NICU - Bottled EBM vs. Breastfeeding

[Mama2RMM]

I have an honest question sparked from several posts here and the Dr. Sears Preemie Baby Book. I don't mean to start flames, so please just share your experience or comment on your NICU's policy.

Our girls were born at 32W. We knew they were going to be premature, so I'd done a ton of research about breastfeeding preemies. Everywhere I read talked about pumping and bottle feeding and then how to transition back to the breast. I also read a lot of stories of Moms that never got their preemies to the breast and had to EP. I was determined not to have that happen. I wanted to suceed and knew that with a toddler and two newborns I wouldn't do well keeping up with pumping and feeding.

We simply requested from Day 1 that our girls never receive bottles. They were fed through their NG tubes up until they went home. I was at the hospital for 2-3 breastfeeding sessions per day and I did one 24-hour rooming in stint and one 48-hour rooming in stint right before they came home. We worked with the LC weekly to ensure proper latches and the girls proved they could gain weight solely breastfeeding over the longer durations that I roomed in.

All of our nurses and doctors readily agreed that learning to nipple from a bottle was no easier or faster than learning to feed from the breast. Yet this isn't presented as an option anywhere that I researched. I honestly thought they were going to tell me flat out no when I made my initial request because I'd not read that it was possible to skip bottle feeding with preemies.

Our girls were born at 32W, started latching on for short bursts at 33W, did well by 36W and came home at 37W.

X-Posted to Breastfeeding to get a broader response.

[twins10705]

My NICU was not bfing friendly at all -- when the NP told me that we could try nippling(around 2 weeks after their birth), I asked about bfing and she told me that they would just have to wait and see how they did with a bottle. I got such a runaround about bfing(and there wasn't any privacy really in our NICU plus it was more a pain for the nurses I guess ). My babies were never even put to breast until 35 weeks gestation(6 weeks pp). Of course, they didn't know what to do with it! They were used to super fast flow rubber NICU bottle nipples. Everything has been an uphill battle because of this. Although I pumped religiously every 2 hours, I never got a full supply of milk in(about 12 oz every 24). I know that if I had been putting them to breast from the start of their feedings I would have had enough milk and they would have learned to do it just fine. Stubbornly, I kept eeking out those drops of milk for them month after month until one baby stopped screaming when offered the breast and started nursing 5 months pp. He is a pretty good nurser now -- it is still a constant fight with my other baby however. As long as he nurses at least twice in a day I am happy he is getting some, though I am hoping he will want to nurse more as he gets older.
I wish I could go back and say "no bottles." -- though I really doubt that would have gone over well.

[Mama2RMM]

I admire SO much Mamas that have stories like yours because I know what hard work you've had to put into pumping and getting babies on the breast. It breaks my heart that hospitals are not more supportive and it's rarely addressed in literature.

I just can't fathom why there isn't more out there to inform people that it is possible not to bottle feed in the hospital. I was really shocked to find no info here or in the Sears preemie book. I didn't read KKG's book on feeding multiples, perhaps there is mention of it in there?

I posted here since a good amount of multiples are preterm. I know it has to be a hard subject to discuss, and feelings are sesitive if the breastfeeding relationship isn't established as a Mom wishes.

I hope even if one person can take away suggesting no bottles in the hospital and save themselves such a hard journey that posting our story is worth it. I just hope it didn't come across as boastful... I certainly am not trying to be "above" what other people have done.

[cdahlgrd]

Hospitals are coming from the other side. . . at least their alive. They don't see anyting wrong with formula or with pumping for mom (because most of them haven't tried it! Especially with multiples!)

Sooo, just remember where they are coming from when making requests. Also, most NICU's see your babies and "their" babies until they go home. When you try to make the rules or be the dominant figure in these kid's lives, it can get nasty (not always, but can).

That said, I agree that we need to keep at the docs and nurses. Eventually, they will catch on about breastfeeding/kangaroo care etc.

As I tell most people, I wouldn't wish my worst enemy a stint in the NICU with her child, but thank God it is there when we need it.

[Nessa's Quiverfull]

My boys were in the NICU for 7 days. I pretty much did whatever I needed to do to get my boys home. I would pump and bring breastmilk to the hospital 3-4 times a day. At first they were being tube fed..and then they were being bottle fed. During the times that I wasn't there to nurse them they would get the bottle. Both of my boys were lazy nursers, so eventually when we got home we switched over to the bottle. I pumped for them for 8 weeks before switching them over to formula. I really wanted to breastfeed them like I had done with my girls..and I was sad when I stopped...I was just to the breaking point and needed some relief.

[Periwinkle]

My twins were 2 mos. early and were tube fed initially, followed by bottle, followed by breast. They could not get enough from the breast to gain weight in the NICU (they barely woke up at all and their sucks were very weak), and did not nurse well until they were about 1 week past their original due date, i.e., when they were supposed to be born anyway. Nursing skills vary a lot and some babies - even barely early, healthy babies who are just born at 35 or 36 weeks - are too sleepy and/or just don't get it togther with nursing until more like 40 or 42 weeks equivalent.

So I guess what I'm trying to say is, if your babies can nurse well enough to thrive then great, but a lot of babies can't that early. So in order to get them the hell out of there (my numero uno priority) you do what you gotta do.

After we got home (they came home from the NICU equiv. to 35 weeks gestation!), I worked with an IBCLC who specialized in preemies - she was wonderful and it was due to her knowledge and perserverence that we were finally able to exclusively BF. That happened for us around the time they should have been born anyway.

[2QTs]

We also did not have a BF friendly staff at the NICU. My boys were born at 30 weeks, so of course we started with the tube and then at 33 weeks they wanted them to nipple. BF was out of the question they said at that gestational age and they needed to measure the amounts they were getting. I wish I would have stood up for myself better in there, but like others, I just wanted to get out of there! As soon as they were able to get the nippling down and gain weight they could be released. We were relased 7 weeks later. I immediately got with a LC who came to the house everyday to help us get back on track. It was not easy as the babies were very confused but after a couple weeks we got ot down and we are still going strong today. I'm sorry for anyone that has to go thru the nicu experience!

[crissei]

: Sigh... pretty much the same story.

DS was born at 30 weeks. I lived an hour from the hospital and was only able to come in once a day.
The neonatologist actually made me cry, he said I was trying to nurse DS to often. I decided that it was best for us to get him out of there by any means neccesary and, then do damage control when we got home.
My only resources were my instincts and this site but, I managed to hold on and DS is still going strong at 18 months.
The ped. was no help either. When I asked for help with getting DS off bottles and to the breast, he flat out said "you won't be able to, I have never heard of a preemie that was exclusively breastfed":

[JoyJoy1975]

My DD was born at 32 weeks and was 3 pounds 12 oz I refused to let them put a tube in her nose. I called a lactation lady up and I BF her from the breast she was out of the hospital in a week. Thats our story she never had a bottle their except at night and it was EBM and the NICU was the easist time to feed her it was when I went home I got bad advice.:

[tikva18]

Our hospital wsn't supportive either. I pushed for Gedalya to have the n/g tube instead of bottles, and then they convinced me that if he had bottles it would be faster to go home - and that they had a method which would teach him how to suck/swallow/breathe. So we did that for both babies - gedalya was breastfed solely one week out of nicu and TEhila took a month (until their due date). Our ped was insistent that no one can nurse twins exclusively. HA! She always mentions how shocked she is that they are exclusively nursing.

Oh, and I recently read somewhere (wish I could remember where) that preemies actually do better when they are breastfed rather than bottlefed.

[puffelly]

The hospital and NICU staff were very good.
They tried very hard to accomodate my wishes and we were able to meet half way on all our issues.
Kilian and Bjorgvin were born at 35 weeks.
Kili went to the breast right away and Bjorgvin at two days old.
I requested that the boys had no bottles, although they did receive my pumped milk and formula while they were in the NICU for 6 days.
However, the hospital had an exceptional lactation staff!
When the boys came home, I was diligent about putting them to the breast (using the nipple shields) and pumping afterwords. For the first few weeks they got two bottles of breastmilk and put to the breast, so I could sleep a bit. By four weeks they were getting only the breast and by six weeks we didn't need nipple shields anymore.
I am so proud of them! At seven months they are still bfing like pros.

[tanyaandallie]

My ds was born at 34 weeks. I had given my dh strict orders early on in my pregnancy that if anything happened (premature birth, c-section) that he was to follow the baby around and allow no bottles or formula period. That didn't exactly happen. He started bottles the evening he was born and started bf the next day.

I guess I don't have a huge problem with bottles in general when it comes to preemies. Before my son was born I sort of had the evil-bottle mentality and didn't want my son having one. After he was born I suppose I did some rethinking.

I don't prefer to bottle feed my kids but while he was in the nicu I was simply not able to be there for every feed. Plus he just could not take enough milk in from bf alone. He suck was just not strong enough. It was not until he hit 37 or 38ish weeks that he was nursing well enough to take all feeds 100% nursing. For us the bottle caused no problems and for that I am grateful. I knew that tube feeding was an option if I wanted to skip the bottle but I didn't want to push as I was already the pushiest mom in the nicu (or so it seemed like). Plus as crazy as this sounds, I wanted him to get some comfort when he was feeding. Babies need to suck. Sucking is comfort to them. Since I was not able to be with him all the time and bf him all the time like I would if he were home, the bottle and the paci were there to comfort him. I totally understand the fear that the bottle or the paci will disrupt the bf relationship, but I also would not want my baby screaming in his isolette with nothing to comfort him when I could not be there. Plus, even if I was there, they didn't want him out of his isolette for extended periods so I couldn't have just sat there and held and nursed him all day.

I was allowed to bf once or twice a day and I really had to push for it. The nurses were not supportive at all. They did have 2 really amazing nicu lc that worked strictly in the nicu. I am so thankful for their support!

[boscopup]

Originally Posted by tikva18

Oh, and I recently read somewhere (wish I could remember where) that preemies actually do better when they are breastfed rather than bottlefed.

The NICU LC told me that breastfeeding was better for preemies who are having apnea issues! So when I told her that he was having some feeding apnea, she said "Get that baby on the breast!", and she talked to the NICU staff for me. It was great!

But I also agree with PPs about some babies not having the physical ability to get milk out of the breast, even with the help of the nipple shield. I got lucky. My DS took to it right away (with nipple shield) and his belly was full after each feeding. But alot of babies don't have that strong a suck so young.

I'm saddened by the ped's comment about never seeing an exclusively breastfed preemie though. I know several of us here have done it! It *is* more difficult, but it certainly can happen. DS was home at 33w3d gestation, 100% at the breast (with nipple shield). 4 weeks later, we were off the nipple shield. He did get bottles during his stay, and a pacifier during tube feedings. I truly think I just got lucky, but I'm proof that it can be done! But in alot of hospitals, the support just isn't there, both in the NICU and in the regular postpartum units.

[Lousli]

Originally Posted by boscopup

But I also agree with PPs about some babies not having the physical ability to get milk out of the breast, even with the help of the nipple shield.

This was my dd. We tried in the NICU, weighing her on a scale before and after nursing, and she just wasn't really getting any milk out. She came home after 23 days but wasn't able to nurse without a shield until she was 3 months old.

But she's still nursing now at 19 months! And nursed exclusively until 7 months when we first added in a bit of solid food. It was a ton of work, but it can be done. I was lucky that my older dd was nursing while I was pumping and my supply was kept up!

[ApplePieBaby]

Mia was five weeks early- we requested no bottles & they syringe or finger fed her my pumped milk when I wasn't there to nurse her- which was only like twice a day. They were very good with listening us about it.
Unfortunately, Elora is in a different (higher level) NICU that's much further away and we can only visit once a day... I don't know what I am going to do when she's big enough to start taking feeds by mouth. Right now I'm pumping about 20 ounces a day though for her. I've talked a bit to them about transferring her to the NICU Mia was in when she needs less critical care, and then I'll be able to nurse her. I think at this point though, with her being 15 weeks early, I am just happy she's still doing so well. I will pump for her & if I have to give her EBM in a bottle, so be it. I just want her to grow and come home.

[jkpmomtoboys]

My ds was in the hospital for 2 months and for us, we had to prioritize our issues. We wanted him to get the hell out of there, and the sooner the better. Our hospital, which is EXTREMELY supportive of bf'ing, has as one of the discharge rules that the babies must be able to nipple all their feeds.

Well, I was at the hospital 12 hours a day, but since I couldn't be there 24 hours a day, I had no problem, and even encouraged them to give ds a bottle of EBM when I wasn't there.

He never had any trouble switching back and forth between nipples and in fact started bf'ing like a champ at 32 weeks.

So while I applaud all NICU moms, there is no one right way and those of us who had longer stays and more complications frequently had different priorities.

[tikva18]

Originally Posted by boscopup

I'm saddened by the ped's comment about never seeing an exclusively breastfed preemie though. I know several of us here have done it! It *is* more difficult, but it certainly can happen. DS was home at 33w3d gestation, 100% at the breast (with nipple shield). 4 weeks later, we were off the nipple shield. He did get bottles during his stay, and a pacifier during tube feedings. I truly think I just got lucky, but I'm proof that it can be done! But in alot of hospitals, the support just isn't there, both in the NICU and in the regular postpartum units.

You misunderstood my post; the ped wasn't saying that she was surprised about successfully nursing preemies, she was surprised that I was successfully nursing TWINS.

[Happypants]

the first nicu we were at told us we would have to bottle feed first to have ds' latch evalutated, and then we could start bfing normally. luckily, we came back to our local nicu before he was ready to start, and the very day we got back the neonatologist asked me if i'd started putting him to the breast yet. i almost broke down just at the question. anyway, my ds was either tube fed or breastfed his entire time in the nicu, never once received a bottle, and came home bfing with a nipple shield. a week later, he had transitioned to not needing the shield. i am so thankful that the second nicu was as supportive as it was.

eta: ds was born at 26 weeks and was moved back to the local nicu at about 32 weeks. we did a lot of practice nursing where whatever milk he got didn't "count" and he'd get a full meal through his tube. it wasn't until much later, maybe 37 weeks, that he actually started getting full meals bfing. and it wasn't until they quit giving him so much through the tube that he woke up and got hungry enough to get serious about eating! he came home at 38 weeks 2 days.

[CallMeMommy]

Tube or breast 100%, never once got a bottle (or formula for that matter - did get the HMF in his tubed milk, though). I did actually have to lie to the nurses to get DS home, he was nursing fairly well but not good enough for them, so I lied and said he was doing better than he was because I KNEW he'd do fine once he was off their stupid 3-hour schedule (and he did!). If it wasn't for Nurse Judy switching to an old nursing guideline that they weren't using anymore but fit my son better, we would have been in there a lot longer. I read somewhere, and I wish I could find it, that premature babies (as opposed to preterm babies) don't learn to breathe-swallow-suck any faster on bottles than they do breast, and bottling their feeds won't get them home any faster. The nurses at our hospital were more concerned with the quality of the nursing sessions rather than the exact amount of intake he was getting, and as long as he was gaining every day they were happy.

[boscopup]

Originally Posted by tikva18

You misunderstood my post; the ped wasn't saying that she was surprised about successfully nursing preemies, she was surprised that I was successfully nursing TWINS.

Sorry, I was commenting on crissei's post... should have quoted her...

Originally Posted by crissei

When I asked for help with getting DS off bottles and to the breast, he flat out said "you won't be able to, I have never heard of a preemie that was exclusively breastfed"

That was what I was referring to - a ped that hadn't ever seen a singleton preemie exclusively breastfed.