Twin moms who've had babes in the NICU - Mothering Forums

View Poll Results: Twin Moms- Did you supplement with formula?
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#1 of 25 Old 08-23-2012, 03:32 PM - Thread Starter
 
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I hoping not to be there, but I've been talking to a twin mom I know IRL and she was telling me about all the pressure to use formula. She wound up mixing formula and breastmilk "to add fat". Have other people done this, and if so, what formula did you use. Im asking because I want to make sure to have a good (non- HFCS formula) on hand when the babes are born. There is often limited selection around here, so I want to make sure I have it if I have to order online instead of needing it at the time and not having it and just giving the go ahead to use whatever the hospital has on hand.


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#2 of 25 Old 08-23-2012, 05:22 PM
 
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My girl got some formula in the NICU because I was not able to pump enough for her once she was home they both got an ounce of formula here  and there for the first couple of weeks. After that they've been exclusively breastfed. All regular formulas are HFCS free the ones htat have it are the sensitive and other especialized formula.


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#3 of 25 Old 08-23-2012, 05:44 PM - Thread Starter
 
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It seems like almost all of the regular brands (not for sensitivity) list corn syrup solids as their first ingredients (over 40%). I know that isnt exactly hfcs, but surely there is something better?


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#4 of 25 Old 08-23-2012, 05:59 PM
 
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Regular formula is sweetened with lactose (same as breastmilk)

 

These are the ingridients for regular similac

 

Nonfat Milk, Lactose, High Oleic Safflower Oil, Soy Oil, Coconut Oil, Galactooligosaccharides, Whey Protein Concentrate. Less than 2% of the Following: C. Cohnii Oil, M. Alpina Oil, Beta-Carotene, Lutein, Lycopene, Potassium Citrate, Calcium Carbonate, Ascorbic Acid, Soy Lecithin, Potassium Chloride, Magnesium Chloride, Ferrous Sulfate, Choline Bitartrate, Choline Chloride, Ascorbyl Palmitate, Salt, Taurine, m-Inositol, Zinc Sulfate, Mixed Tocopherols, d-Alpha-Tocopheryl Acetate, Niacinamide, Calcium Pantothenate, L-Carnitine, Vitamin A Palmitate, Cupric Sulfate, Thiamine Chloride Hydrochloride, Riboflavin, Pyridoxine Hydrochloride, Folic Acid, Manganese Sulfate, Phylloquinone, Biotin, Sodium Selenate, Vitamin D3, Cyanocobalamin, Calcium Phosphate, Potassium Phosphate, Potassium Hydroxide, and Nucleotides (Adenosine 5’-Monophosphate, Cytidine 5’-Monophosphate, Disodium Guanosine 5’-Monophosphate, Disodium Uridine 5’-Monophosphate).
Contains milk and soy ingredients.


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#5 of 25 Old 08-23-2012, 06:09 PM
 
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i think planning ahed is always good, though i would also plan to rent a hospital grade pump and have the good sized flanges all out your home by at least 34-35 weeks, sooner if you show any signs of going earlier.  pumping from the same pump from day one and getting in the rhythm of that will help you out a lot. 

 

as for the NICU and getting a feel for what life might be like in that world, i would suggest you might find some good into on the forum here about it.

 

i did not have nicu babies, they were born at 5lb-3 and 5lb-10 and made the 36 week cut off by 6 hours, i got lucky. they wanted to send my little one there cause she was not keeping her body heat up, but i fought to do kangaroo care with her and it balanced her out right away, 10 min on moms chest did what an hour of a premie heater system could not, silly doctors


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#6 of 25 Old 08-23-2012, 06:47 PM - Thread Starter
 
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Adorkable-

I've got a good medela that I've used before and not had any trouble getting plenty of milk- do you think I need to rent a hospital pump too? I have been searching on the NICU forum for info, but I thought this question might be out of place there.

 

Keria-

Thanks, I guess I can just go to the grocery and look at the ingredients to see which one I like the best. I just wondered if there was some brand that was superduperawesome more than any of the others.


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#7 of 25 Old 08-23-2012, 07:04 PM
 
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if you like your pump, stick with it!! i had a medela hospitol grade rental for the frist 4 months and a conserver version after that, i felt that hte rental was a smoother pul and there for nicer to my boobs (i had a chance to have them both for about a month and used them back and forth to test.  so in that way i missed my high grade one. but i personally got the same amount of milk from both. 

now i pumped hugh amounts and fast. 20oz in less than 20 min, so i only had to pump twice a day and didnt get a chance to get too sick of it. had i had to pump 6 times a day for 20 min, then that firmer tug would have been the end of me,

 

you have the benefit of knowing you make good supply and knowing you can use a pump well, you are way ahead of many of us twin mommies.  i was terrified personally, i have had breast reconstructive surgery, implants and areola incisions to boot, so i had good reason to worry. in the end i was a milk machine and i laughed at my fretting.


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#8 of 25 Old 08-23-2012, 07:12 PM
 
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WOW 20 oz You are my hero lol. The max I ever got was 4 oz. I did get sick of pumping around 3 months or so. I had a PIS and it worked well for me.

 

As far as formulas yeah read the labels I know Similac organic is sweetened with sucrose so we stayed away from that other than that I think all the milk based formulas are more or less the same. We used regular similac and never even finished 1 can.


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#9 of 25 Old 08-23-2012, 07:17 PM - Thread Starter
 
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20 oz!! Holy moly! I have an overactive let down, and can pump about 4 oz in 6 minutes, but then nothing else comes out. I cant decide if you make me jealous or terrified. I wonder if it's going to be way different this time.

 

Keria- I have a PIS too, and I like it.


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#10 of 25 Old 08-23-2012, 07:20 PM
 
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yeah i apparently out of laziness trained my boobs to pump tons less times a day, i didnt realize it was odd till i mentioned it to a friend. i never pumped less than 15oz and would get 24-26oz if i pumped late at night right before bed.  my babes have never nursed longer than a 5-8 min a feeding either, not in the early days and certainly not once they got the hang of it. yeah i was really lucky

frankyl im shocked i never got mastitis from my lazy feast and famine pumping, though i did have a few trouble ducts that got blocked from time to time.  boy i love that trick of a hot water filled sposie diaper!


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#11 of 25 Old 08-23-2012, 08:07 PM
 
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Ugh. Just seeing the word "NICU" makes me shudder. My girls were born at 34 weeks and were 4 lbs each. They were born at home after a very fast (no midwife, no paramedics, only DH made it in time!) labour and we were transported to hospital by ambulance. Although they were both doing well, breathing on their own, had both latched on at home.... the hospital staff were extremely cautious. I started pumping asap but actually found that I got way more collostrum by hand expressing. I was lucky to have an ample supply and have not had to supplement at all (we're still going strong at 7 months). For us, the biggest issue was that the doctors wanted to limit the amount of time that they could nurse. They said that they were worried about something called Necrotising Enterocolitis, and basically said that because they were preterm, my girls' stomachs would likely not be able to tolerate significant amounts of breastmilk. I had to fight for every minute of latching on time and actually had nurses standing over me with a stopwatch and telling me to unlatch after the doctor's prescribed amount of time. They really wanted to be able to control and log every ounce that the girls ingested and, as a result, the girls were quite slow to gain weight. It took about a week and a half before they "allowed" me to have the girls nurse for 15 mins each, and for the feedings that I had to miss, because of rounds, shift changes, or when I was at home with my 3 year old, the nurses would offer bottles of my expressed breastmilk,with a prescribed amount of breastmilk. Our time in the NICU was extremely stressful and is still, 7 months later, a real source of sadness for me. I did the best I could to advocate for my girls despite many barriers and after they were home, I did my best to register concerns and complaints with anyone who would listen. My sense is that every hospital is different and that we were unlucky enough to be in a pretty toxic and unenlightened NICU. My hope is that it'll be a complete non-issue for you, but in the event that you need to pump and are concerned about potentially needing to supplement, my best advice is to get pumping as soon as possible - whether by hand expressing or with an electric pump (I rented a hospital grade Medela and found it worked only marginally better than hand expressing, and this only because it allowed me to do both breasts at the same time), pump often (I think it's something like 8 - 12 times in a 24 hr period) and try to establish a really good supply early on.

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#12 of 25 Old 08-24-2012, 08:37 AM
 
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Ah, the NICU. I had a C-section at 36 weeks (one of the twins was in distress and they wanted him out asap), and started pumping right away after surgery. We live in Europe and my mother brought me a madela symphony pump & style, and it was amazing. I got to my room two hours after surgery and they brought me D who was just over five pounds and he was in the nursery. He latched right away and nursed until he was 18 months, serious die-hard nurser. R was taken to the NICU because he was just under 4 pounds, breathing on his own, but he was put there for weight issues only. They were breastfeeding friendly up to a point, in fact they had never seen a baby under 5 pounds nurse so well. My need to see my baby was greater than my need to faint, so he nursed for the first time after 10 hours. They weighed him when I started and when I stopped to see how much he was getting which was annoying. They preferred that I give him bottles for the first few days to make sure he was actually gettting food becuase sucking can tire premies out. They were also concerned that he would eat too much and his stomach would explode. I am also a milk machine and had enough right away. D had one bottle on his first day, the formula that they have on hand at the hospital because all of the milk I was pumping went to R. On day 2 I was already pumping enough milk for both of them and D was nursing like a champ (a few latch issues, but those were easily corrected by the lactation consultant on hand at the hospital). I actually fought with them really hard when I got to the NICU to nurse D. They were born at 11 in the morning, and I finally got to him at 10 at night, and they almost didn't let me feed him. But I pulled the
"mommy" card - something somebody once told me - I'm the mommy, I outrank you, I win. It worked and they unhooked him from the heart monitor and let me nurse him. Also a natural, but it was tiring for him. After about a week of nursing/bottles, he was exclusively nursing and also nursed to 18 months. I think it depends on your hospital, on the weights and on the babies ability to suck. I pumped when we got home until they were about 9 months and started solids. At the beginning it was nurse, an hour later pump, an hour later nurse. That was a hard two months, but by then I had enough milk in the freezer and I didn't need to pump anymore. 

 

I hope you are successful.


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#13 of 25 Old 08-24-2012, 11:10 AM
 
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For us, the biggest issue was that the doctors wanted to limit the amount of time that they could nurse. They said that they were worried about something called Necrotising Enterocolitis, and basically said that because they were preterm, my girls' stomachs would likely not be able to tolerate significant amounts of breastmilk.

I have never heard of this. I've heard of NEC, but I've never heard that premature babies are not able to handle significant amounts of breast milk. Don't they put a feeding tube down their nose into their stomach and just put the milk in that way? I thought the reason they did THAT was because they couldn't suck for extended amounts of time? headscratch.gif

Sorry to hijack your thread...


ETA: These articles seems to indicate that breastmilk causes less NEC than formula. (BTW, NEC scares the crap out of me and I'm just trying to formulate a plan if I ever find myself in a similar situation.)

http://kidshealth.org/parent/medical/digestive/nec.html

http://preemies.about.com/od/preemiehealthproblems/f/nec.htm

http://en.wikipedia.org/wiki/Necrotizing_enterocolitis

http://www.ncbi.nlm.nih.gov/pubmed/11236727

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#14 of 25 Old 08-24-2012, 01:18 PM - Thread Starter
 
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Wow, so much great information! Thanks :)

Im really hoping to go to term, but I just want to be prepared, and the books are scary....

I've been fretting, so as much info I can get from real people the better. No worries about hijacking...


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#15 of 25 Old 08-24-2012, 01:28 PM
 
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I think planning ahead is a good idea and it saved me a lot of stress.  I would start by touring the NICU(s) near you and deciding where to deliver.  Finding a baby friendly hospital would be best.  Then, see if you can contact them to ask about formulas and fortifiers.  Generally breastmilk its fortified to add calories and for nutrients that a premature baby didn't receive in the womb by nature of early delivery.  There are human milk derived human milk fortifiers, and banked human milk (as I'm sure you are aware).  I would suggest a hospital grade pump in the beginning because if babies are not removing milk well right away you will need something to build and maintain your supply.  The hospital grade pumps are less "tuggy" and will be more comfortable for you in the even you find yourself pumping 8 times a day (as you likely would with preemies).  NEC is a concern with both breastmilk and formula, but moreso with formula. 

Hopefully you won't need any of this information but if you are like me, planning for the "what ifs" helps.  

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#16 of 25 Old 08-24-2012, 01:34 PM - Thread Starter
 
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Definetly like you in the planning for the what ifs helping :)

 

The hospital we will deliver will depend when I go into labor. If everything goes well, and I make it to 35 weeks, I can deliver at my hospital. If I go way early, I will need to drive to the city to deliver, and will deliver at the hospital that is attached to the Children's Hospital NICU. It may or may not be as baby friendly, but it has the highest rates of preterm delivery success and it is where all of the other NICUs transfer to if something is seriously wrong. I hadn't thought of touring the NICU- that's a really good idea. I guess I just always thought it would be off limits to anyone who didnt have a child there.


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#17 of 25 Old 08-24-2012, 01:44 PM
 
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Our baby friendly hospital had a class for parents expecting multiples with a tour of nicu at end.  its a level III nicu so we are quite fortunate.  Id ask to tour if possible sooner the better if they close the unit during cold and flu season.  Feel free to PM me with any questions.  To answer your poll--we used formula in the NICU to fortify breastmilk for calories, calcium and phosphorous but not because I had insufficient quantities of milk.  I hope that helps. I'd also ask them about the prospect of providing your own formula should you need it.  Not sure if that would be an option or not so best to ask.


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#18 of 25 Old 08-24-2012, 01:45 PM
 
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We are fostering twins who were preemie. One was in the NICU for a couple weeks because he didn't have the sucking reflex when he was born. That is common for babies born at or before 35 weeks. He was put on a feeding tube until he learned to eat. Obviously, in our situation I was not breastfeeding that baby. As they were teaching him to eat they were using high-calorie formula. It's specially designed to help preemies gain weight. I think one of the reasons NICU nurses might pressure moms to use formula instead of breastmilk is for that reason - formula can be higher calorie than thus can help preemies gain weight faster. If they have to suck for more than 20 minutes, then the energy used for sucking is more than the energy they're gaining from drinking the breastmilk/formula. So in that situation they get a feeding tube or higher calorie formula. It's important to remember that breast is best for most babies, not all babies. In the instance of preemies who need to gain weight fast, formula really is a very good option.

 

But for any baby, bonding is extremely important. And so for twins the real issue is that if one goes home and the other goes to the NICU, it makes it hard to spend quality time with both of them. It's hard enough when they're in the same house, but when you have to drive to the hospital to visit one, well that makes things rough. But the baby in the NICU really absolutely needs mommy time. The nurses might be excellent, but the fact is they are nurses with rotating shifts. My foster baby had at least 7 different nurses care for him during the time I visited. He needed more consistency and more holding. Now at over a month of age, he's much more sensitive than the other twin. He wants to be held more often and he cries louder. I think that has to do, in part, with his time in the NICU. He needed more "mommy time." So you may want to try to work something out with your partner, family member, or a friend so you can spend a lot of quality time with your twins. Personally, I think that bonding time is more important than which formula you use or if you can use breastmilk.

 

All that said, there were teeny tiny preemies in the NICU who were being fed breastmilk. The nurses were obeying the law and following the parent's instructions to feed breastmilk. So I'm pretty sure that you can basically demand that your baby gets breastmilk. You might get a lot of push-back from nurses and it might be hard to make it happen, but if you stick to your guns I think you can do it. Or at the very least you can feed breastmilk some of the time.

 

Also, young babies can change formulas pretty easily. If you don't like the brand they use at the hospital, then you can probably get your babies to eat something else or breastmilk if you just do a transition mixing the old with the new. A little bit older babies (4-5 months or older I think) they tend to be pretty picky about what they will eat. So... you can probably switch to breastmilk or a better quality formula when you and your babies get home from the hospital. I wouldn't worry too much about it, just try to plan for it by pumping very regularly, eating well, etc.

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#19 of 25 Old 08-24-2012, 07:26 PM
 
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Well that makes me fell like crap. I visited my girl about two hours every day. I was recovering from an emergency c section, was still dealing with high blood pressure and had another newborn to take care of. She is  definitely the one that wants to be held more and only wants mommy. I guess what's done is done it's not like I can go back in time and visit her more.


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#20 of 25 Old 08-24-2012, 08:24 PM
 
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I have never heard of this. I've heard of NEC, but I've never heard that premature babies are not able to handle significant amounts of breast milk. Don't they put a feeding tube down their nose into their stomach and just put the milk in that way? I thought the reason they did THAT was because they couldn't suck for extended amounts of time? headscratch.gif
Sorry to hijack your thread...
ETA: These articles seems to indicate that breastmilk causes less NEC than formula. (BTW, NEC scares the crap out of me and I'm just trying to formulate a plan if I ever find myself in a similar situation.)
http://kidshealth.org/parent/medical/digestive/nec.html
http://preemies.about.com/od/preemiehealthproblems/f/nec.htm
http://en.wikipedia.org/wiki/Necrotizing_enterocolitis
http://www.ncbi.nlm.nih.gov/pubmed/11236727


Yuppers - all the literature I looked at said the same thing: NEC is rare, the risk of NEC is lower with breastmilk.... I printed numerous articles and offered them to their doctor to no avail. She advised me that because of my babes' gestational age, they were definitely at risk for NEC, and that the best way to manage the risk was to limit their intake. She said that the problem with breastfeeding is "that there's no way to know exactly how much they are ingesting, which makes it too risky", so she could only let me breastfeed for very brief periods of time in the beginning. We started out with something they called "gut stim" - basically, I was "allowed" to have them latch on for 2 minutes every 8 hour shift. Then we moved to 2 mins every 3 hours. When I couldn't be at the NICU for a feeding, they would give the girls 5 ccs/mls by bottle. I offered to have the girls weighed before and after every nursing session, so that they'd know exactly how much they were getting, and was told that a) they didn't have the proper scale for that and b) it would take too long for the nursing staff. We slowly worked our way up to my being "allowed" to nurse them for 15 minutes every 3 hours. We were completely at the mercy of whichever nurse was on shift - some were lenient and told me that they disagreed with the doctor's orders and that I could nurse on demand (provided I didn't tell anyone!), some stood over me with a stopwatch.

 

I also produce TONS of milk. At the end of the stay in the NICU I was pumping 16 oz in less than 5 mins, after I'd already nursed the girls. This made the doctor even more concerned. The girls were discharged with strict instructions to me NOT to feed them on demand (which I did not abide by)! I was told that the risk of NEC only decreases after 1 month!!!!

 

I could write PAGES about all the barriers we faced in the NICU. As I said in my previous post, 7 months later, our time in the NICU still haunts me. I still wonder if I could have done more to advocate for my babes, gotten them home sooner.... I try to remind myself that it was such a difficult time and that I did the best I could. We were unlucky enough to be in a NICU that did not follow evidence-based practice, one where decisions about patient care had more to do with ego and power struggles than best practice. Once we were discharged, I registered complaints to anyone I could, but I'd say that the most meaningful response came from medical director who oversees several NICUs in the area including the one we were at. Unfortunately, he's based several hours away, so we never got a chance to meet him or discuss our concerns while the girls were in the NICU. Basically, he was appalled and horrified. He assured me that there would be changes in the way the NICU operated.

 

I like to think that our experience was pretty abnormal. I really hope I'm not stressing anyone out/ haven't added any anxiety to anyone's experience. I'm usually much more of a stalker and wonder if any of this is helpful, or just the rantings of a NICU obsessed, sleep deprived mama!!

 

Adaline'sMama, my hope is that you and your babes won't have to be in a NICU (even a great one) at all!

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#21 of 25 Old 08-25-2012, 12:42 PM
 
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julyaugust - I'm so sorry you've had such a horrible experience. How long ago were your babies in the NICU? And can I ask where (just a general country/state if you don't want to be more specific [although I think I'd be shouting their name at the top of my lungs as the most horrible place to go])?

Married to one of the last good guys left Jim
Mom to AJ 4/07 and Genevieve 5/09

And then: I'm really, really tired of making angels.

But wait, could it really be true?


The whole story at: www.xerxella.blogspot.com
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#22 of 25 Old 08-25-2012, 03:19 PM
 
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We've had experience with three NICU's now. My triplets are currently still in one. All our NICU's have been militantly pro-breastmilk. They are my biggest supporters. A lot of our current NICU nurses are also LC's and are great. The only incident I had this time was that the neo (NICU doc) asked me at about the 48 hour mark to lift my ban on formula "just in case". I refused- I was clear that IF formula was needed that they could contact me 24/7 and I would discuss it then, but I wouldnt say yes for no reason. Moral of the story: make sure they know you wont allow formula- mark it in the plans, and notate it on the NICU admitting forms. 

 

My triplets are 5 weeks now and have never had formula. My milk is the only thing that has crossed their lips. 

 

Well... kind of. 

 

Human milk fortifier is something you need to research. Some preemies need it. Some NICU's will give you a choice, some wont. It depends on a lot of things. My babies milk was fortified for a short period of time. I am OK with that. 

 

I am less ok with the poly-vi-sol. Whole 'nother story. 


Mama to nine gorgeous babies, with finale #10 due April'14.
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#23 of 25 Old 08-25-2012, 07:08 PM
 
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Quote:
Originally Posted by Xerxella View Post

julyaugust - I'm so sorry you've had such a horrible experience. How long ago were your babies in the NICU? And can I ask where (just a general country/state if you don't want to be more specific [although I think I'd be shouting their name at the top of my lungs as the most horrible place to go])?

 

 7 months ago, and we were in New York state. There was one LC for the entire hospital, which basically meant she was so busy she was practically unavailable. The first pump that they gave me was actually quite old and faulty (didn't work at all) and it took several days before I was finally able to see her face to face and get a different one. I had pretty much no breastfeeding suppor and was actually "forbidden" by the doctor to nurse both girls at the same time. She said it would take too much coordination and was therefore too risky (I think she was worried I'd drop them!). Even a day before their discharge, when I suggested that the NICU might be a good place for me to practice nursing both at the same time, I was told by a senior nurse that she thought it would be better for me to leave things as they were and not try to incur the wrath of the doctor any more than I already had.
I count my blessings that they had good latches from the start, I knew more or less what I was doing because I had nursed DS, I had a good supply and I had access to great info online!!

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#24 of 25 Old 08-26-2012, 05:41 AM
 
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Julyaugust---thay spunds horrible. I am so.sorry you had to go through that.

I am glad this thread is here, because i.would.probably not have given it much thought or research. The hospital i plan to deliver at has a levelIII(???the best one) so i just assumed that is all i needed to.know Can anyone direct me to other sources of information that would pertain to nicu stay? Maybe based on the care i have been receiving i.would be better off ignorant and blissful though (and i mean that non-snarky).
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#25 of 25 Old 08-26-2012, 06:44 AM - Thread Starter
 
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Well that makes me fell like crap. I visited my girl about two hours every day. I was recovering from an emergency c section, was still dealing with high blood pressure and had another newborn to take care of. She is  definitely the one that wants to be held more and only wants mommy. I guess what's done is done it's not like I can go back in time and visit her more.


Be gentle with yourself, that's a lot of crap to be going through.


Holly and David partners.gif

Adaline love.gif (3/20/10), and Charlie brokenheart.gif (1/26/12- 4/10/12) and our identical  rainbow1284.gif  twins Callie and Wendy (01/04/13)

SIDS happens. 

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