Need HelpTransitioning a Preemie from Bottle to Breast

[Lorilynne88]

All I can say is...help!

My little girl was born prematurely at 30 weeks of gestation. Her sucking/gag reflexes, etc. (everything needed to BF), were not developed sufficiently yet for her feed by bottle or breast, so she had to start on tube feedings. During her month stay in the NICU, she was primarily fed by bottle with my pumped milk, and we kept trying to introduce the breast to her when I could be there. She has now been home with us for about 6 weeks, and is growing well. My original due date with her was Oct 23rd, so we are just now reaching "normal" newborn size, energy level, etc. It has been very difficult as I was determined to BF before she was born, still am, but our relationship has gotten off to a rocky start. I don't know what to do!

Our usual feeding routine has been to BF for as long as I can keep her awake/interested, then give her a bottle of pumped breastmilk until she is satisfied, and then once she's asleep I'll pump whatever is left and store it for future bottles. I have several concerns with this routine. For one, her latch doesn't look/feel right to me, and she is not draining the breast. She'll nurse for about 10-20 minutes each side, but does not act satisfied and my breasts still feel full or nearly full. Nursing tends to push my pumping sessions fewer and farther inbetween because of the time it takes to nurse/bottle feed her, whereas when she was in the NICU, I'd pump every 2-3 hours 24/7. So, I'm a little worried my supply will go down. I also don't get much if any sleep doing things this way because I'm pulling double duty, BF, bottle, and pumping. So, I can tell sleep deprivation is hurting my supply sometimes, too.

I really want to transition her to exclusive BF, but don't know how. I think her latch is the main concern, and I probably need to talk to a LC, but getting out in cold weather with a preemie is not exactly encouraged. She looks like she is not opening her mouth wide enough/getting enough breast in her mouth. She'll also tends to grab with her lips and try "slurping" the nipple, all of which don't get her much milk except for the initial let-down. Besides talking to LC, any ideas/suggestions on how I can teach her to latch on correctly? Once she does latch on properly, is it ok to stop bottles entirely, or would can I transition gradually? I just don't want her to lose weight or "starve". I've heard both things, so I don't which is right. Any ideas or suggestions would be greatly appreciated!!!

[mm's mom]

My son was born prematurely and had problems learning to feed. I contact a LC who actually came out to our house a few times and I didn't have to go anywhere. She taught me what a correct latch looks like, helped me to get him nursing, weighed him before and after feedings to confirm he was taking in a good quantity of milk. Within a week, we were off bottles and breatfeeding only. She was really great. My advice would be to find someone, preferably who will come to you!

Good luck!

[Mrs-Mama]

DS was born at 32 weeks and he was bottle-fed my breast milk while he was in the hospital. I introduced the breast only a couple days before he was discharged, but when we got home, we made it a priority to get him off the bottles. Our routine was like yours: nurse, bottle-feed, pump; nurse, bottle-feed, pump. Luckily DH did most of the bottle-feeds so that I could pump right away. During the night, I did not offer the breast. I felt like sleep was important, so I would just bottle-feed and pump during the night so that the routine didn't take so long.

Once we realized he was gaining plenty of weight, we backed way off on the bottles. I'd nurse him for 5 minutes, and then he'd fall asleep and wake back up hungry again 20 minutes later. I'd nurse him again (same side). I just went with it and switched breasts every couple of hours. When I sensed he was super-frustrated, I would give him a bottle of pumped milk, but just enough to make sure he wasn't overly hungry. Eventually, fewer and fewer bottles were needed and after about 3 weeks at home, we had our first bottle-free day. He even got where he would refuse bottles.

As for the latch, do contact an LC. DS didn't have a very deep latch at first, and part of the problem was that his mouth was just so small. After he was on, I'd put my finger in that little "dip" in his chin and try to pull it down more to open his mouth wider and get more of my breast in his mouth. It got easier as he got bigger.

Good luck...the transition from bottle to breast is tough, but it can be done!

[guestmama9916]

Originally Posted by Mrs-Mama

During the night, I did not offer the breast. I felt like sleep was important, so I would just bottle-feed and pump during the night so that the routine didn't take so long.

I did this too and I don't think I would have made it very long if I had tried to keep up BF'ing during the night during those early weeks. My DD was a 35 weeker and she was so sleepy that I couldn't get her to eat much at night from the breast at first. Then as she got more alert, because I had to turn a light on to see what I was doing, she would stay up after BF'ing for an hour or two. Not good!! So I pumped during the night and once I was past the 6-8 week mark, I cut back my pumping during the night so I could get some much needed rest. It was very helpful for me to do this and my supply did not seem affected by me cutting out the middle of the night session. As a matter of fact, my supply seemed to increase probably because I was getting rest and not stressing so much. Sleep and nourishment for mama are so very important - especially when pumping for a preemie is involved. The main thing I've learned throughout my journey is to not stress out - if nursing isn't going well, just pump and give your baby a few days or a week then try again. My DD just started nursing like a pro this week at 3 months 3 weeks of age. I had almost given up but thought I'd give it another try and lo and behold she's finally got it - she's finally big enough and strong enough to do it right. Give your baby some time, don't rush, don't stress -- it will happen.

[Alice27]

Have you thought of using an SNS or Lact-aid? That could help her to spend more time at the breast. Bottle feeding requires a different kind of latch (shallower, nipple sucking) so phasing out the bottles would help and the supplementary feeder would allow her to get her supplement directly at the breast. The extra breast stimulation would also help your pumping as your breasts would get extra stimulation. You might find your supply dropping as your daughter will start getting more milk directly from you.

Alic

[flminivanmama]

Hi Lorilynne - welcome to Mothering!

my twins were born at 29 weeks and we have a similar story - It took several weeks *after* we got home to get them nursing.

We used a nipple shield that the LC gave me - it was from medela and had a little cut out for the baby's nose....

I would also suggest *starting* with the bottle rathe than finishing there... that way your LO can get the edge off her hunger and then spend as loooong as she wants to on the breast

also this is a very good meathod of bottle feeding that reinforces breastfeeding http://www.lowmilksupply.org/bottlefeeding.pdf

HTH!