I have my heart set on breastfeeding – I have bought my nursing pads, support pillows, nursing covers (hooter hider – baby au lait), books from la leche league, talked to lactation consultants, etc. and now I’m having to prepare for the fact that my baby may be born 3 months premature. I know you can nurse in the NICU, but will they let you nurse a baby born that early? Will a baby that early even know how to nurse or have the sucking reflex yet? I heard babies get the sucking reflex after 36 weeks usually. If you have a preemie & pump until your baby makes it to when his/her due date would have been, is it possible to get them to nurse after months of feeding tubes and/or bottles?
I haven’t had the baby yet, I’m on bedrest, but I’d like to be prepared so I’ll have my facts together & know what to tell the NICU nurses if I do indeed go into labor within next 2 weeks like they’re preparing me for.
October 31st, 2009 at 9:19 pm
I had twins at 30 weeks. I can tell you the policies at my hospital…. At first they will not let you nurse, but will ask that you pump. They will feed your baby via a gavage tube, on a continuous feed (pumped through an IV-like machine) until sometime between 32-34 weeks, when the sucking reflex kicks in. The bottle will be introduced first, so the nurse can watch the monitors and make sure the baby isn’t having apnic spells or bradycardia. Around this time they will start doing more feeding on-demand, usually with 10-20 ml in a bottle, followed by the rest of the meal in a gavage tube. They have predetermined amounts that they will give a baby at each feed, based on weight and age and tolerance. If the baby tolerates the feeds, they will gradually up the amount fed to the baby, and increase the amt given by bottle. Usually within a few days of the bottles being started, if all goes well, they will let you attempt nursing once a shift (so twice a day). The sucking required on the breast is entirely different than on a bottle, so it’ll take some getting used to. If the baby isn’t tolerating feeds well, this will take more time. They will then gradually increase the number of times you can nurse, until you are allowed to nurse each feed. If you aren’t there at feed time, they will use the bottle. Also, the NICU had a dedicated LC with knowledge geared towards preemies (it’s not the same as nursing a full-termer), so she helped out a lot. Ask if your NICU has a dedicated LC with preemie experience.
My hospital lent out a hospital-grade electric double pump while my kids were in the NICU, and it made life much easier. After both kids were discharged, I used the Ameda Purely Yours, which worked great and I thought was quieter than the Medela Pump-In-Style. You’ll most likely still have to pump after the baby is discharged (depending on age anyways) because you’ll have to fortify the milk with extra calories, and probably add in a multi-vitamin with iron once a day. A good pump is essential.
Of my twins, one had a hard time adapting to the breast, and the other did great on his first try. And of course the one that did really well on the breast actually had serious trouble tolerating food due to reflux, so we didn’t start breastfeeding until closer to 37 weeks.
Hope this info helps!
November 1st, 2009 at 12:06 am
I wish that I could help you with this, but I can’t. I hope the best for yotu and your baby. It sounds like you have asked the right people about this.
November 1st, 2009 at 4:05 am
I had a preemie and breastfed fine. Now, mine wasn’t that tiny. I hope that yours stays in longer too because preemies are hungry!!!
I pumped. A lot! Every three hours (round the clock) for 20 minutes on each side. I had a Medella pump…it was the Cadillac of breast pumps and I produced a ton of milk.
When my son started nursing he was voracious! He wanted to nurse every two to three hours…and I let him, and he caught up in his size in a big hurry.
The nurses in our NICU were very supportive of breastfeeding. We had a great lactation consultant and she helped a ton. They had to gavage (tube) feed my guy for the first several days (until he pulled out the gavage) and they just used breast milk for that. He did get fed some formula too. And that’s okay! While breast milk is much better than everything else, there is a time and a place where formula is okay…in my case, my baby was in a different hospital in a different town, and my milk was simply not available.
My best advice is to express your desires to the NICU nurses. They will more than likely try to help you breastfeed. But do listen to the medical professionals. Your baby might need TPN (this is an IV full of fats and protein and it helps these little preemies catch up) and you might not be able to pump (but I sure hope that you can!) Don’t get discouraged if it all doesn’t go according to your initial plan…adjust your plan and drive on. And do not feel guilty either! Your heart is in the right place.
Finally, I found La Leche League had some good information, but they don’t fit every situation. Take what works for you and use it, but don’t feel bad if you modify what they say. Pacifiers are sometimes a wonderful thing, especially with a preemie!
All the very, very best to you. I hope for you that this baby is patient enough to stay put for a few more weeks. Good luck, mommy!!!
November 1st, 2009 at 11:03 am
Wow.
All I can suggest is finding a copy of Dr Jack Newman’s book, “The Ultimate Breastfeeding Book of Answers” (in the US; aka “Dr Jack Newman’s Guide to Breastfeeding” in Canada), because it has quite a bit that’d be useful to you. (Including ways to refute the idea that a preemie needs ‘help’ from formula; stuff like that.)
He is VERY centred on the idea that mothers make the best milk for their babies, period; that breasts are the best way to feed a baby, period…
Searching his site for ‘premature’ brought up nice stuff like this:
“Studies have shown that even premature babies, as small as 1200 g (2 lb 10 oz) are more stable metabolically (including the level of their blood sugars) and breathe better if they are skin to skin immediately after birth. The need for an intravenous infusion, oxygen therapy or a nasogastric tube, for example, or all the preceding, does not preclude skin to skin contact. Skin to skin contact is quite compatible with other measures taken to keep the baby healthy. Of course, if the baby is quite sick, the baby’s health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin to skin with the mother immediately after birth. Indeed, in the premature baby, as in the full term baby, skin to skin contact may decrease rapid breathing into the normal range…”http://www.drjacknewman.com/index.php?op…
I wish you and your baby the best.
edit: some more stuff that may be of interest –
“The use of fortified human milk generally provides the premature infant adequate growth, nutrient retention, and biochemical indices of nutritional status when fed at approximately 180 mL/kg/day compared with unfortified human milk. Human milk can only support the needs of the premature infant if adequate milk volumes are produced. Intensive efforts at lactation support are desirable. Therefore, neonatal centers should encourage the feeding of fortified human milk for premature infants”http://www.ncbi.nlm.nih.gov/sites/entrez…
I *believe* Newman’s book discussed ‘fortifying’ human milk with…human milk. Not sure if it’s being done yet, but. You might want to Google “supplemental nursing system.”
“Premature babies can, and should, breastfeed. Although establishing a milk supply and the transition to breastfeeds can be difficult, both are possible. Because early bottle-feeds can impede later attempts to breastfeed, the newborn intensive care unit at Methodist Hosptial in Indianapolis developed a protocol for successfully breastfeeding premature infants that excludes bottle-feeding. The babies are introduced to the breast as soon as possible, and supplementation is provided by gavage feeding. The amount of supplement is adjusted based on maternal and nursing observations of the breastfeeding experience. The hospital stays are not prolonged by this approach and most of the babies whose mothers intended to breasfeed are discharged exclusively breastfeeding.”http://jhl.sagepub.com/cgi/content/abstr…
Now _that_ looks interesting and worth tracking down more on.
Some more reading:http://www.bfmed.org/ace-files/protocol/…http://www.bmj.com/cgi/content/full/329/…
November 1st, 2009 at 11:34 am
http://www.aboutkidshealth.ca/PrematureB…
November 1st, 2009 at 12:42 pm
If you do have your baby that early, chances are he/she will not be bottle fed in the NICU. They just don’t have the sucking ability yet. They will most likely gavage feed or tube feed. You in turn will pump. The pump is going to become your best friend. You are going to get yourself a good high quality pump and pump all the milk you can for your baby. When they decide that the sucking and nursing ability is starting to show itself, they should be calling you in to start nursing. It will be slow. Baby will tire quickly, You will get frustrated. Then you will pump. Each time that baby will nurse just that little bit longer and you will still pump but just that little bit less. Chances are, by the time you come home, you are going to have a baby who is happily nursing and a freezer with stored breast milk. Just don’t allow them to introduce the bottle and soothers to baby until you have breastfeeding under control. Its a different form of sucking and it is much easier to drink from a bottle than from breast.
It is a lot of work. It really, really is. Many women cannot cope with the sheer amount of work involved. Good luck in trying but remember. If you can’t do it, if you are too worn out and it is taking to big a toll on you, don’t do it. Baby needs a healthy mum more than a breast. Remember to look after yourself too.
All the best to you.
November 1st, 2009 at 4:04 pm
my daughter was born the first day of my 7th month, she did not have the sucking reflex she had a tube in her nose until she was able to suck but during that time I was pumping the nicu had a fridge you could store your milk…good luck to you
November 1st, 2009 at 10:09 pm
You sound like a great mom!
Some preemies may be too small to nurse, HOWEVER you can exclusively pump your milk. It’s challening, but not impossible.
Do a search for “exclusively pumping” – and there’s a yahoo group called EPers.
November 1st, 2009 at 11:23 pm
I don’t know alot about preemies or BFing, but why not ask the NICU about thier policies and whether they have a lactation consultant on hand for the unit? That could help you ease your fears, or give you insight into what sort of information you will need to gather to convince them you should be able to pump and/or breast feed. My mother is a neonatologist and she has always been VERY pro-BFing. She made sure that her NICU had BF friendly policies, and they had a lactation consultant just for the NICU. Its quite possible that your hospital does the same. Talking to the NICU’s lactation consultant now could help because she will have had alot of experience with preemie babies specifically. So long as your milk supply is in and you are healthy there shouldn’t be any reason that your baby needs to go on a bottle, provided you can be available to nurse whenever needed. As soon as his sucking reflex comes in I dont see why he couldnt go straight to the breast, until then tube feeding may be nessecary, but skin to skin contact should still be encouraged. -Neb
November 2nd, 2009 at 5:58 am
Check out this site for support: http://www.llli.org Look at the other-to-mother forums to connect with moms nursing preemies.
Hang in there momma! Bedrest is hard work! I was one of the lucky ones who made it on bedrest for 3 months and had an almost full-term (37wk) baby who latched on right away after birth. I’m praying the same happens to you.