Am I wrong to consider pumping and bottle feeding instead of BFing?

[CeeCee123]

Hi,

Just feeling a little overwhelmed here. My son is was four weeks premature. During the first 10 days we did a "triple feed" - I tried to nurse him, then pumped and fed him the pumped milk because he was too sleepy and little to nurse. After 10 days he just "got it" and latched on and I switched to mostly nursing with the odd bottle thrown in if my DH was helping out.

I've had some issues since then with terribly sore and cracked nipples and I've been working really hard to try and get him positioned/latched correctly to try and alleviate that. I've met with lactation consultants twice and it seems everything is perfect when I'm meeting with them but when I'm at home it never goes as smoothly.

At this point he is three weeks old or technically "minus one week" gestational age. I'm getting frustrated with the breast feeding not least because of the soreness, but also because he seems to not be efficient enough to get what he needs. He can spend 45 mins - 1 hour nursing, and I know from having him weighed before and after that he takes in around 1 - 1.5 ounces. He also falls asleep a lot, even to the point where I cannot rouse him until of course I decide to stop feeding him, at which point he decides to start rooting again. Not to mention that during that time he seems to spend a lot of his time gumming on my nipples, at least that is what it feels like and it really hurts!

Give him a bottle of pumped milk and he can drink up to 3 - 4 ounces in about 15 minutes, and be satisfied when he's done without all of this falling asleep and deciding he still wants to eat a few minutes later. The amount he can drink from the bottle makes me wonder if he just isn't getting enough out of my breasts, although clearly I have the milk supply because it's there if I pump.

I'm lucky in as much as I can get a huge amount of milk if I pump - I seem to have a great let down response to the pump and can get as much as 5oz in ten minutes. I've begun to feel like for the sake of my sanity and my nipples that I would prefer to just pump and feed him the bottle. I don't know whether I should try that for a couple of weeks to let him get a bit bigger and stronger. I don't know what the disadvantages are for doing that other than missing out on the physical closeness, but I feel that i could easily make that up with cuddling, especially since I won't be as uncomfortable as I am during nursing!

Anyone have any insight/thoughts/suggestions? I am going back to a breast feeding support group and meeting with a lactation consultant again to see if I can get this figured out, but this solution seems awfully tempting, I just don't know if it's the right thing to do....

[alegna]

I'd say give it awhile longer. Exclusively pumping is HARD. Often impossible eventually.

For a *term* baby the first 6 weeks can be horribly difficult. I would set a deadline to keep trying until he's 6 weeks adjusted then see where things are.

I would say you need to work hard for a bit to move away from the bottle. Do needed supplements in another manner (sns or lactaid, cup feeding, syringe, finger feeding etc)

good luck!

-Angela

[Genesis]

I agree with Angela.
Hang in there, it will get better.

[Ruthla]

If you DO decide to pump and bottlefeed for most feedings, I would urge you to BF him directly once or twice a day so he doesn't forget how to do it.

I've never had a preemie so I really don't know what it's like caring for one- full term babies are exhausting enough! You need to find ways to balance your needs with the baby's needs.

[attachedmamaof3]

pumping and then bottle feeding is a giant pain in the butt.

I second the previous posters. It is REALLY tough for the first six weeks, even for a seasoned mom and full-term baby!!

Keep in mind that the baby does have to "work" to nurse, which can make them a little tired....and sometimes even full-term babies stay on the boob ALL DAY LONG DRIVING US IN-SANE!!!!

Hang in there!! Once it clicks it will be so worth it.

www.kellymom.com

One of the best breastfeeding sites out there!

La Leche League in your area may have members with preemies and similar issues!!

[pinky]

I would really encourage you to hang in there. The early weeks are hard under the best of circumstances, and you have a bigger hump to get over than most. The thing is, if you can get breastfeeding working well, it will be so so so much easier than pumping and bottle-feeding. Really.

I agree that if you can, work away from using bottles at all. Can you supplement with a SNS? Finger feed? Unfortunately, the ease of getting milk from a bottle is probably contributing to his inefficient nursing, since he "knows" he can and does get it more easily that way, he won't work so hard at the breast.

Good luck. Getting support and help is a great idea!

[wendyland]

I know it's stressful and painful. I just went through it myself, although I did not have a preemie. My daughter has a shallow latch. She's 10 weeks and I still have to work with her to get her on good. I also had really cracked nipples at first. I grinned and beared it & it's so much better now. It's also a lot easier and more effective than pumping.

[Natsuki]

My DS was born at 39 weeks - so the same adjusted age as your DS is now - and whenever i would try to get him to nurse he would fall asleep. It was frustrating but passed after a few days. I tell you that to reassure you that what he's doing is developmentally normal given how young he is.

Exclusive pumping is HARD HARD HARD - much harder than nursing over the long term. Plus, it is difficult to sustain a milk supply for an extended period of time with just a pump.

I strongly recommend that you stop using bottles and instead supplement him with an SNS (supplemental nursing system) or finger feeding/cup feeding so that he doesn't get lazy with his latch - at this point a bottle will work against him latching well b/c it doesn't use the same muscles strength.

[sbgrace]

I was breastfeeding then pumping and bottle feeding and it was beyond awful. Then I had to just bottle feed one expressed milk while I did the whole routine with the other...and so I gave up and decided to just pump.
It was easier than the uphill battle to get them total breastfeeding seemed like it was going to be. And I was exhausted and discouraged.
If I had it to do over again I would have fought that battle. Pumping exclusively is very hard. The hardest way to feed hands down. And while it can be done most people don't make it as long as they would have liked or as long as they would have breastfeeding. So my advice is to stick with it--maybe set a manageable time frame of say a month after the due date (or two weeks...whatever seems manageable) and if it still isn't going well reconsider. But if you can get on breast you will be so much better off/easier going long term. He's still not term and I think that is likely a large part of what is making this so tough.

[Valian]

The short answer? Yes.
Its wrong to consider going long term as an "EP-er" that is, an exclusive pumper, so soon. Pumping long-term is VERY hard and for many women its difficult to keep your supply up and meet baby's increasing need. Check out some of the EP threads and read more about what your future would be like.

Bottle feeding *only* for a few weeks is a big risk as baby could 'forget' how to nurse--latch is different on bottles and sucking is a different action and requires coordination of different muscles.

I wouldn't expect a preemie who is still minus one week to be anywhere near efficent enough to do a full feeding at the breast. He's falling asleep during nursing sessions because nursing takes an incredible amount of energy and your baby lacks the muscle strength to nurse for an extended period. Try to revise your view of your nursing sessions to see them as a workout for your baby who really is working hard even if it doesn't seem that way. Baby needs time to build strength and rest between sessions. Nurse on demand but don't wake baby more often than 2.5-3 hours if sleeping.

Nurse first, then offer EBM in a bottle when baby stops nursing or after 20 min TOPS. Its great that you're getting lots of milk from pumping! Keep that up since baby may not be able to nurse enough alone to keep your supply up.

Baby shouldn't be 'guming' on your nipples, it sounds like baby is having trouble keeping the nippled pulled out into a good latch and this is making you sore. Chomping at the nipple also happens when the baby feels they are losing the nipple and they are trying to keep it in their mouth. Nursing position can help with this. Nipple shields may help preeimes latch (these are sized to the baby's mouth and make a smaller/easier target) also they should help with your soreness. I do NOT reccomend starting with shields unless your LC agrees it would be a good idea but it is something to ask about. Using them for a week or two would be much easier, long-term than EP-ing.

I am not saying this lightly. My preemie took 6 mo (yes, months) to fully learn how to breastfeed like a full term baby and it was so, so, so incredibly worth it. You can find lots of info on the Preemic/NICU board about getting preemies onto the breast, or do a search throught he Breastfeeding challenges board.

[2crazykids]

Keep at it Mama! It's sooo worth it!!

All the replies are great.

Here's something to try: All Purpose Nipple Ointment or APNO for short. My OB had to prescribe it for me but it made a huge difference for me in those first crazy weeks of sore, cracked nips.

If your ob or ped is having a hard time finding a pharmacy to whip it up for you print out this recipe and get the ped to find a pharmacist who can do it for you.

BTW some nipple pain, cracks, and soreness are totally normal for the first few weeks, it goes away I promise!

[avedagrrl]

Congrats on the new babe! Sorry you are having some challenges. I agree with the PPs that it takes time for both of you to learn the basics of your nursing relationship. Both of my babies were 4 weeks preemie. With DS (first) it was hard, but I stuck it out and it was worth it.

ITA try not to do bottles for awhile. Preemies are even more prone to nipple confusion/lazy eating, and it sounds like your babe is chomping your nipples the way he would a bottle. With my DS I just used a syringe with a few CCs of breastmilk to get him excited about eating, letting him suck on my finger to coordinate his suck, and avoiding all synthetic nipples completely. Also, IME pumping makes sore nipples even more sore. When you finish a feed, squeeze some milk onto them and let them air dry.

The benefits your baby gets from nursing directly from you are more than just skin-to-skin. Your body will respond to his antibody needs through the mouth contact, and preemies need this immunity boost so so so much. I know it is hard mama, I've been there. My DS slept about 22 hours a day for the first month, getting him to eat was really tough. I started doing a football position and would rock him upwards when he'd fall asleep. Or rub his forehead. Or unlatch and start over... but after that first 6 weeks, we were rockin'! You can do this. Just keep telling yourself that. And I think getting in touch with LLL is a good idea, also to have someone who can see you in home, where you are getting the most frustrated might help.

[mamallama]

I think you've gotten great advice.

My first baby didn't latch until she was 35 days old. It's a long and fairly typical story of wrong information/poor support, so I won't bother telling it. The point is that pumping and bottle feeding is not a solution. Been there, and it was not a fun time!

The only other thing I can add to what other posters have said is that I just had my 3rd baby, term, healthy, good supply and mostly decent latch from the beginning, and it still hurt on week 3. It was enormously better by week 5.

It will get better!

[wannabe]

I would give it at least until he's two weeks corrected.

newborns are SLEEPY, and your baby isn't even a newborn yet! Hang in there.

[VeganMamaRed]

Hey there. I had a baby who was 4 weeks premature and was almost impossible to wake up to feed. It wasn't unusual for him to sleep more than 20 hours in a 24 hour period. As soon as I would FINALLY get him awake enough to latch he would settle onto the breast, nurse for two minutes, and get right back to sleep. It was HARD! He didn't have a great latch=sore me. My advice to you would be to stick with it because it will get better. In a month it is probably going to be smooth sailing for you to just pop him onto the breast when he's hungry (and by then he will most likely be very vocal and regular about letting you know he's hungry and staying awake for the feed!) rather than having to pump and then bottle feed. Premature babies do take their time and they can be incredibly frustrating. If you are getting sore from him just gumming I would try to take him off when he gets like that and either try again in a little while or wake him up again and start over. While my son was in the nicu (5 weeks) we had to do a few of his feedings as a finger feed because he was so sleepy. We also had to use a nipple shield for a few weeks because he wasn't strong enough to keep the nipple in his mouth properly.

This is a rough patch, but it will pass and you will be glad that you stuck through it. I would say to give him a few more weeks (as long as he's wetting his diapers and pooping and gaining). Hugs to you and congratulations on the new baby.

[miche28]

Yay for lots of milk and a determined mama - that's a lucky boy! PP have given good advice - you're not wrong at all to be tired and frustrated, but I'm not sure you're going to get the outcome you really want by EPing. Both my 35 weekers went for periods on EBM and bottles - besides the fact that it is gruelling, many mothers find they just can't maintain supply (or the schedule required i is just too much for them).

The thing about bottle feeding is that baby really gulps down the food because of the nipple - it's sometimes referred to as 'defensive swallowing'.

And, as you know, the action to get milk out of bottle makes for a very inefficient latch at the breast - a good way to get a sense of this is to try putting your pinky pad up in his mouth. You'll probably notice that his tongue is back in his mouth rather than forward - good for blocking the milk from an artificial nipple, not so good for compressing breast tissue. You need to that tongue forward so he can get milk out and to spare your poor nipples!

I know a lot of experts will suggest rousing a sleepy baby at the breast if they haven't nurse for such and such a time - I'm not so much a fan because I just don't think they're efficient if they're tired, esp. when they are wee. But obviously, you'll need to judge whether that results in him eating sufficiently. A couple things you might try:

- get some good advice on your nipples: it sounds like the pain of nursing is really interfering with your quality of life. Keep seeking out advice until you find someone who can help you reproduce a comfortable latch and give you some advice on comfort measures (APNO ointment, rinses, keep nipples exposed to air)
- get to bed and do nothing but nurse and rest for three days. Many mothers find that they get frustrated with the constant feeding because it keeps them from accomplishing anything else. But if this is the most important thing to you, then consider the 72 hours in bed time well invested - it's not forever and the payback of getting nursing on track could be infinitely more time than you'll have if tied to a pump. Let DH (or another support person) know that you'll need to be fed and watered and the baby will need to be changed
- breast compressions: as soon as baby starts sucking, compress your breast for as long as he will keep drinking. When he stops, switch sides and compress again. Repeat until he's tired.
- an SNS: this will allow him to get flow at the breast and help correct his latch while ensuring he gets the milk he needs. Yes, they can be addictive and hard to wean from, but better nurse with an SNS forever then end up having to move to formula

If there's one thing about nursing (esp. a preemie), it's that it is truly is hardest in the period when your ability to cope is lowest - there is light at the end of the tunnel (your baby can latch, you've gots lots of milk, a good support network).
HTH!

[Breastfeeding Insomniac]

Giving breastmilk in a bottle is better than giving formula, but I hate to see a women and a baby miss out on the wonderful bond of breastfeeding. If baby does well w/ the LC's and then once you get home it doesn't go as well, then I would suggest a postpartum doula maybe for a week or two. Doulas are wonderful and so knowledgeable with bf assistance, so if you had someone for a couple hours a day, just to be there w/ constant breastfeeding help, then there is a good chance you can get through this.

[GooeyRN]

I exclusively pumped for my dd for 18 months. She could never latch. It didn't seem so bad in the beginning. Especially when dh was still home to help out. But after she stopped sleeping so much, and dh went back to work, it became very difficult. I liked to pump when she napped, but when she went to only 2 naps a day, it was hard to pump with her sitting on my lap. She wasn't happy to sit and play with toys while I pumped. I also became resentful that I had to pump when she napped. I didn't get to take a nap myself or do whatever I wanted. Then it gets more interesting when they become mobile. Its hard to supervise them properly when you are attached to the pump. It sucks getting up during the night to pump. It also sucks having to take the pump with you when you go out for more than 3 hours. Your supply will drop if you don't pump often enough, even if you have enough milk stored up. It is doable to exclusively pump, obviously, but its a lot of work. I would use exclusively pumping as a last resort. Your baby is still so young, and didn't get efficient at nursing yet. Hang in there a few more weeks before you decide to EP. It should get better soon. If you are exhausted, see if you can hire someone to watch the baby while they are not nursing a little bit during the day so you can nap. Or, you can use an SNS/Lactaid temporarily to keep baby at the breast and fill them up more so you can get some sleep/rest. PM me if you want more details about EPing. There is also a tribe for exclusive pumpers in you are interested. It is under bfing challanges.

[Tofu the Geek]

Someone recently posted a breastfeeding video from Dr. Jack Newman and in that video Dr. Jack Newman says:

There's so much more to breastfeeding than breastmilk. Unfortunately people don't seem to understand that and they don't help the mothers to understand that...

He then goes on to say it's rough and it usually starts to get better around 6 weeks.

Dr. Newman runs a breastfeeding clinic with a colleague and here is a bit about their clinic http://www.drjacknewman.com/index.ph...d=13&Itemid=33

Additionally, you might not be able to keep your supply by exclusively pumping. Some people can, some people can't. Not a risk I would take if I didn't have to. My friend's baby was bottle fed pumped milk on a regular basis and baby eventually gave up on the breast at 9 weeks of age. Friend's supply dropped while pumping and baby was on 100% formula by 12 weeks of age.

[luminesce]

Personally, I'd give it several more weeks. I think the more you try and the more time you give it, the faster things may get better. I think a lot of the issues you are worried about are totally normal and will almost assuredly get better in a few weeks. It could be that it will take a few weeks longer for you or that some of the problems are a little more pronounced (like sleepiness) since he is a preemie.

Babies get very, very efficient at getting the milk out with practice. It is entirely normal for a teeny baby to feed for an hour and then want to feed again. My babe couldn't be put down at ALL for four weeks. He always wanted to be attached. I had to constantly wake him to eat, too. Now, he can eat in five minutes and I wish he'd stop squirming and let me cuddle him more.

I don't think the amount a baby drinks from a bottle is an indicator of much of anything. The bottle is not even remotely like the breast. A baby can overeat when fed from a bottle and get used to a faster flow. And - when he eats from the bottle, he isn't practicing his latch or at getting better at getting milk out of your breast.

Pumping is not the same as a baby. I'd be afraid that my milk supply would decrease if I started to exchange the baby for the pump.

My nipples were SORE, SORE, SORE for the first few weeks and I was sure from everything that I had read that I had to be doing something wrong but I wasn't. I tried repositioning him. I called my midwives/nurses for help. They offered advice on how to train his tongue, etc. But, in the end, just like the LLL told me at birth -- his latch was excellent. It just took a while for my nipples to get used to the shock. They looked like raw meat in a big line where he constantly gummed down HARD. I remember thinking there was no way they would ever heal or the pain would ever go away. But it got better. I used lanolin until the cracks healed (maybe 2-4 weeks?) It took longer (maybe 8-10 weeks?) for the pain on latch to be completely gone. My baby had a super, super, super strong latch that I almost couldn't break. His latch decreased in strength significantly after a few weeks and my nipples got more used to it. So now, nothing hurts and I can pop him off by just touching the side of my nipple. In fact, he pops on and off all the time while feeding. In the beginning, I thought I was going to die and grabbed on to anything in sight if I had to relatch him during a feed. :

In the end, I think you are still really early into this and if you give in to what seems like the more convenient path now, you'll probably kick yourself in the butt later. Think about feeding the baby in quickly from your breast with no pain -- versus -- constantly pumping, cleaning the pump and parts, trying to keep up supply, storing the milk, washing the bottles, etc.

It may be that you have to end up EPing -- but from what you've said so far, I don't see why you'd have to -- what you describe sounds totally normal and very similar to what I experienced (minus the low supply!) and I'd definitely give it several more weeks, especially since he is a preemie.