Another breastfeeding after NICU question

[dsb76]

Hi,

My twins were late-preterm and are hopefully being discharged from the NICU today and tomorrow (yea!)  I have been pumping around the clock and have adequate milk supply for the time being and both babies have a good latch though will only take about 20-26 ml per feeding from the breast (per pre and post nursing weight) and then I give a bottle while in the NICU.  I have been doing between 1 and 3 nursing sessions a day while they have been in the NICU.  They are finally gaining weight, "nippling" adequately (no more tube feedings), and are maintaining their body temperature.

My plan is to breastfeed my twins when they are home and I have been told to only gradually increase nursing sessions and give a bottle for the other feedings.  So I'd be starting out with only about 3 nursing sessions a day and increasing over the course of weeks as they show weight gain.

Has anyone BTDT?  I'm thinking of renting a baby scale to see if I can track milk transfer - One twin seems to be a super fast nurser (taking in 20cc in a just a few minutes before popping off and going to sleep) while the other will nurse for 20 minutes and take the same amt - but I don't want to get obsessed with the numbers either.  If you have any experience with this did you track weights at home? measure milk transfer? just count wet/poopie diapers?  and how fast were you able to increase nursing sessions?  How long did you continue to pump after each nursing session?

I tried kellymom but all the links for breastfeeding after NICU were broken :(

Well, wish me luck!  It is so weird to be going to the hospital to pick up a baby - I feel like I'm going to go pick up a present or a puppy or something.  It won't feel real until they are home with me.

[emilysmama]

Originally Posted by dsb76 
I'm thinking of renting a baby scale to see if I can track milk transfer - One twin seems to be a super fast nurser (taking in 20cc in a just a few minutes before popping off and going to sleep) while the other will nurse for 20 minutes and take the same amt - but I don't want to get obsessed with the numbers either.  If you have any experience with this did you track weights at home? measure milk transfer? just count wet/poopie diapers?  and how fast were you able to increase nursing sessions?  How long did you continue to pump after each nursing session?

I don't think I can help you with the last two questions, but I can tell you about the rest of the questions above. 

At the NICU, the lactation consultant attempted to help me figure out the weighing thing. In principle, it sounds simple.  Start the nursing session with a dry diaper, by changing the diaper right before. Weigh baby with dry diaper to the nearest 0.1 gram.    Attempt breastfeeding.  Then right after the nursing session ends, weigh the baby with same diaper to the nearest 0.1 gram, possibly no longer dry. Subtract, and get this difference in grams to the nearest 0.1 grams.  That number of grams is the number of cc's ingested.  For example, if baby weighs 2.1 grams more after than before, then baby has ingested 2.1 ccs.  (You are assuming that breast milk has the same density as water, which is 1 gram per 1 mL.)

When I did it in the NICU, I got zero.  That sounded about right because my dd wasn't taking anything in.  So I didn't do that any more in the NICU.

The lactation consultant at the hospital tried very hard to figure out how to rent a scale for me to use at home in the same way.  The problem, if I remember correctly, is that baby scales usually are accurate only to the nearest 1 gram.  For what you want to measure, you need the scale to be ten times more accurate, down to the nearest 0.1 gram. I think that these types of scales are specifically for breastfeeding.  Otherwise, the results are meaningless. 

If I remember correctly, I had to chase down the correct scale when I was in the NICU, because even most of the hospital scales in the NICU were not able to measure down to the nearest 0.1 gram.  The hospital scale is just trying to see if babies are gaining tens of grams from one day to the next, not ingesting tiny quantities of liquid over a 20 minute feeding.

The lactation consultant tried to contact Medela, as well as the local hospital supply vendors, to see if she could arrange a rental for me, but without success.  (However, this was 7 years ago, so maybe it's easier now?)

So after it became clear that a scale was not in my future, I did the counting diapers thing.

In retrospect, I do think that counting diapers worked better than weighing ever would have.  I work with very high tech equipment in my occupation, but my experience in general is that the lower tech, the more reliable the information gathered.  The diapers versus the scale are no different.  

What I did was record in a notebook the following:  time and duration of feeding, and time and condition (dry, wet, or poopy) of diaper change. Also if the diaper was sopping wet, or just slightly damp.

I changed the diaper as often as I could: after every feeding or every two hours, which ever was more often.  I did this because the diapers were cloth, and also so that I could keep track of how long it took for the milk to pass through the system.

My dd took 45 minutes on each side, so by the time we finished feeding and hour and a half after the beginning of the feeding session, the diaper was already wet.  (You're fast nippler will probably be different, and you'll probably have to wait a while before the diaper gets wet.)

Everytime the diaper was sopping wet, I made a tally mark.  I totaled the number of tally marks for each 24 hour period, and compared it to what the baby books say you should have.  The books say that you should have, I can't remember exactly, something like 8 wet diapers per 24 hours.  However, I think that is for disposable diapers.  When I had 10-12 sopping wet diapers per 24 hour duration, I started to feel much more reassured.

But by keeping my records in this way, I also started to see the pattern and connection. My notes helped me figure out that my baby had a rhythm.  In my baby's case, it was feed, and then wet diaper by the end of the feeding.   I found that an hour and a half after beginning the feeding, the diaper was consistently very wet.  So I established a consistent pattern of cause and effect. 

Once I saw that the correlation was regular enough that I could predict when the diaper would get wet, I knew that I was home free. That made me feel much more confident than the scale, which could have been rife with systematic error, could ever possibly have done. When I explained my reasoning to the pediatrician and to the lactation consultant, they agreed. 

So in my case, the numbers from the scale wouldn't have necessarily made the information any better than simply counting diapers.