Breastfeeding and NICU

[Mama2RMM]

I am currently pregnant with twins that will be delivered prematurely due to a medical condition. We can't predict when they will be delivered, but it will be no later than 34W.

After reading so many stories of NICU babies refusing the breast after being bottlefed EBM, I am really concerned about our options while in the NICU. I didn't have a supply issue or problems pumping with my first daughter, and I have a Medela PIS for home use, and will have a hospital grade pump rental for use at the NICU. I really believe I will produce enough EBM for them, and I do understand that it may need to have fortifier added. I am okay with that.

I know that some NICUs and Neonatoligists require that babies "nipple" all feedings before being released. It seems not to matter, to them, whether this is a bottle or a breast. I certainly prefer it be my breast, but I will not be able to physically be at every feeding. I also have a very young toddler that will need me at home.

How much ruckus am I going to cause if I refuse bottle feedings all together, and request gavage feedings when I am not present? If both twins show the ability to feed at the breast during the majority of the daytime feedings is there really a leg for them to stand on about bottle feeding in the evening?

Any input appreciated... also posting in Multiples, so I apologize if you read twice. :)

[ChattyCat]

Hugs to you.

How much animosity you face largely depends on the individual hospital and doctors you are dealing with. I don't have any personal experience with NICUs, but my sister's twins were early and ended up there for a bit, as did one of my close friend's children. Both hospitals were completely different.

The one my sister and her babies were at were horrible. They insisted on the babies taking bottles. They wouldn't hear of feeding them any other way. She was actually berated and made to feel guilty for wanting to bf. Many of the doctors and even a lactation consultant told her she would be unable to. The nurses were very impatient. If her son didn't take the entire bottle in the alloted time period, they would shove it down his feeding tube. At 3 months, both kiddos are now exclusively bf at the breast, and have been for about 6 weeks. No thanks to that hospital.

Now my friend had a slightly better experience. She had a csec at one hospital, but the baby wasn't doing well and had to be intubated. The hospital they were at only had a level II NICU, so the baby had to be transferred to a different hospital about 30 miles down the highway. Well, my friend got discharged early, but it was about 36 hours before she could get to her babe. They gave her baby formula in a bottle before she could get there, but once she was there, they were extremely supportive and let her bf all the feedings.

From what I've heard, most NICUs require 8 good, consecutive nipple feedings before they'll discharge a baby.

I'm sure if you research your rights that pertain to your location, you'll be able to come up with a plan in advance. Good luck to you and your babies! I hope that everyone is happy and healthy. :)

[bri276]

Good luck and I think it is great that you are still planning to bf thru what is going to be a difficult time...whew...two in the NICU and one at home...I don't envy you mama but you will get thru it!

my dd was in the NICU for five days. some hospitals are great with bf, some are horrible, and mine was in the middle- depending on what nurse was on. I have had to EP (see siggy) and there were a good amount of times I'd come in to find that baby had been fed formula with perfectly fine colostrum sitting in the fridge (it still makes my blood boil).

A few thoughts. preemies are small, and sleepy. Small can sometimes mean difficult to latch. Sleepy often means difficult to feed, period, whether it's the breast or bottle. Feedings can tire them out, and this is where it gets sticky. The gavage is....not nice. True, it will not create nipple confusion. But several times dd puked immediately after gavage because it often just all goes in too fast for them. The NICU wants to see your babes suckling at every feed before they can go home- getting OFF the gavage is a milestone. So maybe syringe, cup, spoon, or finger feedings would be okay, but again, your hospital may be very reluctant to try any of those methods- the nurses are usually overworked and have several babies to care for.

I totally understand your desire to have the BF work out!!! believe me! pumping ain't easy! but in this case you might have no choice to let them use a bottle sometimes, if you cannot be there for every feeding, (and how can you be there at 12, 3, and 6 with a toddler at home?!) and they DO feed on schedules. I also believe you will make enough ebm. good luck.

[msumomma]

I don't know what hospital in TN you will be delivering at, but one of my very good friends just gave birth in TN (she lives in knoxville too), her baby was 6 weeks early and I was very impressed with the support she recieved about breastfeeding while her babe was in the NICU. I'm extrememly jealous, in fact. I live in MI, and when my babe was born last year 3 weeks early she was put in the nicu for 48 hours and put on a strict formula feeding schedule every 3 hours. I was told I could come in and attempt to nurse before her bottle feedings. They told me there was no such thing as nipple confusion, they told me to supplement "just until your milk comes in, to flush out the jaundice." :irked:
With my friend's baby, all her feedings were done via tube or breast, and she also used gavage feedings when she was not there. The nurses and the drs she spoke of all sounded overwhelmingly supportive of her decision to breastfeed. Oh, and her baby was never given formula without her permission, nor every given a bottle in the hospital. I think maybe she delivered at UT....does that sound familiar?
Good Luck to you, and I think it's great you have decided to bf twins!

Heather
dd 2.11.05

[CallMeMommy]

It all depends on the hospital. My son was a 31-weeker and never got a bottle. He was on TPN for the first week or two, then gavage feedings of only breast milk until he was stong enough to nurse. There's absolutely no reason to give them a bottle when you're not there, when they get older and stronger you may need to make arrangements for your toddler so you can be at the hospital in order for them to get the full 8 or however many nipple feedings are required so they can go home, but in the beginning they'll probably only be able to take one or two feedings a day by mouth and the rest will be by gavage. I'd get in touch with a lactation consultant BEFORE you deliver so you have someone fighting for you in case yours is a hospital that doesn't support breastfeeding like it should. Do your homework before hand and go in prepared, and stand your ground! Who knows, you may end up with an awesome breastfeeding hospital like I did, but it's better to be safe than sorry.

[Mama2RMM]

That's awesome to hear Heather... we will be at UT. :)

Bri, I know gavage feeding isn't pleasant. :( I don't like the thought of it, but I've met so many Mamas here and there that are exclusively pumping and haven't ever gotten the babies to latch properly that I am scared to death it will happen to me. I don't know if *insertdeityhere* could handle a 16ish month old, two newborns, and full-time pumping with a partner that works full-time! It would be SO nice to have both of them take the breast without issue. Perhaps if they do refuse to gavage feed when I'm not present they would still be amiable to syringe feeding. Lots of good thoughts!

I do have a Lactation Consultant as my first number in my notebook of important numbers! One of the Neonatoligists we met with is also a LC, so that is a huge bonus.

If the demand is 8 feedings (or close to that) in a row, I can certainly manage care for my toddler for a day. It's just hard to commit to full-time at the NICU not knowing how long they will even be in the NICU. My Mom will be here for the first week, and my husband can take two weeks whenever needed... it's just the uncertainty of it all.

Thanks for all the advice!

[msumomma]

Anna,
I also wanted to add that my friend stayed right at the hospital for a couple days too...they have in hospital accomodations for parents of nicu babies. They had her stay in the hospital for a couple days before they released the baby to go home, and let the baby room in with her at night. (can I again say how jealous I am of all of this! lol). I spoke with her today, and yep she delivered at UT. Good Luck! :)

[Mama2RMM]

Anna,
I also wanted to add that my friend stayed right at the hospital for a couple days too...they have in hospital accomodations for parents of nicu babies. They had her stay in the hospital for a couple days before they released the baby to go home, and let the baby room in with her at night. (can I again say how jealous I am of all of this! lol). I spoke with her today, and yep she delivered at UT. Good Luck! :)

If they provide that before release, it will certainly be easy to get in all the required feedings at the breast. :) We're only 5 minutes away, but being right there is certainly lots better when they make room for you to stay overnight!

It's wonderful to hear her experience went so well! Thank you so much for posting... it's a huge bright spot!

[busybusymomma]

Anna- just wanted to wish you the best! :thumb It's great that you're already making plans.

Just an FYI, but a mom from church had twins (twin to twin transfusion) last summer that were born at 32 weeks and she was able to successfully breastfeed them even though they were given fortified ebm in bottles a lot before being released. They did extraordinarily well. :thumb She has since moved out of state but last I heard they were nursing quite well.

[karlin]

My ds was born at 34 weeks (though he was 6.5 pounds) and stayed in the NICU for almost 6 days. They gave him a bottle without my consent, and he did get nipple confusion. I was allowed to attempt to breastfeed him before he got a bottle, but I only got a certain amount of time. Although my son was big and healthy, the nurses were pretty awful. Once, DS did not take a whole bottle in the alloted time, so a nuse stuck a tube down his nose and had me feed him through that. He promptly vomited it back up. That was one of the worst nights of my life. There was one nurse that I'd love to find and thank today though. Not only did she take out that feeding tube right away when I told he about what happened, but she let me try to nurse as long as I needed....gave me a nipple shield and taught me about pumping. The day after I got we got home from the hospital, my milk finally came in full force. He got breastmilk in a bottle for awhile. My son finally latched on when he was 3 weeks old, and we've never looked back. He's almost 29 months and still nursing.

I have a friend whose baby only nursed with a nipple shield. She never had to supplement after leaving the hospital (he was born at 35 weeks and was small), and the toddler is still nursing today (he's almost 18 months) with the shield. She was never able to wean him off of it, but she still got to nurse him.

[farmlife]

Wanted to offer my support to you on your journey. Different reasons brought my ds to the NICU at birth and he was given bottles with ebm and formula until I had "enough" milk - they had a certain calculation based on his weight and he had to get it through a measured feed or weighed on the medela scale after nursing. The sns was a huge help.
Sounds like your hospital is more breastfeeding friendly.
Just wanted to say now he is all breast milk and prefers the breast. I was so afraid of the confusion but it worked out for us. With the lack of strength my baby had in the NICU, I credit the supplementation and crazy amounts of pumping that got his strength up.