baby in NICU, pumping help?

[justmama]

My daughter was just born yesterday at 34weeks due to preterm premature rupture of membranes. She will be in the NICU for at least 2 weeks to grow stronger and learn to maintain her body temp. I am forced to pump for her because she's not strong enough to nurse yet. Does anyone have any good ideas for how to keep my milk supply up enough for her???? Obviously since my milk isn't even in yet she's getting only tiny little bits of colostrum. She is however getting formula because she's small enough that she needs the calories. I pump every 2-2 1/2hours, drink lots of water, and try to rest(though it's not easy with a 4 year old and running around trying to get the new baby's stuff ready for her) but I'm getting barely anything. She just drank a 30cc bottle today and I'm getting just 10cc of colostrum. Any thoughts for me??? Does anyone know if pacifiers are okay for preemies??? Her NICU nurses have to use them because she's got such a sucking reflex and she tries to suck her iv lock. Will this interfere when we finally get a chance to nurse??? Any thoughts for the transition from bottle to breast for such a little one???? Please help, anyone who's been here. We are so stressed out. I'm just happy she's okay but I would love my little preemie to get momma's milk more often.
Meg

[Dmitrizmom]

mama!

Congrats on your baby girl. Hope that she grows strong fast and can be home soon.

Just thinking outloud here...Have you asked about using a SNS so that she can learn to suckle and still be getting some expressed milk even if her suck isn't strong enough? Not only would it do her good, it would give you some nipple stimulation that should help your milk production. Other than that, mother's milk tea, brewer's yeast, and lots of pumping.

FWIW, have you also asked about supplementing with milk from a mother's milk bank instead of (or in addition to) formula? Then she'll still be getting bm (2nd best - your milk being the best). I know that there are 6 milk banks in the US. If your doc prescribes it, your insurance should pay for it - medically necessary treatment and all.

Hopefully another mama who has been where you are right now will be able to offer more suggestions that might be more helpful.

[sofiabugmom]

Congrats on the birth of baby #2!

I had a 31-weeker, in NICU for four weeks, born preemie for the same reason. (DH likes to say she kicked a hole in the swimming pool )

As far as pumping, you're doing EVERYTHING right as far as timing and drinking. 10 cc's of colostrum was about what I was getting that soon after DD was born.

One thing I'd suggest is to find someone to help with getting things ready at the house and maybe even watch your older child for a bit. I know from experience: the stress you're under is incredible. The lactation consultant for DD's NICU told me that stress will hinder production like almost nothing else (it happened when they told me she was being discharged -- when I told the nurse about my dry-up, she said, "The 'D word' does it to everyone!")

Another is get a picture of the baby to look at when pumping. Weird as it sounds, it seemed to help me on many occasions.

DD also used a pacifier, and it had no effect on nursing with her. She never wanted another one when she came home except during teething, but that's another story altogether ...

One important question: Does your NICU (not the hospital in general) have a lactation consultant -- one with whom you can make an appointment for one-on-one help for more than fifteen minutes? If not, two things:

First, find (or have someone find for you, since you've got enough on your plate) a midwife, post-partum doula or private lactation consultant PRONTO. You may have to get permission from the hospital to let her into the NICU with you. Believe me, you will want someone right there to guide you when you're getting started, and not be distracted by other babies in her care. She'll also be able to help with an SNS if necessary.

Second, tell the hospital management to GET ONE! Mother's milk is the best thing for preemies -- our milk has more calories and nutrients, it's as if our bodies know the baby's not done cooking yet. (Got the study on this from the staff at Yale, where DD was born -- can't find my copy though, bummer). While I agree with PP on getting in touch with a milk bank as a back-up, in your case YOUR milk is a much better option.

And one last note, get to know some of the other moms in the NICU. They'll be there with advice, hugs and big shoulders when you need them, and I found it relieved some of the stress to know I wasn't alone. (And remember what I said about stress ... )

Please feel free to PM me or post again if you have any other questions for someone who's BTDT!

Best,

JA

[TiredX2]

I'm really confused.

Everything I have read suggests that bfeeding takes *less* energy than bottle feeding. I have not had a premee so do not know the ins and outs, but why can you not comfort nurse & nurse as much as possible, and then if she needs extra use a SNS or cup feed?

Congrats and I hope you get some more info from people who actually know. I'd just like the info.

Thanks,
Kay

[wende]

I had a 32 weeker who spent 3 weeks in the NICU. The first few days of pumping were torture, after that, though, I was making enough milk to feed every baby in the NICU. Keep yourself on a schedule, pump every 2-3 hours. Try to stay relaxed. Pump as often as you can in the NICU after you offer the breast to your dd. DS had a pacifier in the NICU and refused to take it after we got home. I was also told that he would never learn to nurse properly and I'd always have to supplement. 2 weeks after he came home he was a nursing pro and never touched a bottle again. Just stay persistant and eventually she will get it! Good luck and congrats!!!

[kavamamakava]

Awwww. My daughter was in the NICU for a week. She wasn't a preemie though. I couldn't keep up with her needs by pumping either. It sure was stressful and depressing I gave her a pacifier because I couldn't stand to see her all alone in that little bed without anything comforting. She used it to fall asleep until she was about 8 months old and then she just forgot about it one day. I used the hospital Soothie ones.

Here's what my midwife/lactation consultant advised me:
Roll your nipple between your thumb and forefinger for a bit before starting to pump. Have a piece of your daughter's clothing with you to smell.
Drink lots of water.
Eat oatmeal daily.
Put her to the breast as often as you can between pumpings.
Skin to skin contact will correct most nursing issues in the early days so hold her against your belly with her dressed in only a diaper when you spend time with her in the NICU.

Here's my mother's sweet for milk production that really helped me:
1 Tablespoon of each ingredient mixed together and formed into 6 balls. Eat 2 a day.
Softened butter
Honey
Raw, hulled sesame seeds
Blanched (skinless) almonds, chopped (about 5-6 almonds)
Dates, pitted (about 2-3)
Carraway seeds

It's easier to eat when refrigerated but can be eaten at room temperature.
Congratulations on your daughter's safe birth and good luck with the pumping. I know how much it sucks.

[mamakaren]

My son was born 4 weeks early with a gastrointestinal defect and couldn't handle anything by mouth until about 5 weeks of age and was discharged from the NICU at 6 weeks old. It seems as though you are doing everything well, I only offer that you try to contact La Leche League for breastfeeding support. Even though they are not trained professionals, they have a wide range of experience. Kangaroo care really boosted my milk supply and it helped my son to heal better, it seemed. He also had a pacifier in the NICU, but tossed it out around 3 months. We were also told that he would probably have a harder time learning to nurse than a full-term baby, but he took to it like a champ and got going and nursed until 19 months. I did experience a drop in my milk supply before he left the hospital and was told by a local lactation consultant to take 3 capsules of fenugreek 3 times a day until my milk supply seemed to be at the level it should, then decrease slowly over a matter of days. It seemed to help me, but it does not help every mother.

I wish you much luck with your new little one. It's a scary time being in the NICU, but it's all worth it.

[irinam]

No NICU experience, but had to constantly worry about my supply.

Oatmeal was the best, also:

Camomile tea with honey and milk

Mother's Milk Tea (herb mixture)

Blessed Thistle

Marshmallow Root

[Mrs Dimples]

You are doing everything riht as far as pumping goes. Every 2-3 hours around the clock, with a hospital-grade pump. Don't worry that you're not getting much volume yet, it's only day 2. That's totally normal, and in a couple of days I bey you will start seeing more and more. BTW, if your baby has such an awesome strong suck need/reflex, why can't you put her to breast? Not that you haven't thought of this before, I am just wondering.

[mum2 4]

Our 7 week premie was in NICU for 31 days and fed expressed milk in easy flow bottles only ( except for the times some nurse forgot and gave him formula!)As we were being discharged one nurse told me, he'd get too tired bf; another sighed at the thought he would starve. Starve! I was bringing in a quart of milk everyday...
As we drove home, I told him, I only knew how to nurse and sure hoped he'd like it. I was a bit cowed by the nurses and the long time apart so I offered an ounce of expressed milk in the middle of most feeds for a few weeks just in case. At 6 months he had gained from 4 lbs to 16 pounds and was up to speed on all his developmental skills and his heart condition had resolved itself-all on Mom's milk alone...We did not use a pacifier except in the car sometimes.
Remember to have a drink each time you express so you have about 3 quarts total a day. Eat some oatmeal, take your vitamins, and learn to rest whenever you can. This can be a very up and down time as NICU is a scary place no matter how kind the Staff. Supplements can be given by finger feeding instead of bottle and finger can be used for pacifing as well. There is an article on breastfeeding.com describing this alternative to bottles. You can even upgrade your expressed milk by pouring off some of the fore milk ( save it for cereal later on) if ped thinks baby needs more calories per ounce.
Stay strong and think positively. You can resolve any bf roadblocks once you get baby home...

[orangebird]

I am a NICU nurse, you got some great ideas already. It is so hard to pump as it is, I can't imagine how hard it must be doing it without your baby near you for so long. The fortunate thing is you are only talking a couple weeks, not 8 months like some moms. But anyway, the binky. If you can't be there 24 hours a day to let her suck your breast, I think pacifiers in the NICU are a good thing. They really need that sucking for comfort and for normal development. I'd let her have it when you can't be there. I don't know how they are at that hospital but nurse as much as you can hen you go there. Some nurses I work with won't let mom nurse two feedings in a row or if the baby wakes up early they won't let mom try to feed again until the three hour mark. I on the other hand turn a blind eye and let mom nurse whenever when she is there as long as it isn't adversly affecting the baby. Find a nurse (or more) who shares your philosophy and if they have primary nursing ask her (or him) to be your baby's primary nurse. Sometimes the staff can be so great but sometimes they can be so discouraging. I hope your sweet baby comes home soon.

[Shirada]

Glad your baby dd is doing well and is getting your colostrum. This is a particularly interesting thread for me right now since my friend gave birth to her dd this morning also at 34 weeks. She weighed 4lbs 11oz and is breathing on her own but is still obviously in the NCIU and will be for a couple of weeks. Anyway, I saw her dh today and he told me that the hospital staff don't want the baby nursing right now in case it interfers with her respiratory system. I have never had a preemie and so have no experience of it so I just accepted what he told me although I thought it a little odd since I thought the best thing for a preemie would be colostum/bm and kangaroo care. Anyone can tell me why the hospital would say that. They are encouraging mom to pump, I think.

[BlueHydrangea]

Your situation sounds so much like my little guy - he was 6 1/2 weeks preemie and couldn't latch on. It sounds like you're doing everything right. Keep on pumping every 2-3 hours. It took me about 3 or 4 days for my milk to come in, but once it did, I had more than enough for him, so I started freezing the extra.

Meeting with an LC is also an excellent idea and definitely try to get her in the NICU with you. My hospital had no problems with it.

I'd also look into the alternatives to bottles for supplementing (with the LC's guidance, of course). I wasn't given the option of anything other than a bottle, and the little guy is now almost 8 weeks old and still won't latch on - he has a great suck now, but just can't take the boob. I really wish we had used something other than bottles in the beginning because maybe he'd be able to nurse now.

[Changed]

THIS I know....

Ok fist off you're doing great! Everything right. I'm so sorry you are going through this. It's a scary thing and so hard on a new mama. I pumped the whole time my 2nd child was in the NICU and then some. She was there 4 months.

First off, get a LC to meet you at bedside. They can tell help you with the nurses and docs tend to listen to NICU experienced LC's. Then, get a screen set up for you and a hospital grade electric double pump and pump AT the isolette. Yes, right there watching your baby sleep. You wouldn't believe the difference this makes. Relax. That's so important. Your baby should be able to nurse very soon.

Keep in mind, just because your baby CAN take 30CC's doesn't mean he/she needs that much or would nurse that much. You just had him/her yesterday. It's no problem that you have little milk. That's normal. Milk comes in around day 3. AND, your milk will be specificly adjusted to your preemies needs. Try not to worry too much. Your baby will be strong enough to start trying to nurse any day now. I actually disagree that a 34 weeks shouldn't be allowed to try. IMO< a 34 weeker is strong enough and kangaroo nursing will keep the baby warm. I breastfed a 2(and change) pound baby. I can't remember now exactly how big she was when we started nursing but I can tell you that she was only 4.4 pounds when she came home the first time and she was3 months old and had been nursing for a long while.


Good luck!!!! HTH!

[ishkabibble]

I agree with the advice from the pp's, but I have the following to add:

STOP them using the bottle ASAP. NOW. Find out about cup feeding or using a finger feeder or syringe.

The bottles caused my son horrible nipple confusion during his 2 weeks in the NICU, which almost lead to breastfeeding failure. If my husband hadn't had a long paternity leave I would probably not have made it.

I got bad advice at the hospital "just go home and nurse" because the hospital LC said I was doing great. WELL. I nursed for a week and then found out my son was not gaining weight properly... he wasn't sufficiently sucking... and so my supply had diminished. This lead to pumping after every nursing session for the first two months & having to use formula for a couple weeks in addition.

The best things you can do are: find a great LC, and rent a hospital-quality scale when you get home so you can check to make sure your child is gaining weight. I got the kind that could calculate the difference pre- and post- feeding (Medela BabyWeigh?) and this was the only way I made it. I weighed him once a day and slowly tapered off first the formula then the expressed bottles of breast milk, etc.

I would recommend finger feeding but if you can't get the nurses to do that ANYTHING is better than the bottle.

As to your supply issues, your supply will increase as the colostrum changes to mature milk, and also what the pp said about just cause they eat X ounces doesn't mean they need X ounces is true.

I had to pump from the moment my son was born and at first I was only getting drops then 10cc then more and more and before the 2 weeks in the nicu were up I would get a decent 3 ounces.

So just keep pump pump pumping!

Hang in there.

Diana

[schatz]

Two years ago I was in your situation! Water broke at 34 weeks, 10 day NICU stay. Everyone has given good advice so I don't have much to add other than get in as much kangaroo care (skin to skin contact) as you can. This will help your milk flow and you and your dc can bond. Second, try to nurse before as many "feedings" as possible while your dc is in the NICU. With dd, they would weigh her first, she would nurse, then weigh her again and finish with the NG tube or bottle. This way your dc will learn that milk comes from your breast and it will be easier to transition when you get home. And have an IBCLC lactation consultant meet with you when you feed your dc. This is critical. You may also have to remove some or all of the baby's clothes to keep him awake for bfing at first.

Keep up the good work! Your efforts will pay off.