Bottle bias?

[sbrinton]

Over and over I've read about NICU nurses and doctors who prefer the bottle to the breast. Likewise, so many families we've talked to who have been through this repeat things like "the breast won't get your baby home, the bottle will."

Is there research that backs this up?

My experience with my son Micah (born at 35w) was that I fought right away to exclusively breastfeed and I was stubborn enough that the NICU agreed. I was there around the clock and I would not leave him with nurses I didn't trust. He was healthy enough that we could go straight to breastfeeding as soon as he was stable enough to try eating anything. This time we're anticipating another preemie, likely earlier than Micah.

I know that a baby born prior to 34-36 weeks will need to be tube fed, but can we go straight to breast from (or with) the tube?

It seems to me that breastfeeding is not any harder than bottle feeding, that it's more soothing for the baby and mom...the benefit of the bottle is that it is easier to "measure" and nurses can do it, but are there really benefits for baby?

I fully plan on being in the NICU for every feeding if I need to - we can room in our NICU.

[chio88]

From what i know mothers' milk is still best for babies

[MusicianDad]

Physical contact benifits the baby. That's what breastfeeding does. It brings the little one into skin to skin contact with mom and (I can't remember where I read it I have terrible source amnesia unfortunatly) a mother who delivers prematurly has different breastmilk then a woman who delivers at full term. Thats the great thing about mommy milk, her body knows what the baby needs at that stage of life and provides it, free of charge too.

[irangel]

A lot of it depends on the gestation of the baby and the health situation. A baby born around 34-36wks may very well be able to do that but there's also the matter of a lot of moms being unable to be at the NICU 24/7. I know that for me with my third baby I had a 12mos old (still nursing) and a 3yr old at home so it was physically impossible for me to be at the NICU 100% of the time. There's also the issue of babies being unable to coordinate the suck/swallow/breathe and let down can often throw off that pattern. And yes it is true that breastfeeding burns more calories and takes more effort than bottle feeding. With a bottle the milk just drips out and with breastfeeding a firm suck needs to be present. I wish all it took was being present for all feeding to establish breastfeeding but that's not the reality for a lot of women. The important thing is the breast milk which can be given through a tube or a bottle and skin to skin contact which can happen through kangaroo care.

I'm so glad it worked out for you to nurse your baby. It no doubt helped that he was born at a later gestation. Breastfeeding is more difficult than bottle feeding for a lot of term (if not most) infants so take away several weeks in utero and imagine how hard it is for preemies. I don't know if there are any documented studies but I would full heartedly agree that bottle feeding gets most babies home sooner.

[CallMeMommy]

My son was born at 31 weeks and never received a bottle in the NICU. It was either tube or boob. So yes, it can be done. And I wasn't a special case, either, it was just policy in our NICU - if you're breastfeeding, you're breastfeeding. If you weren't there for a feed, they used the NG tube. The only babies that got bottles were the formula-fed ones.

I went through a bad period where he just wasn't awake enough to nurse, and I begged the nurses to just let me pump and give him bottles, thinking it would get him home faster. They swore up and down, left and right, that for his gestational age he wouldn't come home any faster if he was bottle-fed versus breast-fed. So I kept it up, he came home, and nursed for the next 17 months.

[buckysprplmonkey]

I know that the NICU my son was at actually prefers and encourages breastfeeding. But few women are able to be at the NICU around the clock to nurse their baby. My son was a 28 weeker that needed tube feedings for about 5 weeks after he was born (and that's actually really good for a 28 weeker, many need it longer) and was given my milk. He began a few nursing sessions a day while still getting tube feedings, but even when he was on all oral feedings, I just couldn't be there for all his meals. Even though I live only 5 minutes from the NICU he was at, I have older kids at home and not being around for them for several weeks was just not an option. He was given bottles of breastmilk when I couldn't be there. They required that babies be on all oral feeds before returning home to make sure they aren't having any feeding issues. As it is, when he came home he took really well to nursing around the clock and prefers it to a bottle.

They try to convince moms at our hospital to at least pump while baby is in the NICU because of research (and their own experience) that says breastmilkfed babies are ready to go home sooner than formula fed babies. But I don't think there's been anything that suggests the bottle has anything to do with it, it's the nutrition within.

[felix23]

Originally Posted by irangel

A lot of it depends on the gestation of the baby and the health situation. A baby born around 34-36wks may very well be able to do that but there's also the matter of a lot of moms being unable to be at the NICU 24/7. I know that for me with my third baby I had a 12mos old (still nursing) and a 3yr old at home so it was physically impossible for me to be at the NICU 100% of the time. There's also the issue of babies being unable to coordinate the suck/swallow/breathe and let down can often throw off that pattern. And yes it is true that breastfeeding burns more calories and takes more effort than bottle feeding. With a bottle the milk just drips out and with breastfeeding a firm suck needs to be present. I wish all it took was being present for all feeding to establish breastfeeding but that's not the reality for a lot of women. The important thing is the breast milk which can be given through a tube or a bottle and skin to skin contact which can happen through kangaroo care.

I'm so glad it worked out for you to nurse your baby. It no doubt helped that he was born at a later gestation. Breastfeeding is more difficult than bottle feeding for a lot of term (if not most) infants so take away several weeks in utero and imagine how hard it is for preemies. I don't know if there are any documented studies but I would full heartedly agree that bottle feeding gets most babies home sooner.

ITA with this. I don't know when my dd would have gotten to come home if we had to wait for her to breastfeed. She just didn't have the stregth and it really does burn more calories. We tried at first to not use bottles but she wasn't getting enough milk, it was making her really, really tired, and she started to lose weight. With bottle feeding she didn't have to struggle as hard and she was easily able to take full feeds of breastmilk without it totally exhausting her. So yes, IMO bottles really do get babies home earlier and for me I was ready to do anything I could to go home.

[sbrinton]

I know our hospital is in general very supportive of breastfeeding. Likewise, the NICU is set up to be comfortable for mom to stay there around the clock for a few weeks if this needed. If we end up with another preemie, I think I will push for "tube to boob" if our little guy is not ready to breastfeed.

I guess that without more data, I just don't buy the "harder to breastfeed than bottlefeed" thing.

[felix23]

Originally Posted by sbrinton

I know our hospital is in general very supportive of breastfeeding. Likewise, the NICU is set up to be comfortable for mom to stay there around the clock for a few weeks if this needed. If we end up with another preemie, I think I will push for "tube to boob" if our little guy is not ready to breastfeed.

I guess that without more data, I just don't buy the "harder to breastfeed than bottlefeed" thing.

You don't have to buy it but for me it was really true.

[BugMacGee]

I just went to a talk about this today. It is harder to get the breast milk to flow immediately so some babies who are both bottle and breast fed get frustrated at breast. It's a "flow preference" You can sometimes combat this by pumping a bit just to get the milk to come faster. You can also have the nurses use slower flow nipples for bottle feeds. This is good for babies that need more pacing with feeds.

We use nipple shields a lot for our little ones to learn with. Helps shape the nipple to get it in the mouth. I've just spend 3 days taking care of ex-27 week twins (now 33'ish weeks) who are doing quite well latching on and sucking. Their cheek muscles are still pretty weak so they don't get much, but they're improving.

[Spring Lily]

Originally Posted by sbrinton

I guess that without more data, I just don't buy the "harder to breastfeed than bottlefeed" thing.

Luckily your little one was born closer to full term, so that statement might seem more like an opinion to you. Hopefully you'll never need to experience anything different.

But I can tell you that even with an extremely supportive NICU and LCs stopping by for daily check-ins there, my 34 wk twins were unable to breastfeed more than twice a day. Breastfeeding made them so tired that they often had to do a few tube feedings after BFing. There were times when I showed up to visit and could not wake either baby up enough to even attempt a latch because they were so tired from BFing for 10 minutes earlier in the day.

Bottles aren't necessarily a bad thing with preemies, either. As I found out, sucking on the bottle can actually IMPROVE their ability to breastfeed, because it gives them practice sucking and builds up their muscles. My babies' BFing attempts actually got much better after they started taking bottles in addition to tube feeds.

[tanyaandallie]

I do think that nicu's do have a bottle bias! But, in most cases there is a reason. I tried to avoid the bottle with my 34 week baby but it simply didn't happen. I could not be there for every single feeding during the 2 weeks he was in the nicu. In addition, bf did make him tired. The suck swallow reflex is generally not fully developed until term (37 weeks). So, many preemies have a tough time with the breast. They are not strong enough to pull the nipple to the back of their mouth.

We bf 1 or 2 times a day until my ds came home and then slowly transitioned to nursing once we came home.

[OGirlieMama]

I like the idea of tube to boob in theory, but given that my girls were born at 29 weeks and discharged at 38 and still not breastfeeding very well (and I ended up going on to EP for 18 months because they never quite caught on) I don't know. Would they have had to have an NG tube that entire time? Would it always be there, or would they actually place it if I weren't around to feed them? Because man, that NG tube placement isn't pleasant. We were at the NICU for about 10-12 hours most days, but with them eating every 3 hours, that's still several missed feedings per day. I'd hate for them to have an NG constantly placed and removed like that. I'd also hate for them to have it in constantly, because it is an irritant, and more so as they get older and more aware.

As with everything else preemie (or baby, for that matter), there's no absolute answers here.

[sunflowers]

Originally Posted by OGirlieMama

I like the idea of tube to boob in theory, but given that my girls were born at 29 weeks and discharged at 38 and still not breastfeeding very well (and I ended up going on to EP for 18 months because they never quite caught on) I don't know. Would they have had to have an NG tube that entire time? Would it always be there, or would they actually place it if I weren't around to feed them? Because man, that NG tube placement isn't pleasant. We were at the NICU for about 10-12 hours most days, but with them eating every 3 hours, that's still several missed feedings per day. I'd hate for them to have an NG constantly placed and removed like that. I'd also hate for them to have it in constantly, because it is an irritant, and more so as they get older and more aware.

As with everything else preemie (or baby, for that matter), there's no absolute answers here.

My experience was similar. By the time my dd was ready to come home, she still wasn't strong enough to BF for every feeding. Some days, she wasn't ready to even take a bottle every 3 hours. I took the class for NG placement and was prepared to bring her home with it. Luckily, it turned out she got stronger faster than they expected!

But an NG tube would be left in place for up to 30 days if the baby didn't pull it and there were no issues with it. But having an NG tube often caused oral aversions that could delay BFing or even any mouth feeding. It could contribute to feeding difficulties for months or years.

Also, for some of us with babies that were born earlier or sicker, they may require fortified feeds. You can pump BM and fortify it to a higher calorie content but you can't fortify milk straight from the tap.

[sbrinton]

One of my best friends had preemie twins at almost the same GA as my son Micah (34w6d an 35w2d). We had very different experiences.

I was allowed to try going straight to breastfeeding. My son was able to breastfeed almost right away, after about 18 hours on an IV and oxygen. I had no trouble with supply, his latch was good, etc. We never used a schedule, measured how much he was eating, etc. We hardly took him to the pediatrician.

My friend, on the other hand, was told her girls could not breastfeed right away (although they were breathing fine, no infection, had a good suck on a pacifier). They were put on NG tubes and then taught to bottle feed. My friend pumped faithfully for months, but the girls never got the hang of breastfeeding. All year they struggled with oral aversions. They were on a detailed schedule, fortifying this and that, weighing them daily, going to the doctor all the time. Etc.

Basically, the girls started at a very similar place to my son. And by 18 months, they are basically the same. Walking, talking, about 20 pounds and as cute as can be...but in between our experiences were so completely different!

I cannot help but wonder if she has been at a hospital that was more supportive of breastfeeding - both mom's ability to feed twins and the babies ability to breastfeed - that things could have been very different.

I know that I have an advantage over some other esp. first time preemie moms in that I have not had trouble with supply, I let down easily, I have small breasts and nipples so it's not too hard for a small baby to do what they need to do, and I'm experienced at all of this.

I still wonder how much of this is attitude and how much is science?

[OGirlieMama]

Originally Posted by sunflowers

You can pump BM and fortify it to a higher calorie content but you can't fortify milk straight from the tap.

Mmm, but imagine if you could? "OK, Mrs O'Girlie, just go home and eat 2 pints of ice cream, a stick of butter, 3 cakes and a chocolate bar - that oughta get you up to 30 cal/ounce."

[sunflowers]

Originally Posted by OGirlieMama

Mmm, but imagine if you could? "OK, Mrs O'Girlie, just go home and eat 2 pints of ice cream, a stick of butter, 3 cakes and a chocolate bar - that oughta get you up to 30 cal/ounce."

[sunflowers]

Originally Posted by sbrinton

I know our hospital is in general very supportive of breastfeeding. Likewise, the NICU is set up to be comfortable for mom to stay there around the clock for a few weeks if this needed. If we end up with another preemie, I think I will push for "tube to boob" if our little guy is not ready to breastfeed.

I can't help but notice that you have two LO's at home now. Will your hospital's NICU provide a place for your other children as well as yourself? Are you prepared to leave your family at home for several weeks or months if necessary? Those weeks and months might be in addition to several weeks or months you spend virtually inaccessable to them because of a hospital bedrest or strict home BR... Something to consider.

[buckysprplmonkey]

Originally Posted by sunflowers

I can't help but notice that you have two LO's at home now. Will your hospital's NICU provide a place for your other children as well as yourself? Are you prepared to leave your family at home for several weeks or months if necessary? Those weeks and months might be in addition to several weeks or months you spend virtually inaccessable to them because of a hospital bedrest or strict home BR... Something to consider.

This was what I had to find the balance of myself. I was on bedrest for 2 months, followed by a week in the hospital and 7 weeks running between home and NICU. My other kids needed me and the bottle did get my son home faster. I was unbending on no formula (although I did let them add fortifier to my breastmilk for a while) but I decided it was more beneficial for all of us to let them give him bottles to get him home sooner and we'd deal with any nipple confusion or latch/laziness issues later. Turns out he didn't have any trouble and made the transition to EBF nicely. Breastfeeding was important, but not as important as the overall health and happiness of the rest of my family.

[mommylovesra]

This was what I had to find the balance of myself. I was on bedrest for 2 months, followed by a week in the hospital and 7 weeks running between home and NICU. My other kids needed me and the bottle did get my son home faster. I was unbending on no formula (although I did let them add fortifier to my breastmilk for a while) but I decided it was more beneficial for all of us to let them give him bottles to get him home sooner and we'd deal with any nipple confusion or latch/laziness issues later. Turns out he didn't have any trouble and made the transition to EBF nicely. Breastfeeding was important, but not as important as the overall health and happiness of the rest of my family.

This is the situation I found myself in too. I was on hospital bedrest for a month with a 2 year old at home who had still been nursing himself when I was hospitalized so he went through a bit of trauma. He is still biting his nails from the stress. A month is an eternity to a small child and that is not counting my 3 older children and my husband who was trying to hold down a job and care for them all. Sometimes it is more important to get your baby home in the quickest manner possible. I don't believe the bottles are better hype either nor do I think there is any research to prove it. If you can be there for every feeding then I would say go for it but realistically unless the NICU is set up to room in you can't be there in the middle of the night. I stayed at the Ronald McDonald house to be close enough to breastfeed but I still had to skip that middle of the night feed for my own recovery and need of sleep.

FWIW my 2 year old was born at 34 weeks and I have also had a 35 and 36 weeker and my last baby at 31 weeks was a whole different ballgame when it came to breastfeeding. These earlier babies are not as strong and even if you do get them on the breast they may have to have a bottle or gavage in the beginning to finish out the feeding. We persisited and we left the hospital after 25 days exclusively breastfeeding but it took a lot of work and lowered expectations on my part. Every baby is different though. I was told my baby was latching great for as early as he was and coordinating sucking and swallowing well. Some babies don't. I hope things go easy for you this time. My advice would be not to be surprised to hit some setbacks, that does not mean you will not suceed with nursing.