - I think it's time to have someone look at those breastfeeding attempts closely. Apparently, her weird midwife is some kind of lactation consultant or at least proudly claims so on her brochure, but has never taken the time to spend a full nursing session with the two of them. She said she won't bother firing her, because she hardly ever appears at all these days, just sends round her assistant who she actually clicks with much better because she is very nice and reassuring and really spends time with mother and baby.

post #14 of 18
Thread Starter 

Again thank you so much to everyone who related their experiences and had advice. My friend is so grateful. It is odd how vividly those challenging times with a preemie (both the NICU and the difficult few weeks at home until we had breastfeeding down) remain present in your mind, isn't it? I remember that i could not even talk about it for two years without getting all worked up over it. I am so glad I can at least turn the experience into something productive now and help reassure my friend that they'll be okay.

post #15 of 18

Hello OP!

 

How lucky your friend is to have such a great friend to lean on!  So glad to hear that the baby is thriving!

post #16 of 18
Thread Starter 

a quick update for everyone who's helped us:

My friend is still pumping (11 weeks and going strong), the baby is taking the bottle well, but breastfeeding never clicked for them and my friend has pretty much given up after being screamed at and pushed away constantly. Because the child is crying so much, exhaustion is setting in but she'll pump as long as she can take it! The baby has also had thrush (must remind friend that this might have been one of the complicating issues and she should give it a last try as soon as that has cleared up), has now developed bronchitis (probably due to inhaling the anti-thrush ointment, but maybe it's just because of the inclement weather) and they are now having to deal with inhalers and nebzlizers to boot. Never a moment's rest! But aprt from that, the baby is growing and feeding so small gains are being made.

Thanks for being with us so far!

post #17 of 18
It's great that baby is growing and mom's supply is good!
Is she interested in getting back to the breast? A nipple shield combined with a lactation aid such as a Medela SNS might give her baby some "bottle-like" to latch onto plus the immediate reward of flowing milk. She's still need to pump until baby is transferring well but it might be worth a shot.
post #18 of 18
Thread Starter 

I just wanted to post another update.

 

Baby K never took to the breast - but mama is still pumping! Baby K will accept formula at night and her husband has taken over night feedings so she has given herself permission to refrain from both pumping and feeding at night and getting some rest, so she can still pump during the day and offer her breastmilk then.

 

Because she kept feeding so badly during daytime and they were so confused about when and how much to offer, the baby developed a veritable feeding disorder, however. They found a "baby whisperer" that came highly recommended and was atrociously expensive but who managed to clear that one up for them  in several home visits - they had been totally confused about whether the baby was fussing due to wanting to feed or wanting to rest, thus completely stressing out the baby, who started to refuse the bottle at daytime altogether, requiring them to throw away all that hard-won breastmilk. The "baby whisperer" said that she was the hardest baby to read ever and she had seen some hard cases! They've got it down now and she's got two teeth and has started solids - happily, those go down well so they may be able to put the feeding drama behind them soon.

 

She does appear somewhat delayed in early gross motor skills but I expect with IUGR that is to be expected.

 

Thanks for helping us during the hardest time!

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