Originally Posted by Tigerle
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!
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.
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.
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.
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.
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.
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.
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.
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.
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.
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