Feeding a Preemie in the NICU

[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 Parenting Multiples as well to get a broader response.

[ApplePieBaby]

My daughter Mia was born at 35 weeks and spent just under two weeks in the NICU...
I did the same thing- pumped until she could eat & requested they not give her a bottle... I was lucky in that I was able to go to nurse her for almost all of her feedings, I think I only missed two a day... it was exhausting... but she was in a hospital only 10 minutes away & my MIL was here and my DH was on leave...
Anyway... for the feedings I wasn't there for, the nurses syringe or finger fed her
Now with Elora, I am only able to visit her once a day since she's so far away
We're hoping by the time she's ready to try nursing, we can get her transferred to the local hospital- they just don't have a good enough NICU for her right now...

[bri276]

my NICU wanted babies off the ng tube due to risk of aspiration. I'm not saying I agree with their assessment of the possible risk. But that's why it was policy. And considering I had nurses who didn't even bother to use my refrigerated milk and went straight for the formula against my requests, I"m thinking they'd not be willing to finger or syringe feed.

[chlaal]

Well, we were in the Level 2 nursery, not NICU (Level 2 is in between the NICU and regular nursery) but we did a combination. My DS was born at 34 weeks and he did receive some formula in the Level 2, but they also worked very closely with me to get him nursing. At each feeding, there was a nurse or LC who helped with latching, and we tried to get him to nurse at least 10 minutes on each side, and afterward they would have me give him a bottle (formula). I was also pumping, but for the first few days of course only getting a few drops of colostrum. However they did use a syringe to carefully suck up every drop of what I pumped, and gave it to him in a bottle.

They did also use the ng tube, mainly to remove his stomach contents so they could measure how he was digesting. That was just for the first 2-3 days.

When we went home, they told me to put powdered formula into the pumped milk. At that time we were staying with my mom and she would give him a bottle of ebm once each night so I could get a little extra sleep. We only did the adding formula thing a few times, after which I decided it seemed dumb so we stopped. He was growing well and clearly healthy, and my milk had come in, so I didn't think the formula was necessary by then.

If I had it to do again, I would probably resist the formula more strongly, and question them more carefully on why they thought he needed it. But I was a first-time mom with a TOTALLY unexpected preemie, so I was just kind of shell-shocked and did whatever they told me. The hospital was very supportive of bfing and gave me lots of help with it -- and DS went on to nurse until he was almost 2 and a half, so it all worked out.

Oh, and when he started daycare at 6 months, it was a struggle to get him to take ebm from bottles again! So certainly having bottles in the hospital did not ruin him for nursing or anything. I really think this depends a lot on the individual baby's personality, in addition to the other factors.

Not sure if I answered your question : but that's my story!

-Joan

[plantmama]

Ds was born at 30 weeks and had a gavage until he started to move around and pulled it out a couple of times, this was not 'til 34 weeks or so. I requested that they not use bottles until he had been breastfeeding a bit. From 31 weeks on I tried very slowly and without any expectation until he started nursing (maybe a week or so later), just for a few seconds at first, and then by the time we went home at 36 weeks he was exclusively breastfeeding and rapidly gaining weight. When they took out the gavage he received several bottles a night when I went home to sleep- always pumped milk.
Another mother whose son was in the NICU was having a much harder time and her baby had been givin bottles against her wishes. But he was having other problems too.
I was told by everyone who had experience with successful breastfeeding to avoid the bottle until breastfeeding had been accomplished- and it worked for us.
I think for the most part the whole 'bottle feeding is easier and breastfeeding stresses them out' is bs. I did hear that from several nurses and simply had to ignore them. Luckily they had 3 other babies to look after and keep them busy.
Keep in mind that my ds was a normal, healthy, preemie without other challenges that might sometimes get in the way of breastfeeding.
I can't think of why bottle feeding would work over breastfeeding, but perhaps for some babies it is truly hard to get what they need from a real nipple.
Another thing I did was I always pumped BEFORE I tried nursing him (when he was still on the gavage), so I wouldn't choke him with let down, and then I gradually stopped until he could handle all my milk at once and in fact needed it. The gavage was nice because it took pressure off of us to get him necessary nourishment while nursing and if he wasn't into it- no big deal. When he had the gavage out, he started trying in earnest to nurse, so it was important to get it out at the right time.
Sorry for the long post- this is kind of a passion of mine I guess.
I really wish NICU staff were all more educated about helping preemies learn to nurse. Luckily ours was super into the benefits of breastmilk, so that was good. And some of them were so wonderfully helpful and supportive.

[mm's mom]

DS started with NG feedings and as he developed a good suck, we tried to breastfeed but he would not latch. The only thing keeping him at the hospital was the feeding issue at that point, so we introduced the bottle, and he took the bottle well. I still tried BF during that time, but he wouldn't latch on. So, once he was taking enough expressed BM by bottle, we took him home and over the next two weeks we transitioned to EBF. It did take 2 home visits by a LC, but we did it and nursed for 1 year.

I really was just at the point where i wanted him home and decided to do the switch to EBF once we were at home. I couldn't stand being at the hospital anymore.

[wende]

My son wouldn't latch on at the hospital. He did take to the bottle easier and I wanted him home so I let them give him a bottle. Once I got him home I worked with him until he nursed well. The only other option would have been leaving him in the NICU another couple of weeks and I just was not about to do that. I knew I could get him to nurse at home and I figured the time spent at home with me would be more beneficial than the 2 extra weeks in the hospital bottle free.

My dd never took a bottle and they wouldn't let her come home because of it. I even let them attempt to give her one. She wasn't having it. She nursed around the clock and I still had to fight to get her home because she wouldn't take a bottle.

Some hospitals are just not great with breastfeeding so we are limited in our options.