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Baby in NICU, urgently need breastfeeding help!

1446 Views 10 Replies 10 Participants Last post by  ~bookcase~
Baby in NICU, urgently need breastfeeding advice
Hi all,

This is Heather's husband, Josh - we have had our second child, Althea, about four weeks early. We had her by caesarean section. at 3:38 p.m. on 4/8.

She had some respiratory distress, so she has been in the NICU since she was born. I am down here with her now as Heather is up in our room attempting to get some rest. There are many many other stories to tell regarding this birth, but right now we very much need your help with an evolving issue.

Heather was able to produce enough colostrum for Althea in the first few pumpings after the birth. We have convinced the staff to feed Althea the colostrum through a feeding tube, as she has shown serious inclination toward breastfeeding already but little stamina as yet. However, starting late last evening and going through until now, Heather's colostrum is almost not pumping at all. We just completed about a 30-minute session with the pump, while Heather was in the NICU room with Althea by her side and after having gotten skin-to-skin contact and some sucking from Althea, but the yield was probably not even 1 cc.

We are going to get with a lactation consultant first thing in the morning (actually, I'm e-mailing one now), but in the meantime, there is no more colostrum to feed Althea through the tube. We are looking for ANY and ALL tips for getting Heather's colostrum flowing again and for avoiding the use of formula entirely. Given that we are due for another feeding in about an hour and a half, I don't know how we're going to get around this, but we really want to very much. We have asked the staff for advice on getting Althea back on the dextrose drip she was on before we introduced colostrum, but we don't have a definitive answer on that yet and won't until feeding time.

So, please, help! We really want to get Althea out of here and want to provide her with milk. Again, any and all ideas welcome and appreciated. Thanks!

Josh Denkmire
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Welcome to little Althea, and best wishes to you all.

I would suggest that you increase the frequency of pumping sessions so that Heather's body is really cued to an increased demand.

Additionally, I wonder whether there is a way to adjust the pump 'latch' at all, maybe changing a little the way it is positioned could help? Finally, massaging during pumping always worked well for me for getting more milk out, I wonder if this could also help for colostrum. I've also read here on mothering that hand expression may be more useful for getting colostrum out because it is thicker. Perhaps some warmth (like a warm cloth) on the breasts could help as well?

Also make sure that Heather is getting a lot of fluids and eating well.

I hope that you are able to resolve this.
I did not get much colostrum in the first three days. After three days it finally came in. My baby was over ten weeks premature. But it may not be different with a 36 weeker. Tell her not to stress since that hinders milk production. Talk to a lactation consultant, which you are doing. Sometimes the older nurses can be helpful. Good luck.
eat and drink well

get a good fitting pump piece (hospital should have differnt sizes to try out)

double pump where possible.

pump every 2 HOURS - regardless of what she is getting out; by day 3/4 you will find an abundance, God willing

(it's ok if she's goes slightly longer at night, but the more pumping initially, the better supply later on, so it's worth a few days of intense focus)

the birth can affect how milk production goes initially, so try to relax about how much you are seeing right now and know that the single most important thing is making a demand on the breast (by pumping at the moment; breastfeeding later on)

ask for cup feeds/ staying on tube feeds rather than bottles if baby cannot go straight to the breast as you'll cut out nipple confusion later on.

i don't know the full health status for your wife and daughter, but once baby is stable you should demand kangaroo care as this is excellent for everyone emotionally and for milk production hormones too.

at 36 weeks she should be able to either 'nipple' at the breast (lick and nuzzle at mum's breast) or even latch on and feed already. it will depend on some factors, but you'll find out naturally what she's ready for during kangaroo care.

congrats, and sorry to hear this initial time is working out to be a challenge.
you can rise to it!!! you are rising to it!!!
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It's normal even for it to take a few days for milk to come in, especially after a c-section and a preemie. Keep at the pumping and make sure mom is getting plenty of rest, fluids and food. Is mom on any meds that could be preventing her milk from coming in?

When you talk with the lactation conusltant, ask about tea, herbs, or other things that could support lactation.

I agree, kangaroo care with time at the breast will help.

It's not the end of the world if your baby needs a few ounces of formula before mom's milk comes in. Just keep at the pumping and the kangaroo care. I also agree that a "tube to boob" approach can be helpful, but NG tubes are not comfortable for babies, so somtimes a bottle can be a better choice.
My son was 10 weeks early and I had a c-section too. I didn't get a pump until more than 24 hours after he was born, and I started pumping every 2-3 hours. I got colostrom on the second day of pumping, but no milk until the 3rd day. At that point, I'd only seen my baby once as he was wheeled off to the NICU!

My advice would be for her to pump for 15 minutes, every two hours. She should start by applying warm cloths to her breasts and massaging them. Hand expression might help her get a let-down.

Here is a great video about pumping for a preemie:
I was in a similar situation, although I did wind up producing enough colostrum, it was the most stressful feeling in the world fighting the clock to make enough for the next feeding and feeling like I just couldn't get ahead and crying through every pumping- *hugs* to you and your partner.

I obtained a few bottles of donor milk as back-up, so that if it came down to it I could avoid formula.

The glucose thing is another good option- I had it written into his care plan that if his dexi was just a little too low or he needed just a little boost, but the colostrum was mostly meeting his needs, that we would use that as a short term solution.

Also, I am not sure what you meant by tube, if you meant intubating, but I was able to do finger feeding, with a gavage tube taped to my finger. Syringe feeding is another option to avoid artificial nipples.

As others have said, it's not the end of the world if your baby needs some formula, but I do firmly agree that there are benefits to breastmilk only, and think that it's worth striving for. I wish you the best.

eta: And yes, more frequent rather than longer pumpings should help.
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I found that warm washcloths on my breast before pumping helped. Also doing breast compressions made quite a big difference

When was pumping for DD I tried to use the electric pump at least every couple of hours. I did find that hand expressing got more coloustrum in the bottle though (it was to sticky to run down the tubing) so I would do that first then use the pump.
How's it going? My twins were born at 31 weeks and I took a few days for my milk to come in. C-sections are harder on the body then natural, especially if there was no labor (which does help your milk come in by releasing some hormone or something). Keep pumping, drinking water, and resting as hard as that seems!
In case SereneBabe herself didn't know to update here or forgot, she updated our DDC that her milk came in gushing once they were able to have baby in her room and out of NICU. Sounds like it's going well.
Alicia - thank you for updating. That's wonderful news
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