preemie in nicu and low milk supply - Mothering Forums

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#1 of 13 Old 07-21-2003, 11:30 AM - Thread Starter
 
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hello. my name is angela and my brand new 32 week daughters name is abigail. i was hanging out on the i'm pg board as i was due in sept. my daughter is in the nicu and has had a chest tube, been on the vent (now off) and had a PDA which required indomethacin. as a result she has just started tube feeds over this past weekend. i started pumping in the recovery room a week ago (csection unfortunately) and am pumping with a hospital grade pump (double pump) every 3 hours for 20-30 minutes at a time. i still have not experienced letdown type sensation and am only getting 20-35 cc total at a time. needless to say i am getting kind of depressed about this. i am taking mothersmilk tea and trying to drink a lot of water and trying (ha) to get a lot of rest. but i seem to be stuck here at this amt. i have not gotten to hold her because of the chest tube although i am hopeful it is coming out today. i have told them i want to breastfeed and i don't want them to use bottles when the time comes but they said they have to use a bottle at least a few times to evaluate her ability to suck and swallow? although they also said once i am able to hold her she can try latching on. i have let them give her a preemie pacifier (shaped like a finger) to comfort her in her isolette although she hasn't used it very often - i feel guilty for letting her use it but i want her to get comfort while she is getting poked at so much so i felt like i was between a rock and a hard place. oh and i haven't felt engorgement either. the thread below was very helpful but specifically did anybody else who had to start off pumping instead of nursing have to do something to increase supply and what worked? TIA -angela and abigail
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#2 of 13 Old 07-21-2003, 12:32 PM
 
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((((hugs)))This must be a very tough time for you. Joy over meeting your new dd, mixed with fear and exhaustion and recovery from the surgery!!! Yes, rest, drink and EAT! You need your strength.

So it has been a week and your supply hasn't seemed to come in yet? You haven't held your dd yet? Perhaps when you do get to hold her, your hormones will come rushing in and you will start producing more.

With a double pump, you may not need to pump for 20-30 mins. Usually 10 mins on a side is enough. Are you working with a good IBCLC?

For a good strong galactogogue, do a search here for domperidone. Also, see this link:

http://www.breastfeedingonline.com/newman.shtml

Scroll down to galactogogues, esp "domperidone." But many of the links may help you with good info.

there is a book out pub by LLL, Bfing your Premature Baby, available here:

https://www.lalecheleague.org/Web_store/web_store.cgi

HTH
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#3 of 13 Old 07-21-2003, 12:40 PM
 
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Both of my kids were 5 weeks early and we had some problems w/dd and lots of problems w/ds nursing. We were fortunate both of them were able to be released the same time I was, so I don't have experience with the nicu.

With dd, she just didn't latch. I would try to nurse, bottle feed, pump- every 2 hrs. At about a week, she latched for the first time, by a month, she was exclusive.

With ds, long story, but I pumped and fingerfed until he latched and nursed at 4 mos old. I agree 10-15 min should do the trick- but you might want to try every 2 hrs during the day. Another trick an LC told me is to try to simulate cluster feeds by pumping for 5 minutes every 15 min for an hour or 2. Domperidone is what did the trick for me. None of the herbs worked. I was pumping only 5 oz a day and after I started the domperidone I pumped 13 oz 2 days later. I stopped measuring after that.

Good luck. I know you can do it.

Michelle -mom to Katlyn 4/00 , Jake 3/02, and Seth 5/04
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#4 of 13 Old 07-21-2003, 12:46 PM
 
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I'm sorry to hear about your rough start. I can't imagine how hard that must be.

Just wanted to say that pumping 20-35cc doesn't sound at all bad to me. My baby was full term (6lb 3) and that's all I could pump at first. I was feeding my dd with a 10ml syringe and sometimes could only pump 1-2 syringes and had to supplement with formula. I can't imagine your baby needs more than that right now. Pumping is the best thing for your supply. Don't worry about feeling letdown, not everyone does. You can also take fenugreek and there are prescription meds also if you need them.

Quote:
but they said they have to use a bottle at least a few times to evaluate her ability to suck and swallow
I'm not so sure about that. I mean the LCs would stick their finger in my dd's mouth to evaluate her suck. I never saw an LC evaluate a baby's suck with a bottle. And I'm sure there must be ways they can tell she's swallowing. If this hospital has a NICU, am I wrong in assuming they'd also have a hospital LC? I'd demand an LC's advice. Else I'd get a private one.

I'm sure others here can give you more advice about the NICU.
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#5 of 13 Old 07-21-2003, 12:53 PM
 
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Hi - congrats on your daughter. Now is a scary time, isn't it?

My ds was born @36 weeks, but needed time on vent, lots of tubes, no nursing until he was a week. I pumped "dry" for days - it is really hard.

Things that helped me were taking a blanket out of his isolette with me to pump and smelling it; taking a photo with me to pump; hanging out near crying babies before it was time to pump (my ds didn't cry because he couldn't); then it all got much better when I got to hold him.

I would be hesitant to go the bottle route - there are other ways to see if baby is sucking. Be confident in your choice to breastfeed and if you don't want to do the bottle thing - speak to every nurse and doctor about it.

Good luck - and know that every little drop of milk that you make for you dd is so precious and good. It is the one thing that only you can do for her. This less than ideal start will be such a small part of your nursing relationship - stay positive and get lots of rest and water.

happykat
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#6 of 13 Old 07-21-2003, 01:02 PM
 
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Believe it or not, it sounds like you're off to a great start!

Pumping can be very difficult, but the rewards really make it worth it. We all start out slow. As Wombat said, your baby doesn't need much more milk that what you've been producing. They only need a drop or two in the first two days to help them clean their systems!

Best of luck, and hugs-
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#7 of 13 Old 07-21-2003, 01:25 PM
 
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Your baby is one week old?


Here are a couple of useful links...
www.kellymom.com/links/bfhelp-premie.html
www.lalecheleague.org/FAQ/pumpwork.html
www.lalecheleague.org/FAQ/premresources.html


You will want to pump 10 to 15 min 8-10x per day. It sounds like you're pumping approx. 7. Many moms find that pumping more frequently will help.
Once your milk is in good,you can continue to pump 8-10x per day. Since you're trying to *increase* your supply,you can pump for 2 minutes after you see the last drop of milk,or 30 minutes(whichever comes first) on as many of your pumpings as is practical. You can stop that and continue your normal pumping routine once your supply is up.
Also,make sure you are getting up at least once to pump at night. You will need to do so at least until your supply is well established.

If you pump more than your premie *needs*,that is okay. Keep pumping. When baby comes home,you'll be thankful for that full supply.

Here's a question. Has your milk been at this amount you're pumping for awhile,or has it abruptly decreased?

You might want to consider talking to your baby's pediatrition/neonatologist about going directly from tube to breast. Studies have shown that babies who do are more successful at making the transition to breast AND breastfeeding has been shown to be less stressful. Don't talk just to the nurses. Let everyone know your wishes. Your LLL Leader can give you the sources of these studies so you can have some information to back up your point of view.

On that note,please contact your local LLL Leader. She will have lots of resources for you and can be a source of information and support. To find a Leader www.lalecheleague.org/leaderinfo.html

Is there an IBCLC at the hospital? Have you visited her?

The links I posted have some great info,as well. I hope you will find some of it helpful.

Hang in there,mama. You're doing great. I think all you need is a little support and TLC. I know you can do this!
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#8 of 13 Old 07-21-2003, 01:47 PM
 
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I pumped for my 29 week preemie for quite a while! (She was in the NICU for 3 months)

Here's what I'd recommend. Pump a bit more if you can. I found that I got the most at certain times (when I was up at the hospital and had been holding her...I'd go into the back room reserved for pumping moms and usually got alot more. Also, when I just woke up from a nap or when I got up in the middle of the night...I was more relaxed.) Rest was a BIG factor in my supply.

I also had a c section and never had that engorgement feeling. BUT I have also had a breast reduction, so that was another factor I had to deal with.

Herbs never did affect my supply much, but I took domperidone and went from pumping drops to pumping several ounces. It made a huge difference. There is info about where to get dpd cheaply on this website: www.bfar.org

You also might want to try practicing breast compressions as your pumping. It takes a bit of coordination, but I got ALOT more milk.

I also had slllllooooowwwww letdown and I often pumped for 30-40 minutes. But that might have been an effect of my surgery..

Hang in there! You are doing AWESOME for you baby. Every precious drop is important.

Do you have a forecast about how long she might be in the hospital? If it's not too long, maybe they'll work with you on feedings and you can use a dropper or supplementer rather than a bottle...
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#9 of 13 Old 07-21-2003, 02:36 PM
 
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I had to chime in here as I am now pumping at work for my 6.5 month old dd who arrived at 34 weeks on New Year's Day. She was in the NICU for 10 days and I too pumped dry for a few days (I called it motivating the milk truck).

I found that I didn't really get much until I could hold my dd. I understand that you can't do that yet but once you can, it may make a big difference (hormones are amazing). I would insist that the hospital let you do kangaroo care (this is skin to skin contact - baby in a diaper, you with your shirt off but both covered by a blanket) -- studies have shown that this helps babies grow and it will do wonders for your hormones (probably make you cry but in a good way).

My hospital fed my dd first through an NG tube and then with a bottle for most feedings (we did all of the daytime feedings with either the tube, bottle or breast and the nurses handled the overnight ones). i didn't know better and just wanted to get her home -- for us feeding was the key here. luckily she was never nipple confused. it sounds like your hospital will let you try to bf soon which is good. do it as often as your baby has strength to. I didn't get my dd completely switched over to breast until she was 3 weeks old. I knew I was coming back to work so she's always done a combination of bottle and breast.

you're doing great! keep up the pumping -- you can lubricate with olive oil if you find there's too much friction with frequent pumpings (I did). hold that baby as much as you can once the tube is out.

Good luck,

Hope
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#10 of 13 Old 07-22-2003, 08:53 AM - Thread Starter
 
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thank you all so much. just reading your responses has helped me feel better. i do have an LC and she has mentioned domperidone and reglan. i was thinking about it although i was going to try fenugreek first. to answer some questions- i am getting up at night to pump every 3 hrs or so and i do hand express or massage at the same time as i pump. at night for some reason i usually get more around 40 cc total then during the day. they let me hold her yesterday after they took out the chest tube but they had given her morphine so she didn't really try to nurse but for a second. however when they checked she had taken 1 cc of breast milk from me. unfortunately her pneumothorax has come back and she is now under a oxygen hood and may need the chest tube reinserted. they were going to let me try to bf once a day but now because of this they are sticking to the tube feeds. i thought holding her yesterday might make a difference in amt but it didn't. and i have been consistently pumping right at 1 oz total for the last 5 or 6 days - it has never been more than that. as far as the bottle thing goes -- they said the occupational therapist? i think has to do a test on her with a bottle to evaluate the suck/ breathing thing at some point- other than that i don't think they are going to give her more than that i hope. i have the LLL numbers i just haven't had time to call. in fact i was at my first LLL meeting when i started leaking my water and endedup at the hospital later that day! thanks again so much for the responses. i think i will try pumping more often also. ps i am double pumping with hospital grade pump for 20-30 min at a time.
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#11 of 13 Old 07-22-2003, 11:44 AM
 
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I know I mentioned breast compression. Here is the info on it. It talks about doing it during a nursing session, but I found it VERY effective to do while pumping.....SO much extra came out...

breast compression
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#12 of 13 Old 07-27-2003, 08:58 AM
 
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If possible - have them place screens around you if need be so you can pump at the bedside. Pump where you can SEE and even touch your baby even though you cannot hold her. For some reason this helps the milk supply! We are in the process of installing curtains around the beds just for this purpose in the unit I work in!

Also be sure to pump for 2 to 4 minutes after the milk flow stops.

We have had mothers who refused to be talked into allowing their babies to have bottles and those babies did just fine - mom fed when she was there, baby was tube fed when she was not. Those mothers got support from very few people in the unit and many chastised them for it. I tell those moms to stick to their guns! If you really want that then stand up for it and dont let them back you down. THEY CAN EVALUATE SUCK- SWALLOW - BREATHE ON THE BREAST, I HAVE SEEN THEM DO IT! They just don't like to. In fact according to one of the physicians at the milk bank in Austin - a baby is more likely to take milk into it's lungs on the bottle than on the breast (They cannot however do a barium swallow at the breast, so if baby is used to breast and given a bottle for a swallow test, they may do poorly on the swallow test)

Most babies cannot co-ordinate suck - swallow - breathe when their respiratory rate is greater than 65 breaths per minute. We watch for a baby to consistently be below that number before we start oral feeds so that he has the best chance of being successful and not taking milk into his lungs.
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#13 of 13 Old 07-28-2003, 05:01 AM
 
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I have no experience with pumping for a preemie. I only pumped when ds was a toddler. I found(from him) that "playing" with the other nipple stimulated let down. That's the trick he did to get milk faster lol and I pretty much agreed with what everyone else said
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