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#31 of 40 Old 12-15-2008, 10:04 PM - Thread Starter
 
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Now that we're almost out of here, I can share our experience with the "tube to boob" approach at our NICU.

Zephan was born at 31 weeks. He was healthy, if little, and as soon as he was stable and breathing on his own the nurses encouraged kangaroo care/suckling by the breast. Zephan loved this from day one. Right at 32 weeks he began to latch on. He did not take significant volumes until we began to use a nipple shield at 33 weeks. Between 33-34 weeks, breastfeeding totally clicked.

The doctors generally want breastfed preemies to have 2-3 fortified bottles a day. At first, we said no. We let Zephan have his fortified feeds by gavage and did not introduce a bottle for the first maybe 10 days of breastfeeding. When it was clear that he was good at breastfeeding and I was less worried about a bottle messing it up - and he was really tired of the gavage tube and pulling it out like 5 times a day - we decided to replace the gavage tube with the bottle. By 34 1/2 weeks, Zephan was breastfeeding on demand and having 2 fortified bottles a day.

We decided to do the bottles so that I could have breaks from the NICU and so that I could sleep one longer stretch at night. Our priority was to get breastfeeding established first, and once we did that I was okay with bottles.

At this point (35 weeks) Zephan prefers breastfeeding and is a reluctant bottle feeder. We'll keep giving him a bottle at least a few times a week at home (date night!), but we will not continue to fortify as he's growing just fine on breastmilk.

What I've learned...
-Try a nipple shield!! This made a huge difference for us
-Get lots of skin to skin time and practice pre-breastfeeding as soon as you can
-Room in if possible, especially after 33-34 weeks when you can breastfeed around the clock
-Introduce the breast before the bottle, or the breast while the gavage tube is still in so the baby learns this first
-It might be worth fortifying to get out the door and then reconsidering at home
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#32 of 40 Old 12-16-2008, 07:13 PM
 
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I think I have to retract my previous statement.

We attempted a bottle yesterday, and Nathan wouldn't have it. He is a breast baby, and the bottle was hard for him. Since then, he has taken off with the breastfeeding. I think he was just telling us what he prefers!

At any rate, it appears that the bottle will not help Nathan get home sooner. If they decide he still needs the fortifier in a couple of days, we may need to try one again, but for now, we are focusing on getting good feeds at the breast. I'm desperately trying to get Nathan home for Christmas, but the LC (and I see her point, but...!) doesn't want to push him too fast. Since yesterday, he is suddenly much more alert in general and quite eager at the breast. Hopefully this continues!

He is now 4 lbs 13 oz! I can't believe how big he is!
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#33 of 40 Old 12-19-2008, 01:59 AM - Thread Starter
 
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We're home with Zephan and more or less in newborn survival mode. We've completely neglected the whole bottle and fortifier thing. I think we'll keep trying to do a few bottles a week - just for the sake of date night or an occasional long nap - but Zephan definitely prefers the breast and we'll go with that.

Zephan's getting good at breastfeeding lying down in bed and with the distraction of two older brothers climbing around and goofing off. We won't know what his weight is doing until next Monday, but he's peeing and pooping and doing everything else a newborn should. So we're trying to relax...
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#34 of 40 Old 12-19-2008, 12:07 PM
 
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Congratulations!! :
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#35 of 40 Old 12-19-2008, 01:10 PM
 
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We're working on transitioning my son from bottle to breast right now since he's big enough (born at 2 pounds, now at 6.5 . I can't imagine asking him to do more work to eat when he was so little, and sucking on a breast to get nutrition is harder than sucking a bottle filled with my breastmilk (which was still pretty hard for him!). His s-s-b was good, not great, for a while. I nursed all the time, though, just so that he could enjoy it...and now we nurse for comfort and fun and don't worry about how much milk he is getting.

I went in saying, "I never want him to have a bottle," and my NICU was supportive, but when it started to mean NG tube feedings when I wasn't there or a bottle, I decided that I'd rather make the transition later and help him get his feeding tube out a little sooner. I'm glad I did, because my boy is now perma-congested, and I'm sure having that in his nose for so long didn't help matters much. Basically, I'd say weigh your situation, but trust the information the neonatologist and nurses give you - they're not lying about breast being more difficult.

Good luck!!! I really really hope you are one of the lucky ones for whom it is as easy as falling down outside my house right now (NW PA is pretty darn snowy...thank goodness we don't go anywhere anyway )
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#36 of 40 Old 12-19-2008, 01:14 PM
 
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Gah, should've read the whole thing before posting (maybe looking before I leap would also help with the whole snowy-driveway-getting-mail-connundrum...hmmmm...)

Congratulations, momma!!! Even more congratulations to Zephan! Yay EBF!
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#37 of 40 Old 12-22-2008, 02:42 AM - Thread Starter
 
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We found that our nurses and doctors believed that breastfeeding was in some ways easier and less stressful for babies. They agreed that in most cases bottle feeding might get you home a few days sooner, they felt it was worth it to stay a few days longer to get breastfeeding well established. Breastfeeding does require the baby to suck more strongly to get milk, but we found that with a nipple shield our son - even at 33 weeks and about 4 1/2 pounds - was able to get everything he needed, and then some. Breastfeeding without the nipple shield is still a struggle, but we're not planning on trying to much without the shield until he's close to full term.

Yesterday we measured how much milk our son was drinking for the fun of it. When we left the hospital on Tuesday, his "full feeds" were about 45 cc. Last night he drank almost 100 cc! No wonder he's growing fine on breastmilk!
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#38 of 40 Old 01-03-2009, 01:49 PM
 
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Obviously skin to skin contact is great and breatmilk is almost always best (I cant really think of a situation where it wouldnt be but I suppose it exists) and if you can get your baby onto the breast right away, thats awsome. Having said that...I had 3 full term babies and the last one was a preemie and there was no way he would've transitioned straight to breastfeeding. He learned to eat with bottles after my attempts to breastfeed obviously werent going well. His mouth was just too small and he was just wayyy too sleepy to get more than a very small amount from breastfeeding. I can imagine how frustrating it would be for a first time parent-here I had done it 3 times before and it was so frustrating even for me!

In all honesty, in my sons case, had I pushed for breastfeeding only, he wouldve spent many more weeks in the nicu. I think my goal became to get him home and then worry about other stuff-because I felt that him being home would be of the greatest benefit to him at the time. He got the hang of bottlefeeding (and even with that and an easy flow nipple, he'd fall asleep halfway through), was having normal preemie apnea keeping him there and we decided to take him home AMA. His apnea was immediately better and everyone felt so much more relaxed but even at home he woulnt nurse. What did it was his age. It was literally the day he was due that he suddenly latched on and nursed like a champ.

I do think that some babies should be put straight to breast and at least attempting to breastfeed before heading to bottles should be the norm. I also think that certain woman might be built better for a preemie to nurse-in my case, I have very large breasts and they were a bit, er, overwhelming for him. Really though it was mostly just the sleepiness that was an issue-it just took too much out of him to try to nurse. Having said that, hes now a great nurser and doing really well!!!

Cari-mama to Eriq, Lile, Paikea, Kaidyn, and Mieke is here!! 2/9/10
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#39 of 40 Old 01-07-2009, 10:41 PM
 
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I think it depends on gestational age. There's a huge difference in a 35 weeker and even a 32 weeker. I think that breastfeeding requires more effort on the baby's part, more energy, more calories burned. so a younger preemie will be in the nicu longer typically if trying to exclusively breastfeed. I'd say try bf'ing only if baby tolerates it and gains weight well, or go for both if it doesn't go as planned.
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#40 of 40 Old 01-08-2009, 06:39 PM - Thread Starter
 
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I agree that gestational age makes a big difference. Our 35 weeker was able to breastfeed exclusively from day one, although our 31 weeker needed an NG tube for about 3 weeks. It was around 34 weeks that he was able to breastfeed enough to have the NG tube removed. I don't think it is possible to exclusively breastfeed a baby before that point, but at least for some kids when they get to 34-36 weeks, it may be possible.

I guess I had the "advantage" of small breasts and nipples that make it a little easier to latch and a generous milk supply that made it easy for him to get what he needed.

I know it may not be true for everyone, but in our case I'd say Zephan tolerates bottlefeeding, but he adores breastfeeding. Even at just 32 weeks when I first put him to the breast to nuzzle, he seemed so content.

And an update on Zephan - he's now almost 39 weeks, 6 pounds 8 ounces and gaining about 1 ounce a day, and he's still exclusively breastfeeding. We've been able to stop using the nipple shields this week too.
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