Support needed- 33/34 weekers

[ThankfulMama]

I am 33 weeks with DZ twins and my growth scan this week showed that my IUGR baby B has nearly stopped growing.  He is estimated at 2lb14.  My MFM recommends delivering and so I got my first steroid shot today.  I will get a second tomorrow and will deliver sometime this week or next (waiting to find out).  I am terrified.  I had a beautiful natural birth with DD1 and was hoping for the same with these two.  Now I am facing a section and NICU.  I'm terrified and in need of advice and support so I can advocate for my babies.  I was told that they likely won't be able to suck and will be fed via IV initially.  I need to educate myself quickly so I can get them on the breast as soon as possible.  I really don't know what to expect.  I need tips and advice please.  Resources?

[LunaLady]

I don't know what DZ or IUGR means, but I had a 33 weeker and I can share my experience.

I had PROM at 31 weeks and PE and was on hospital bedrest until my baby was born at 33 weeks. He was in the NICU for 25 days, most as a 'grower/feeder' as there was absolutely nothing wrong with him

What I WISH I had done differently was to be more forward and express my wishes to the NICU nurses and doctors. I wish I would have pushed for more skin to skin and breastfeeding time. As it was, i was told that as soon as my son could take full feeds for 48 hours, he could go home. I mistakenly thought that would happen sooner rather than later. I decided to do all bottles and told myself once we got home we could have all the time in the world to work on breastfeeding and it would be a smooth transition. 

It was NOT. My boy didn't have enough experience at the breast and all the tricks in the bag (SNS, breast shield, etc) did nothing to help him latch to my breast. 

I am happy to say, though, that we had a happy ending - he spontaniously latched at 11 weeks old and we've never looked back. He's six months old, now, and is a nursing champ!

So, if breastfeeding is a priority for you, then tell everyone - every nurse, every doctor, everyone caring for your twins. Get the hospital LCs to help you every time you attempt to feed at the breast. Getting support from them is absolutely critical.

I wish you all the luck and I'll check back here if you have any questions! Hugs!

[ThankfulMama]

Thanks so much for your response and support, LunaLady. I'm having twins and they are dizygotic (DZ) and our baby B is growth restricted (IUGR).  So while they are 33 weeks they are much smaller in size than what they should be for that gestation.  Breastfeeding is HUGE for me and so I will take your advice and tell everyone under the sun.  I will be delivering at a baby-friendly hospital, so I'm hoping that helps.  How soon were you able to begin breastfeeding for the first time?  I'm really hoping to start skin-to-skin and introducing the breast as soon as absolutely possible.  I have so much to learn though.  I was really hoping to wake up and find this all a dream this morning-- this is already so rough and they are still in my womb. . .

[aikigypsy]

My little guy was born at 34 weeks, 50th percentile for size at that gestational age. He was in the NICU for 7 weeks, though, with apnea/bracycardia (I can't even remember how it's spelled! PTSD!)

The most important thing to do is to keep your supply up. I hear that in some hospitals you can room in with your preemie, but that wasn't the case where we were. Everything in the hospital is so constrained, regulated, scheduled that it's really awkward to do things. Like you can't carry the baby with you when you go to get a cup of tea. I nursed the baby as often as I could in the hospital, with help from lactation consultants, pumped about 8 times a day, and used a nipple shield initally when we got home.

I only got to nurse him about 2-4 times a week, since we lived so far from the hospital, BUT, I had a nursing toddler at home, which helped with the supply issues.

We transitioned to EBF within days of coming home -- I just really did not want to pump any more! But it took longer to get him off the hospital-conditioned long gaps between feeds, which gave him some silent reflux problems. He is now 18 months and nursing lots still.

[LunaLady]

Originally Posted by ThankfulMama 

Thanks so much for your response and support, LunaLady. I'm having twins and they are dizygotic (DZ) and our baby B is growth restricted (IUGR).  So while they are 33 weeks they are much smaller in size than what they should be for that gestation.  Breastfeeding is HUGE for me and so I will take your advice and tell everyone under the sun.  I will be delivering at a baby-friendly hospital, so I'm hoping that helps.  How soon were you able to begin breastfeeding for the first time?  I'm really hoping to start skin-to-skin and introducing the breast as soon as absolutely possible.  I have so much to learn though.  I was really hoping to wake up and find this all a dream this morning-- this is already so rough and they are still in my womb. . .

Thanks for explaining those definitions to me :)

They wouldn't let my baby try feeding via mouth (bottle or breast - he had an NG tube) until he was about 8 or 9 days old. We did skin to skin starting the first time I got to visit him (15 hours after birth, grr) which was good, but if I had it to do over I would have spoke with the charge nurse and doctors to get him trying at the breast as early as possible. 

You might be in a different situation than me because my boy was very healthy and had no issues whatsoever. He was on room air the day he was born and only needed IV fluids for the first 24 hours until he got the NG tube placed. 

Anyway, I just urge you to be as bold and frank as you can. I was in such a state after the birth of my boy and I wasn't very competent mentally at the time, but I wish I would have pushed harder to get what I wanted.

Also, the hospital where I birthed had a wonderful lactation team, but I just didn't use them as much as I should have. Use your LC department as often as you can! Get them there every day to help you, if you need it. There were times they'd pop in my boy's room and ask if I wanted help and I'd just shake my head. Ask for help!

Please ask me if you have any other questions! I hope everything goes smoothly for you!! :)

[darthtunaqueen]

Congrats on your little twins!  So exciting!  :)

Since I don't know your general hospital how-they-do-things, this is pretty general.

The babies will come out, be assessed and then transported to the NICU.  We let partner come with us to the NICU and to see the baby.  An IV will be started, they will take blood cultures and start IV antibiotics (little ones have very immature immune systems, the antibiotics are discontinued if the blood cultures don't show any bacterial growth, which takes about 48 hours).  They will be kept nothing by mouth initially just to be assessed until they are stable.  They will be in an incubator.  The IV may be a "peripheral" IV (in the hand, foot or scalp) or an "umbilical line" (a longer IV that is inserted into the umbilical vein).  If either one is having blood pressure issues, or needs more monitoring, they may insert an arterial line into his umbilical artery, which allows the nurses to take blood out of the line instead of the heel poke.  They will be started on IV nutrition, and then slowly started on small amounts of milk and gradually work up to all milk.

But it really depends on if your babies are sick or well when they're born and in the immediate neonate period.  

We have a whole protocol on breastfeeding the prem.  Kangaroo care is the very first step.  Kangaroo care during feeds is great!  If your babies are being fed small amounts of milk every 2 hours, they most likely won't wake up or get very hungry.  They will be transitioned to every 3 hours when their weight gain is stable.  When they are ready to try orally feeding, they will start to wake up around the three hour mark.  When your baby is awake and interested, put them to a freshly pumped breast.  They will lick and taste the nipple, but probably not do too much latching!  As they get bigger and more awake, they will start to latch and suck.  33 weekers can breastfeed, but twins are always slightly behind singletons too.

What you can do to establish is breastfeeding relationship is to be PRESENT as much as you can.  It's very frustrating to have a mom who desperately wants to breastfeed but only shows up for a couple of hours every day.  I totally agree with the rooming in.  

If they are still needing to be fed through a feeding tube (too sleepy), tell the staff no bottles.  This is hard, because sometimes the baby is wiiiidddeee awake at 3am and interested in eating!  I will syringe feed sometimes if I have the time!

Learn to hand express.  A really great video on establishing a milk supply for moms with babies in NICU can be found here: http://newborns.stanford.edu/Breastfeeding/HandExpression.html 

You need to start hand expressing ASAP.  If your post partum nurses tell you that you don't need to do this, IGNORE THEM.  We have issues with our PP RNs not getting moms hand expressing ASAP.  It makes a HUGE difference in milk supply.  You do not need to use a pump for the first 24 hours.  

Good luck!!

[pigirl]

My son was born at 34w5d, but he was a singleton and huge for his age (5lbs10.5oz).  At the same time, he was a very sleepy baby and we struggled with nursing.  Find a good LC, and keep asking for help.  Because my son was preterm, for some reason the hospital decided the LC didn't need to come to see me.  What?!  And this was at a fairly progressive hospital.  I asked eventually, and the LC (or rather, both of them) were a huge help.  They showed me how to self express while pumping, and while trying to feed my son, and that made a HUGE difference in my supply, and in our eventual success nursing.  I also wish I'd done more kangaroo care.  I was really worried about not being a pain in the nurses' necks, and not asking them for too much, and in hindsight that was just silly. 

Having your baby/babies early can be so damn scary, and so not part of the plan.  I hope you guys have a relatively easy time of it.  Oh, and there's a Sears book on premature babies; it might be worth having someone track that down for you.  Best wishes, and let us know how you're doing.

[whoabethy]

what i didn't know, but wish i had known, was that you might be able to get a Rx for a hospital grade breast pump at home. this was the BEST when DD was in the NICU.
 

[AllisonRH]

Hi there - Congratulations on your twins! I gave birth to my little girl at 34w1d and she was 4lbs. 12oz which is pretty big, apparently. I gave birth at a baby-friendly hospital as well and they were absolutely fantastic. Somethings that I found helpful - they gave my daughter a feeding tube through her nose so that we could nurse right from the start with nothing in the way. They did "top her up" with formula for the first two days or so until my supply really came in, but she would always go to the breast first. They had me pumping after every feed (every 3 hours) right from the start and this really helped with getting a good supply established and then were topping her up with my milk as needed. My NICU had a lactation consultant on staff and I asked to see her as soon as I knew they had one. After that she would stop in everyday to see how I was doing and answer any questions I had. That really helped me get established as my daughter had a hard time latching in the beginning with her little mouth and my giant full breasts (even the nurses were teasing me about my breasts...and I'm normally just a C cup). We were very lucky and my daughter was only in NICU for a week before she was discharged, but it felt like an eternity. I really hope you are having a positive experience. All the best to you and your family!