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Need help in transition from NICU to BF

post #1 of 28
Thread Starter 
Hi Ladies,

My babies came earlier than expected - water broke in the middle of the night and there was no going back. So they were born 2/23 at 34w2d gestation, both vag delivery (w/ manipulation - first was a "stargazer" and needed to be rotated, 2nd was breech extraction). She weighed 5lbs1oz and he weighed 4lbs11oz. No intubation as their lungs were good, but needed help with eating and spent about a week in the NICU, being fed with bottles and under the bilirubin lights.

I've been pumping and pumping but am not yet making enough to feed both - can feed more than one, but not 2. I'm working on nipple stimulation with them, and practicing putting them to breast. They each had a short nursing moment but often express frustration there so I immediately remove them. We are using Level 1 nipples (not premie nipples) so they do have to suck at the bottle to eat - but i'm sure it's not the same.

Mentally I know this transition is not going to be easy, and I've heard too many stories from mothers who have not successfully transitioned from pumping into bottles to breastfeeding. So please help - I'll take advice, success stories, any kind of encouragement here.

My pumping details: Overnight I wake up every 3 hours to pump. While running to the hospital every day managed only 9 times daily, 140-160 min. Yesterday is the first day I managed 12 sessions. Output has been in the 400's ml (or cc, or about 13.3 oz) per day. I think yesterday I broke 500ml for the first time. The babies are eating 50-65ml each feed, 8 times daily. I tried to never go more than 4 hours w/out pumping, but hospital visits did interfere with that plan - though never more than once daily. I understand the 1st two weeks are crucial for establishing supply - tomorrow will be 2 weeks post delivery. I've been taking the advice from the LaLeche League book on breastfeeding for multiples by Karen G something.

I'm really hoping that my supply will increase for them so we no longer need to supplement, yet they can continue to grow well. I have heard about just spending a day in bed w/ a baby and only offering the breast, no bottles, but
I'm afraid to do that right now. They only weigh 4lbs10oz right now, and we can't have their bilirubin levels go back up. I just never thought we'd be using bottles!

Again, any kind of encouraging advice/stories are appreciated.

AnnJay
mom to Alexander and Sophia, born 2/23/08
post #2 of 28
AnnJay: You can do it! My boys were in the NICU for 2 and 3 weeks, respectively. They would not ALLOW me to nurse them in the hospital because they said it would make them desat, exhaust them, etc. (grrrr still mad about that). They were so small (under 4 lbs at birth, only a few ounces bigger when they came home), and it was really hard, but we did it! They are huge and fat and chubby now - almost 4 times birth weight at six months- and still EBF.

We worked so hard, and the first 3 months are just a total blur to me now, but I am happy to give you advice, support, whatever you need. The biggest thing is to just stick with it, even though people will ask why you don't just switch to formula, even though it's really hard. Your babies will thank you for it, and this is a great place to come for support.

Feel free to pm me if you want to talk more about it. I would love to help another mom be as successful as we have been!
post #3 of 28
Thread Starter 
Quote:
Originally Posted by valkyrina View Post
They are huge and fat and chubby now - almost 4 times birth weight at six months- and still EBF.

We worked so hard, and the first 3 months are just a total blur to me now, but I am happy to give you advice, support, whatever you need. The biggest thing is to just stick with it, even though people will ask why you don't just switch to formula, even though it's really hard. Your babies will thank you for it, and this is a great place to come for support.

Feel free to pm me if you want to talk more about it. I would love to help another mom be as successful as we have been!
Ahhh a success story! Terrific.
I would love to hear the details of your story. But I haven't figured out how to PM yet. (Sorry!)

The lactation consultant the other day said to me, we're the only species that feeds another species' milk to its young. Ouch that stung - as if I'm having a choice here! OK, gotta go pump.

Look forward to hearing more from you.
post #4 of 28
CONGRATULATIONS!!!!!! I hope you can have some joy in your babies even with the tough circumstances you have had. I'm so glad a twin mom was able to tell you that it will work out, because my story is that of a singleton with my water breaking at 35 weeks, and 2 weeks in the hospital because of challenging feeding issues. But I was going to tell you that it will work out, and that breastfeeding is soooooo much more effective (and ultimately easier) than pumping. My milk supply was almost embarassing, as all the moms w/babies in the NICU put their milk in the same fridge, and mine was literally like 5ml, 6ml, and progressively more and more, but soooo challenging!
And we literally camped out at the hospital, which I'm sure the stress of that didn't help milk supply. Trust that when you are at home with the babes, and able to settle in, things will get easier.
Both LLL and my midwives had recommended the "24 hour cure". It's where you lay in bed with your babes for 24 hours straight (you need someone to wait on you hand and foot) with as much skin to skin contact as you can get (both you and your babes are ideally shirtless). Let them nurse whenever they want to, and just smell you. We actually didn't do this until she was a month old (on her due date), but we were not being very encouraged to breastfeed as it was considered "hard" on her-- similar to the PP's experience. The funny thing was, my DD wanted to eat more frequently than what they were feeding her. Once my body synchronized to her, I produced enough. I never had excess milk production, but it was enough for her, and I believe you can get enough for your twins. I am a big fan of breastfeeding, and almost don't know if I should say this, but if you need to supplement for your peace of mind, then do so. Of course, every time you use formula, you are basically telling your body that it doesn't need to produce just then. But you will find what works for you and your family.
One funny thing that I hadn't thought of was that my DH was bottle feeding her a lot, and really missed it once I did the 24 hour cure and ditched the bottles altogether. I made the focus of my life to be breastfeeding, in order to really get established, and there are supplements you can take (all names evading me right now, but I'm sure someone else will jump in with them). Also, and not sure if you drink, or what you will think of this, but a really good beer sometimes gets the milk flowing (I think it's along the lines of an old wives tale, but seems to work a lot for some people).
I know it is so stressful to have an early baby, let alone early babies, but they will do fantastically, and I believe that everything happens exactly as it's supposed to. For myself, it really changed my thinking about being a mom. I thought I would be back to work, and back to my life in general in 3 months or less, and this really grounded me into being a great mom to my daughter. I laugh (quite hard, actually) at the appetite my DD has today -at 3 1/2 years old. The child has never been "chubby", which I sometimes envied in other kids, but she eats like a horse, and mostly all good foods.
It will work out fabulously for you, and I am so happy that you have your babies and are getting out of the NICU. There is so much support out there (my heart is holding you and your family), as I'm sure so many others on this board will be feeling the same, and sending good energy your way.
Like the PP, know that I am always open to being contacted for any support you might need. I know what it's like, and it would make me so happy to be able to help in any way.
Congrats again!!!!-Elizabeth
post #5 of 28
Quote:
Originally Posted by mamaeliz View Post
Trust that when you are at home with the babes, and able to settle in, things will get easier.... The funny thing was, my DD wanted to eat more frequently than what they were feeding her. Once my body synchronized to her, I produced enough. ...there a re supplements you can take (all names evading me right now, but I'm sure someone else will jump in with them). Also, and not sure if you drink, or what you will think of this, but a really good beer sometimes gets the milk flowing (I think it's along the lines of an old wives tale, but seems to work a lot for some people).

Congrats again!!!!-Elizabeth
Okay, that was really long mamaeliz, so I parsed it. But a great reply.
As far as things getting easier when you're at home.... don't get your hopes up too much. It gets different. I'm not sure about easier. Although I guess it was definitely easier than the hospital. Still hard, though. Okay, so that's the bad news. The good news is:

my babes also wanted to eat far more frequently than the every-three-hours schedule at the hospital. They were loving the all-you-can-eat buffet when they got home! And it really helps with your milk supply, too. There's a tea called "Mother's Milk" that I used when I was having supply issues, and it worked great for me. You should be able to get it at just about any natural foods store. And I know some people frown on it, but a really good, hoppy beer is awesome! Not only does it make for a happy, relaxed mama (which helps with letdown), it actually is good for your milk. And it doesn't seem to have any weird effects on the babes at all.

As far as our success story, I don't have time to write it all now, but I'd be so happy to share. And if pming is an issue (I'm still iffy on it, too), you can email me: ellibby@gmail.com

I'll try to start writing it out, because I would like to post it someday anyway. Good luck, and again: you can totally do it!

and: don't feel bad about supplementing. You do what you have to do, and you are definitely working towards not having to. That's the thing about multiples; sometimes you have to do things you aren't crazy about, just to make it through the day.
post #6 of 28
Congratulations, both on your babies, and your determination to make nursing work!

I have no advice, except maybe check out Kellymom as well ....

Keep us posted!!
post #7 of 28
Yes, I guess you're right, Valkyrina, about it being "different", not necessarily easier. But I guess as a first time mom, I felt like I was a fish in a fishbowl, being watched and evaluated while in the hospital. Of course, we had the title of "homebirthers" on us, and everyone at that hospital thought that was pretty strange. In the end, we made a lot of friends, but I really think that we were considered a bit strange, especially after I demanded to have my baby with me at all times. So.... being at home was hard in its' own way, and yet, we could finally breathe and try to settle in with our baby.
I had to laugh, AnnJay, at the "no turning back" comment you made, as that is exactly it, isn't it, when your water breaks. It's the one thing they can't do much about
As far as the lactation consultant goes, we got a lot of comments that weren't always encouraging, and a bit weird, but know that most people aren't fully appreciating where you are at, and what is appropriate. My mom thought it would be best to just not breastfeed, as it seemed so stressful, but looking back 3 1/2 years later, I'm so glad I did. Not everyone will have the same experience as I did, but my daughter never had a fever over 101 in her life, until last week when she hit 102. She never really was sick, never an ear infection, and every time she was sick, it was short lived. I read that breastfed babies have a lower incidence of meningitis, Hodgkin's disease, pneumonia, digestive problems and ear infections. My family had all of these (we weren't breastfed), and so I really felt motivated to breastfeed. By the way (and this isn't for everyone), but we had such a shaky breastfeeding start, and in the end, my DD just weaned, mostly because of my twin pregnancy. I laugh to think there were days I was just trying to make it to the next day breastfeeding, and there she was, going strong for a good 3 years!
post #8 of 28
Thread Starter 
So we've been practicing nursing, and succeeded for around 15 minutes with Sophia (suck and stop,suck and stop) and not even 5min with Alexander. We're going to switch nipples on the bottles to encourage a stronger suck from them.

Meanwhile, it's pump, supplement, and practice at the nipple.
The lactation consultant seems to think that practice will make perfect, and we just need to get them time at the breast for it to work out. But we also have to keep up their calorie input and their weight gain so their bilirubin levels don't increase.

How long can we expect this transition period to last? I'm afraid to try the day in bed naked until...well I don't know, I guess until I feel more secure about their getting sufficient calories. Is that putting the cart before the horse?

AnnJay
post #9 of 28
So.....are you still at the hospital or at home now? I know for us, there was the fear of God put in us that my DD would not get enough food if left to exclusively breastfeed. Maybe they were right, maybe not. It's sure a hard place to be in. I remember the "threat" of bilirubin levels. I do remember thinking, "let me out of this dark NICU and let me get my baby near some natural light, and we'll be ok" but of course, they don't give you "passes" to leave the NICU w/ your baby
I think that my DD had a mix of issues, one being that she was too hungry on their 3 hour schedule (they wouldn't let us feed her "on demand") and so she would fall asleep all the time instead of eat. They were gavaging her (tube down the throat) and I think that probably made swallowing uncomfortable for her. It's so hard to determine what the "right" thing to do is, but it sounds like you are being such a great mama with all the pumping. It's so hard to pump, isn't it? Like I said, my DD was a month old before we did the 24 hour cure, and it was definitely time for that. I no longer had the fear that she would starve. So.... maybe it will be a while longer. I know it's hard, and each day, each hour feels like weeks. But as Valkyrina and I are here to prove, those days pass and at some point in the next month you will have two voracious eaters, and you will laugh that there was ever a problem w/eating!
We tried everything for supplementing b'feeding in the hospital, including a haberman (I think that's the right name). Basically you have a cow bell of milk around your neck, with a tube that you tape down to your breast, so that when they go to suck at the breast, they get some easy milk in addition to what they suck out of the breast. That's supposed to be encouraging to them, and make them want to suck at the breast, as it gets rewarded with milk. I have to say that nothing was the magical cure for us, and we thought we'd never leave the hospital, until we convinced someone to let us feed her when she wanted to. She ended up eating far more than she ever had, (and at 2 hour intervals). Hope this helps!
post #10 of 28
It does get easier! My guys were born at 36 weeks, 6lbs 7oz, and 4lbs 14oz, and spent 2 weeks in the NICU. While in NICU, they were fed almost exclusivly bottles. A little bit of my milk, but mainly formula (I had pre-e, which lowered my supply). I did try nursing them while in NICU, but it was not the same as at home. It was really hard. It took about 3 months to get the boys off of formula, but we did do it! They nursed for 15 months.

You need to have a lot of determination, and lots of ongoing support (my lovely mom came every day with food and laundry, and an extra set of arms).

As your babies mature, they will get better at nursing. One of my boys needed a nipple shield for a good 2.5 months - then he finally got it. Don't give up...premmies need extra time to mature.

You may want to try a SNS (suplemental nursing system...basiaclly a tube taped to your nipple that supplies the milk while the baby suckles your breast).
post #11 of 28
I didn't have your experience, but I did have nursing challenges with twins. Pumping is so different on the breast than the latch. It really isn't 'priming' the well as well as one might think. Every single time you have a babe to your breast, you are getting so much more. Your body is getting the info it needs best at that point.

I remember we fed every two hours from the beginning. My littlest was 4 lb 15 oz at birth. Maybe you could also post in "Breastfeeding Challenges"
http://www.mothering.com/discussions...play.php?f=363?
You could get some more opinions and figure out if pumping or nursing every two hours is better for you.
All I know is that the 3 hour standard is a very old hospital/wivestale habit, and somewhat based on formula babies.

You really can do this, and it really is worth it for so many reasons.. Those babies need your milk more than ever to build their bodies on the outside now. If you have the dedication and a little luck with your physiology, you really can succeed!

P.S.-Also, formula feeding twins costs a fortune. When I stopped BF at 7 months, we had to start shelling out $300.00 a month. (thought I'd throw in a little extra incentive)

P.P.S.-to send a private message, click on the person's name whom you want to contact. A floating pop-up shows and you will see a line that says "send blank a private message" Click on that and then press send after you write your message.
post #12 of 28
My babies were born just 3 days after yours -- at 34w5d. DD spent 16 days in the NICU and DS was there for close to 6 weeks. They are now 10 months old and I am still BFing exclusively (plus solids of course). DS came home with a distinct preference for the bottle because he had been bottle-fed a lot while in the NICU (I could only be there for 3 feeds a day -- and he got a "top off" bottle even after those 3 feeds). I had a heck of a time transitioning him back to breast. My best advice is to hang in there and approach each feed as a new day. What happened the previous feed does not matter, this feed is a fresh try. You have to have a lot of persistence and a lot of patience and be prepared to listen to a lot of crying and screaming and not let that unnerve you and make you bring out the bottle right away.

More specific pointers: I don't know how long you are trying at the breast. They are used to the bottle so they will probably be frustrated when at the breast. Don't take them off at the first sign of frustration. Keep trying and trying. I would keep trying with them for at least 30-45 min unless they were having a total meltdown. If having a meltdown then I would give a small bottle (15-30cc's) to take the edge off their hunger, then try again. I also found that swaddling helped with the meltdowns. Somehow if they weren't waving their arms and legs all over they seemed to be able to focus better on eating.

Re: increasing supply -- I would pump only immediately after nursing the babies. To increase supply I took fenugreek and I pumped longer at the highest suction I could stand without it being painful. My supply really came in when I started pumping 20 minutes each time instead of 10 minutes each time. I only pumped right after nursing the babies because otherwise there was not enough milk there for the next nursing session. So for me that was every 3 hours. I left at least 1 full hour between pumping and the next nursing time.

So bottom line -- I don't think you can do the nursing marathon idea with babies who don't know how to nurse yet. You will probably have to do some combination of bottle and breast until they get better at breast. I would do breast first, then bottle. At some point when you feel they are getting the hang of it, cut back on the bottles and then make the leap and cut OUT the bottles. Most babies do not make the transition fully until the bottle is no longer available at all. But you need them to be in a place where they are able to breastfeed and all that is stopping them is a preference for the bottle. Good luck, you can do this!
post #13 of 28

hospital-grade pump?

One more thing -- in the meantime to help your pumping -- are you using a hospital grade pump (like Medela Symphony) or are you using a working mom's pump (like Medela Pump In Style)? The type of pump makes a big difference when you are trying to establish and increase supply. IMHO it is very worthwhile to rent a hospital grade pump. Do this if you haven't already. Good luck again!
post #14 of 28
I don't have a lot of advice, but I do have a preemie nursing success story. My boys were born at 32 weeks and 6 days after PPROM. Luckily, I had a vaginal birth with no pain killing drugs or pitocin. They went straight to the NICU, and stayed there for a month.

I asked for a pump about an hour after their birth (the staff tossed that first tiny batch of colostrum--aarrgg!). They were too small even to bottle feed, so they were gavage fed my milk. After a while, I held them to my breast and let them try to nurse while they were tube-fed. My hospital was pretty breastfeeding friendly, and I had a lot of support from La Leche and a lactation consultant. As far as I know, my boys have never had formula.

I made tons of milk--so much that they asked me to stop bringing it to the hospital--I was taking up too much freezer space. I had a pump in the "pod" my boys were in at the NICU, so I could watch them and pump at least twice a day, and I had one at home (both hospital grade Medelas). I pumped every 3 hours. I'd breastfed my daughter well into my twin pregnancy. I think that might have helped with my supply.

The first month or two that the boys were home from the hospital were extremely hard. They were on apnea monitors, and caffeine. Still, they made the transition to EBFing within a week or two of coming home. I was very glad to return my pump to the hospital. I had oversupply and forceful milk ejection issues. Both boys sputtered and puked a lot, and when they "popped off" milk would go everywhere. Months later, I was still finding spilled milk in unlikely places.

I think it's really important to relax when you're breastfeeding or pumping. I did deep breathing exercises while I pumped, and it made the milk come faster.

I tried not to obsess about weight gain. My boys didn't get a lot of traditional medical care after the NICU. They're both small--especially Ira. I trusted my body--that it would make enough food for them. I understand that I was lucky in this way, and if I had needed to supplement, I would have.

I'm still nursing. My boys are 2 years and four months old. I never would have pictured this day, early on. Know that where're you're at now is an extremely difficult place. It will get better. One day, your babes will be annoying 2 year olds standing on the table and grinding pepper, like one of mine is now. Gotta go.
post #15 of 28
Thread Starter 
Lots of great advice here and I love the positive support. You're all so helpful! Thank you.

The hospital did allow us to rent a good pump. It's the Medela Lactina, which is hospital grade accoding to the Medela website and the hospital people.

Quote:
Originally Posted by poppan View Post
So bottom line -- I don't think you can do the nursing marathon idea with babies who don't know how to nurse yet. You will probably have to do some combination of bottle and breast until they get better at breast. I would do breast first, then bottle. At some point when you feel they are getting the hang of it, cut back on the bottles and then make the leap and cut OUT the bottles. Most babies do not make the transition fully until the bottle is no longer available at all. But you need them to be in a place where they are able to breastfeed and all that is stopping them is a preference for the bottle. Good luck, you can do this!
Ahhh - this is what I was kinda thinking - and afraid of going all breast and starving my little ones. What you say here makes sense. So we'll continue practicing and pumping. Maybe by the time they reach what would be 40w is a good time to try the experiment? Or maybe it will just go by how long they can nurse during the practice. Meanwhile, I've really got to get the supply up. It just seems like eating and drinking lots and pumping 10-12 times daily should be giving me more by now. That's a little discouraging, but then I keep hoping for the day when suddenly there's more.

Thank you for all your kind support.
post #16 of 28
My guys were born at 36.5 w and I had only one in the NICU. He was born just under 4lbs. I nursed him when he was about 12 hours old (that was the earliest I could get to him). It helped that it was 10 pm and all the staff were busy with other babies. I actually was encouraged to feed him whenever I could, but not for more than 10 mins and then he got pumped milk. Danny was given formula as well as breast because all that I pumped went to the NICU. All the nurses used to come and watch because they had never seen a baby under 4 kilo nurse before. I was also very adamant and stubborn and used my instincts. They also had a pumping room in the NICU so I would pump after every feed which helped my milk supply as well.

What REALLY helped us was a bottle called the Haberman feeder. My MIL got it for us in England (I am sure that some baby supply stores will be able to get it for you). What it does is mimic the breast. It has a one-way valve inside and it lets the milk out slowly just as the breast does, and, the greatest thing about it: if the baby doesn't suck, the baby doesn't eat. It taught my lazy eater how to suck hard (it has the ability to change the let down so that you can make it harder or easier to get milk). Here is a link for more information.

http://www.selfexpressions.com/habermanfeeder.html

It does get different at home. I'm surprised that none of the LLL consultants has told you about kangaroo feeding (where you put the baby on the breast with a tube attached and they suck on the breast but are really eating pumped milk from a bottle that the other end of the tube is in.) That also really works.

Hugs. And may your babies be home with you very soon.
post #17 of 28
I've only got a few minutes to post here, but as for increasing your milk suppy, the herbs recommended here are right on--if possible, while your babes are still getting used to the breast, see if you can pump closer to every 2 - 2 1/2 hours in the daytime. Drink TONS of water, if not already, and try positive visualization with relaxed breathing as you pump, as well--the one that worked best for me was to envision a river going over a waterfall, and as it hit the falls, turns into milk. Cheesy, but effective. ;-)
I think the pp is correct regarding the 24-hour bed-in, that that will work once it's ONLY nipple preference standing in your way. ATM, your babes don't sound like they are quite there, but practice makes perfect. From most accounts I've heard (and experienced), your babies are likely to wake up and have things click a little better closer to their actual due date.
If you haven't been there already, check out the Preemies/NICU forum under Life with a Babe here as well as Breastfeeding Challenges for other resources.
Best wishes!
post #18 of 28
Quote:
Originally Posted by AnnJayTwins View Post
Ahhh - this is what I was kinda thinking - and afraid of going all breast and starving my little ones. What you say here makes sense. So we'll continue practicing and pumping. Maybe by the time they reach what would be 40w is a good time to try the experiment? Or maybe it will just go by how long they can nurse during the practice. Meanwhile, I've really got to get the supply up. It just seems like eating and drinking lots and pumping 10-12 times daily should be giving me more by now. That's a little discouraging, but then I keep hoping for the day when suddenly there's more.
Sounds like you have a good pump -- cool Yes keep at the breast, you may want to see an LC also for some extra help with latching. LCs have lots of tricks too to get them to nurse (like using a syringe to squirt some EBM in their mouths as they suck, can outfit you with an SNS, etc.). 40w may well be a good time but go with how they're doing rather than a date. They may get the hang of it well before 40w. My DD was all boob by the time she was discharged from the NICU -- at 37w.

Supply -- again talk to an LC but I think you will get more by pumping longer at each pump session than by adding more pumping sessions in a day. You need to signal your body that it needs to make more milk each time -- not just simulate a baby that wants to eat more frequently. So for a while you may want to pump for say, 5-10 minutes past the last let down. It's OK to not get any milk out in those last 5-10 minutes, it is the stimulation to your nipples that you are trying for. Good luck I think you should call an LC or a LLL leader.
post #19 of 28
As Hodia mentioned. GET A SUPPLEMENTAL NURSING SYSTEM. Any supplementation of formula should be done with this at the breast. STOP THE BOTTLES!!! That way all suckling will be at the breast stimulating you and increasing your supply. Your lactation specialist should be able to get you set up with a double set up. Good luck!
post #20 of 28
Thread Starter 
Quote:
Originally Posted by poppan View Post
Supply -- again talk to an LC but I think you will get more by pumping longer at each pump session than by adding more pumping sessions in a day. You need to signal your body that it needs to make more milk each time -- not just simulate a baby that wants to eat more frequently. So for a while you may want to pump for say, 5-10 minutes past the last let down. It's OK to not get any milk out in those last 5-10 minutes, it is the stimulation to your nipples that you are trying for. Good luck I think you should call an LC or a LLL leader.
Great suggestion. Just started this last night, and I think I'm already getting a little more per session.

Have had at least one successful nursing session per day with Sophia, and yesterday Alexander had success for the first time! Now trying to up the frequency, though they don't always suckle. I figure just them being on the nipple is good enough for a start? (Successful session = 10 or more minutes suckling....they're not getting enough to replace a feed yet. Eventually they'll get there.)

Thanks again for all your suggestions and support.
This really means a lot to me.
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