Please help my friend.....she needs info. - Mothering Forums

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#1 of 15 Old 01-07-2009, 09:54 PM - Thread Starter
 
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A friend of mine had her baby yesterday. The baby is in the NICU. She really wants to breastfeed the baby, but was told that he needs to be tube fed and is not strong enough to do so. She has seen a lactation consultant who told her to pump, but didn't really expand from there. One of the nurses told her that sometimes babies like this just need a bottle because they are too week to suck. The questions we both have are : 1. With children who have a hard time with sucking, what can be done? 2. Is there anyone else she should be contacting......speech therapist perhaps? 3. What type of breastfeeding interventions have others had experience with in the NICU? 4. Is Kangaroo care something she should be insisting on?(no one has suggested it thus far). 5. Is there any other words of advice you can offer her when dealing with the NICU? Truly, my friend and I thank everyone in advance for the help they may be able to provide her. This is a tough time and I feel really bad.

Tricia, married to DH. 2MC's & 4 yrs ttc...finally mom to Andrew6/06 and Benjamin 10/09. Adopted bro & sis 2002. My 2 fav. words: Spay and Neuter! I'm an Ultimate Viewer, 2010!

 

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#2 of 15 Old 01-07-2009, 10:36 PM
 
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It's really tough to answer your questions without knowing the baby's gestational age and general condition. I had a lot of trouble breastfeeding my twins and ended up exclusively pumping, so I am probably not great to answer your questions. But the people who can answer them probably need more info to make even a stab at helping. I wish your friend and her baby good health!

Betsy, mama to beautiful, strong MZ twins Lillian and Kate, born 11 weeks early on January 10, 2006.
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#3 of 15 Old 01-08-2009, 07:51 AM
 
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I still can't get my head round the whole bottle thing tbh. Evidence shows that preemie babies' stats remain more stable with b'feeding than bottle feeding and that it is less stress on them than bottles, yet it's always discussed/ assumed that bottle feeding is easier. I know with an older baby bottlefeeding is 'easier' for them because it drips out, but ime my daughter just choked like crazy on a bottle whereas she coped well (choked less ) at the breast even though she would fall asleep etc....I had to tube feed her for weeks because that was the only way to top up and it was driving me crazy that they were suggesting I should try bottles.

How I would have managed it on my terms is:
drop the tube top ups (probably around 36/37 weeks in my daughter's case) and feed little and often rather than the preemie 3 hourly schedule !? but I wasn't allowed to feed 'normally' and it was stupid.
Woops. Last comment my unresolved issues coming out

just posted the above elsewhere but seems a bit relevant to this thread.

YES SHE SHOULD FIGHT FOR KANGAROO CARE ASAP
- and express her milk to get a good supply for when baby is ready.
Kangaroo care will help with the hormones that make milk.

I would personally stick to tube feeds over bottle as less confusing for baby even though there is some evidence smaller preemies get less nipple confusion. Mine b'fed differenty after a pacifier even, so personally would not want to risk it.

The best thing she can do right now is skin to skin and expressing her premium colostrum for her special baby....

What age was the baby born at?

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#4 of 15 Old 01-08-2009, 09:40 AM
 
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Push for kangaroo care if the baby is stable enough to do so. My boys were too unstable to be held for the first month.
She needs to pump. Most preemies will be tube fed to get their bodies ready to eat. The baby will likely get only a few cc's per feeding to start.
Preemies have a hard time eating because they get tired quickly. My boys were mostly bottle fed while in the nicu. I would try to nurse them a few times per day but it took a lot of work, once they came home, to get them 100% nursing. Keeping up a milk supply while the baby is in the nicu is the most important thing. Pump at the nicu if there's a place to do so. Take pictures of the baby and set up a space where you can pump and look at the pictures.
Without knowing the gestational age, it's really hard to be more specific.

Lindsey- SAHM to Skylar (7-12-01), Leah (10-29-04), id twin boys Addison and Riley (6-17-08, born at 25w4d), and Terran (5-29-11, born at 28 weeks)

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#5 of 15 Old 01-08-2009, 12:31 PM
 
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Some NICU's are not as breastfeeding friendly as they could be and you really have to push and advocate to feed. Like others have said it also depends on baby's gestational age.

Generally babies can start at least nonnutritive sucking or practice breastfeeding by 32 weeks gestational age if there are no other medical conditions. Tell your friend that it can be done, the suck and latch will usually improve as the baby gets older. A lot of nurses also prefer bottles because it is so much easier to measure what is going in, she can suggest weighing the baby before and after each feeding to see how much he is taking.

She definitly needs to get on a pumping schedule to keep up her milk supply. A hospital grade pump is best. Once she is discharged if she is on WIC or might qualify for WIC they will usually loan a hospital grade pump for free.

Don't know much about the kangaroo care because my little man had chest tubes for his stay and it was not possible but getting the baby to the breast as many times a day as possible is what helped us leave the NICU.

As far as bottles my preemie went back in forth no problem. I do think this is better for earlier preemies because letting them bottle fed when you are not there will get them home quicker. Sometimes older babies can be cup fed when not at the breast but my NICU would not cup fed until baby was at least 37 weeks gestation.

Wishing your friend the best of luck and (((hugs)).
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#6 of 15 Old 01-08-2009, 07:23 PM
 
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Just kind of echoing what the other mommas have said. DEFINITELY insist on Kangaroo care as much as possible. Talking directly to the doctor seems to get more done than going through the nurses who change so often. I had the same experience with breastfeeding - they were all for me pumping, but thought it would burn too many calories for him to nurse. I HATED the bottles. If I had to go through that again I would be more firm. He always choked on the fast flow. It is possible for them to weigh the baby before and after nursing sessions to see how much made it into it's belly, and then tube feed the rest. That's what I would push for. Good Luck.

Thankful to be a play-at-home-Mommee to my "cage-free" little monkeys, Sam, (1/21/07) and Jonas (8/17/09), a Wifee to my best friend, James, and excited to welcome our first girl-baby this summer. ***Families Are Forever!***

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#7 of 15 Old 01-09-2009, 12:22 AM
 
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If the baby is particularly early or extremely ill, she won't be able to do kangaroo care until she is stable. Once she is stable, it shouldn't be a problem. Again, I agree with the poster who suggested that it is hard to know what to say in regards to breastfeeding right now. There is a thread here about bottle bias in the NICU and it is an interesting read to say the least. There is the discussion of whether bottles are easier, allow babies to come home faster, and what to do if the mom isn't available or allowed to stay in the NICU 24/7. At least, for now, I'd encourage pumping and skin to skin contact if possible.
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#8 of 15 Old 01-09-2009, 12:48 AM
 
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Regarding Kangaroo Care, she should ask about it. It may be that the baby is too unstable right now, or it may be that they think she doesn't want to yet, or they may actually be unsupportive. The last one is the least likely, in my experience, but better to inquire now and figure out what the real story is there. I wasn't able to kangaroo my babies when they had IVs and when Kate was on the vent, but no one really said anything about it until I asked about it. Even once I asked, I realized I had to keep checking because they probably weren't going to bring it up. They weren't unsupportive of kangaroo care - once we started doing it they were all for it - but it wasn't a priority for them in light of taking care of other needs.

Betsy, mama to beautiful, strong MZ twins Lillian and Kate, born 11 weeks early on January 10, 2006.
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#9 of 15 Old 01-09-2009, 04:47 PM - Thread Starter
 
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Thank you so much for the information. While my friend was on her way back to the NICU, I read her the responses and she was very happy to hear some of the suggestions. Just to clear up any confusion......her baby was born at 36 weeks five days. He appears to be making gains, but they are most concerned about getting him, to bottle feed for 48 hours straight before he is allowed to be released. Yesterday my friend noticed that he was interested in sucking more. She is going to ask about at least attempting to breast feed with him, but they have been only bottle or tube feeding up to this point. She agreed that it is hard to keep the limes of communication going when so many nurses are coming and going. If in the end, he only receives bottles in the hospital.....will it be possible to breast feed only once he is home???

Tricia, married to DH. 2MC's & 4 yrs ttc...finally mom to Andrew6/06 and Benjamin 10/09. Adopted bro & sis 2002. My 2 fav. words: Spay and Neuter! I'm an Ultimate Viewer, 2010!

 

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#10 of 15 Old 01-09-2009, 05:17 PM
 
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In the absence of any other medical problems, there is no reason this baby should not be able to breastfeed now. 36 weeks 5 days is very close to term and while the baby may be sleepy or have a little difficulty latching, she should learn with some practice. However, once again, learning to latch properly on the breast may take longer than learning to bottle feed, so it could extend the NICU stay. Most NICUs want you to prove that the baby is taking all their feeds by nipple (breast or bottle) before they go home.

It should be possible for the baby to breastfeed at home, but it may take practice. If the baby is given a bottle, especially bottle only for 48 hours, the transition may not be smooth.

My daughter was tube/bottle fed for 23 days, and after the NICU it took and additional 2.5 months for her to learn to breastfeed. That meant 2.5 months of pumping for her (around the clock) attempting breastfeeding first each time, weighing before and after, then finishing with a pumped bottle of milk if she didn't get enough at the breast. However, she's 4 now, and nursing still, so eventually it worked!
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#11 of 15 Old 01-09-2009, 06:46 PM
 
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Quote:
Originally Posted by shukr View Post
I still can't get my head round the whole bottle thing tbh. Evidence shows that preemie babies' stats remain more stable with b'feeding than bottle feeding and that it is less stress on them than bottles, yet it's always discussed/ assumed that bottle feeding is easier. I know with an older baby bottlefeeding is 'easier' for them because it drips out, but ime my daughter just choked like crazy on a bottle whereas she coped well (choked less ) at the breast even though she would fall asleep etc....I had to tube feed her for weeks because that was the only way to top up and it was driving me crazy that they were suggesting I should try bottles.

How I would have managed it on my terms is:
drop the tube top ups (probably around 36/37 weeks in my daughter's case) and feed little and often rather than the preemie 3 hourly schedule !? but I wasn't allowed to feed 'normally' and it was stupid.
Woops. Last comment my unresolved issues coming out

just posted the above elsewhere but seems a bit relevant to this thread.

YES SHE SHOULD FIGHT FOR KANGAROO CARE ASAP
- and express her milk to get a good supply for when baby is ready.
Kangaroo care will help with the hormones that make milk.

I would personally stick to tube feeds over bottle as less confusing for baby even though there is some evidence smaller preemies get less nipple confusion. Mine b'fed differenty after a pacifier even, so personally would not want to risk it.

The best thing she can do right now is skin to skin and expressing her premium colostrum for her special baby....

What age was the baby born at?
Absolutely agree with this.

1. With children who have a hard time with sucking, what can be done?

Usually, babies are given the NG tube and most feeds are given this way until they are better able to suck. But, if your friend wants to breastfeed, the only way the baby can learn to do this effectively is through practice. Thus, forcing a bottle on the baby will not teach the baby to breastfeed. Now, I know, some babies are so young they cannot breastfeed effectively and are given the bottle. However, if the baby is at 36 weeks, unless there is something else going on, I don't see why the baby shouldn't be offered the breast first if that is your friend's desire. I also believe that babies who show a strong preference of breast over bottle should be given the opportunity to do so.

2. Is there anyone else she should be contacting......speech therapist perhaps?

When my DD was in the NICU, we had occupational therapy come around all the time to check on her bottle-feeding status. Lactation consultants were there if we called. I would recommend having occupational therapists (they look at other things besides bottle feeding) and LC both come pay your friend a visit and answer any questions she might have. Also, a development specialist might stop by to see the baby to check it's progress.

3. What type of breastfeeding interventions have others had experience with in the NICU?

My DD's NICU was not breastfeeding friendly. However, it did have a pumping room so I was able to pump while I visited her. I really pushed for breastfeeding time and I had to fight for that! She will need to always reiterate her desire to breastfeed and/or feed the baby her expressed breastmilk. Doesn't hurt to keep reminding the staff that she's not formula feeding the baby, in my opinion. I also contacted my local LLL while my DD was in the NICU for support. Afterwards, I hired my own LC to help me and DD at home learn how to breastfeed more effectively.

4. Is Kangaroo care something she should be insisting on?(no one has suggested it thus far).

ABSOLUTELY! Preemies love kangaroo care if they are able to. All the research shows that this helps preemies. Check out Dr. Newman's site.

5. Is there any other words of advice you can offer her when dealing with the NICU?

Patience, but realize the baby is in excellent hands. However, tell her to never forget that she is the mother. It is still her right to ask what's going on and stay abreast of the baby's treatment. That's not being in the way, that's being proactive and loving your child.

Good luck! Keep us posted!
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#12 of 15 Old 01-23-2009, 12:30 AM
 
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Advice from a NICU nurse (in a BFing friendly, progressive unit, unlike her hospital it appears)....

If I were your friend:

!. Kangaroo care, kangaroo care, kangaroo care!!!!!! Keep that baby glued to your chest 24/7 if you can. They sleep better, they grow better, they BF better, your supply is better. You can't do too much KC!! I tell my mamas to be prepared to sit there until their bladders pop I also say dads can do it too, but t doesn't do much for their milk supply

2. There's no reason why an almost 37wk baby can't be EBing in the NICU. At my hospital, the baby (depending on condition, of course) would BF with pre and post weights. If, for example, we wanted the baby to take 30ml, if the baby BF 10ml we would tube feed the rest. No bottles. We also do what's called "cue based"... instead of saying "You need 30ml every 3 hours" we say "You need 120ml in 12 hours; how you take that is up to you" (comes out to the same amount). We then supplement with tube feedings as needed during that 12 hour period so they don't fall too behind. So the baby who wants to eat every 1-2 hours can. The baby who likes to sleep 4 hours can. We also try to give EBF babies realistic volumes... 60ml in a 1 day old is NOT realistic; 5-10 ml is. Of course, there may be conditions where a baby truly needs lots of fluids, but if they're that sick they're getting it from IV fluids, not feedings.

3. Look into a nipple shield... a soft silicone nipple that goes over your own nipple. A baby can latch onto this with less effort and get more milk vs just the breast. Not ideal, but better than a bottle. When the baby is stronger you wean them off the shield. Talk to a lactation consultant.

4. Hospital grade double pump. See if insurance covers the rental.

5. Other ways to help the baby suck: there are oral stimulation exercises that occupational therapists or speech therapists can demonstrate. They involve stroking of the cheeks and gums. Keep oral experiences as pleasant as possible. Offer q-tips dipped in BM for baby to suck on. Keep a soft fleece square in your bra and have baby lie with her head on it while she sleeps to get your scent when you can't be there.

6. Be a pain in the butt. You're not there to make friends with the staff. You're there to advocate for your child. Rock the boat. Be the squeaky wheel. Write everything down. The plan for the day, what happened that day, test results, etc. Get a written, agreed upon plan posted at the bedside ("No bottles, no pacifiers, no formula, etc"). Yeah, some nurses dislike families like this but others silently applaud. You may make our 8 hour shift less agreeable, but it's a small, forgotten time in our life. Whereas a short NICU stay where the BFing relationship was not honored will effect your and your child's life forever.

HTH!

ps-- just saw how long ago this post was; hope the baby is home and doing well! And I'll keep this post up in case it helps someone else... and since I took all this time to rant I hate backwards hospitals...

Wife, mother of 2
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#13 of 15 Old 01-24-2009, 10:33 AM
 
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My little guy was a 28 weeker- 2lb, 9oz. He was too little to breast or bottle feed when he was born and spent his first 5 or 6 weeks on NG tube. I pumped like a maniac (demanded a pump just an hour or two after my cesarean) for the entire 7 weeks he was in the hospital. My hubby and I both did as much kangaroo care as possible and when he was big enough to try breatfeeding, he got to nurse as much as I could get there. He latched on the first time at about 31 weeks gestation, much to the surprise of the nurses (they thought that was pretty young). Our hospital was very supportive of nursing and giving babies breastmilk (Dr. Sears gives stats that breastfeed NICU babies come home an average of 2 weeks sooner than formula fed preemies), but it was for us, a matter of how often I could get there to nurse him instead of getting a bottle of milk. I have three other kids at home. But he continued to proove them wrong when he came home and they insisted that he'd still need several bottles a day for a "break" and he went straight to all breast, all the time. At 5 months old, he's still a champion nurser.

EDIT: for clarity, my son was only 35 weeks gestation when he came home and was nursing every feeding every day.
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#14 of 15 Old 01-24-2009, 03:41 PM
 
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Originally Posted by gumby74 View Post
Thank you so much for the information. While my friend was on her way back to the NICU, I read her the responses and she was very happy to hear some of the suggestions. Just to clear up any confusion......her baby was born at 36 weeks five days. He appears to be making gains, but they are most concerned about getting him, to bottle feed for 48 hours straight before he is allowed to be released. Yesterday my friend noticed that he was interested in sucking more. She is going to ask about at least attempting to breast feed with him, but they have been only bottle or tube feeding up to this point. She agreed that it is hard to keep the limes of communication going when so many nurses are coming and going. If in the end, he only receives bottles in the hospital.....will it be possible to breast feed only once he is home???
If he can bottle feed he can breastfeed. You have to teach sucking no matter what. I had a 31 week preemie and I refused all bottles. I made them do only tube feeding or I breastfed (from about 34 weeks on). If this baby is just early and not sick or with other conditions then she needs to get to Kangaroo Care and insist that he neonatalogist write IN THE ORDERS that this kid only gets tube fed or breastfed and ONLY breastmilk. She will have to fight hard and they don't make it easy, but if she gets a bunch of crap she should get the patient advocate and nurse manager and ask for a team meeting (bring husband and make sure they speak as one). It can be done, I did it.
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#15 of 15 Old 01-27-2009, 04:01 AM
 
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There is lots of great advice in this thread!!

I'd second the advice to be determined. Talk to a lactation consultant. And lots of Kangaroo care. And in the meantime, pump frequently to make sure she establishes a good supply (at least every 3 hours during the day - or at least 24 ounces over a 24 hour period).

Unless there are other medical issues going on, I cannot imagine why a 36 week baby should have to be bottle fed or have an NG tube. Both of my preemies were able to be exclusively breastfed (off the tube) by 35 weeks. We more or less went "tube to boob".
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