Help - DS arrived at 33+3, now 36 and home but really struggling with BFing...

[Nikki2510]

Hi All,

Well, our DS arrived at 33+3 and spent 10 days in SCBU. I expressed during that time but have not had huge amounts of milk and this doesn't seem to be improving. In SCBU he then had a combination of whatever I'd expressed and FF either through his NGT or as he got stronger a bottle with me also putting him to the breast.

We brought him home at 35 weeks (last sunday) and since then I've really struggled with BFing him.

Currently I BF him and then he has a bottle top up. But, he takes over 35 mins to feed on each boob meaning the BF alone can take up to 1hr 30 mins. He then also generally has a bottle top up - if I don't give him a topup he is hungry again after 20 mins and won't settle. He is quicker on the bottle but total feeding time inc winding and settling down can often be 2hrs. Now this is ok in the daytime but I'm starting to struggle with it at night.

I'm also not sure what he's getting from my breast - his poo is the dark greeny colour of FF and although he can suckle quite strongly I don't really see him suckling and swallowing in the same way he does on the bottle.

I have had more conflicting advice from people at SCBU (not dissing them at all though, they are amazing people) and from the HV than you can shake a stick at and I'm really confused as to what to do now. I was given Nipple shields by SCBU because DS was prem and finding it difficult to latch and because I have flat nipples. The HV seems to think they are the devil incarnate and basically blamed any and all issues on the fact I am using them but he won't latch on without them - at least not at this stage.

I don't just want to FF him but I'm not sure how much longer I can cope with the length of the BF/bottle feeds. So my thoughts were as follows:

• Just persevere with the BF/bottle top ups and hope that it improves over time
  
• Express and either feed pure Expressed breast milk if enough or mix with FF and feed through a bottle.
  

I'm sort of leaning towards the second option at the moment but I don't really know what the pro's and con's are. Am really confused and emotional too which doesn't help.

Any thoughts from people on here would be really gratefully received as I just don't know what to do for the best anymore

Have also posted in the breastfeeding/bottle feeding section too.

thanks,

[LeBFG]

If you bf/top up that'll probably work with time. If you express and feed with bottle, that'll definately work. If you're having trouble to express now though, I would worry about you doing it longer term. Babies are much better at getting the milk out and are great at fixing reluctant nipples!

My main comment is that I'm amazed they let you home so early. My DS was nearly 33 weeks and stayed in til 37 by which time he was feeding well from the breast. The transitional point from tube feeding to breast was achieved by the very dedicated nurses who feed him with a cup rather than bottle. People do talk about nipple confusion and perhaps this is some of your DS's problem? I then roomed in for a few days while they weighed him after feeds to see he was getting enough. Reassuring for me, though I had a friend who said this completely knocked her confidence.

Whatever happens from now on, you have already done so much good for your DS. You should be really proud of yourself. Prems in particular do so much better with bm - digestively, developmentally and it's great for their brains too.

[LeBFG]

Oh, sorry I meant to say that my DS was only really going for it at 36 weeks. A lot changed over very few days - he seemed to suddenly gain strength, awareness - dunno. They assured me this was to be expected. What was certain, once he found breast nothing else would do .

[Honsandrevels]

Do you have outreach midwives visiting you from neo-natal unit? It sounds as though you'd benefit from specialist support. In our unit nipple shields were encouraged whereas the post-natal midwives on the ward thought they were a terrible idea!

My dd2 was 33+1 but we were only discharged when I'd been feeding her myself for 48hrs with no ng top ups.

What is his weight gain like?

[twinnies26]

Hi there!

Firstly congratulations :)

Can i ask what weight is your baby?

I had premi twins, not that early really (34 weeks) but they were small. Dt2 was 2lbs 9 after birth and she was weak. Like you i began the gruelling schedule of pumping.

I really thought DT2 would never bf properly. Now looking back the problems were due to her tiny size, she didn't have the strength to take the milk from me. I persevered with the same system as you - breast then top up of my milk (formula when i couldn't keep up, i had two babies to feed!) Like you the feeds were ridiculously long at first (2 hours plus)but i found as the girls grew they had the ability to feed more quickly and wind more efficiently. Hang in there it will get easier and you are doing a wonderful job so far!

You said you are finding the nights hard - would your DH give him a bottle a few nights a week and let you sleep? Share the load a little?

Also my hospital encouraged me to give her ebm bottles and only a short amount of time on the breast at first as a small premi baby can burn too many calories ( not gain enough weight fast enough) and exert too much energy trying to suck when they are not strong enough to. This was the case for DT2 anyway.

I would stick with offering breast first, perhaps ten mins each side then top up of your milk or formula but also pump in between feeds to get a big supply. I pumped up to 9 times a day to increase supply and give it back to them in bottles. In time he will feed better he just needs to grow probably, DT2 fed well after 13 weeks (7 corrected) and only when her weight reached above 10lbs.

Could you contact La Leche League or any other bf support groups?They were so helpful to me and I also got a visit from nurse once a week for 7 weeks (i'm not in UK so don't know what's standard there)

Hope that's of some help and reassurance.

Good luck with it all! :)

[Mandy21]

Hi there, I just wanted to give you the benefit of my experience - I know its really hard when everyone has a different solution but I do agree with other posters that it is still very early days and the stringer your DS gets, the better he will get at feeding. I also think perhaps its worth expressing as much as you can, after you've fed him perhaps, to stimulate your supply. That means you'll be producing lots of milk even if he isn't very efficient at getting it at the moment.

I had twins at 27+6 - they were fed by NG tube with my EBM then from about 33 or 34 weeks, I started putting them to the breast when they were having their tube feeds. Gradually we decreased the amount of milk they had via the NG tube as I started to feel them sucking. I also used nipple shields because I also had flat nipples apparently - they seemed to find it easier to feed with those. As others have said, it can change really quickly. I roomed in with them just before 36 weeks and although I demand fed them (and it seemed like I fed them pretty much constantly for 24 hours, they hadn't gained any weight - probably from the effort of feeding) but then at 36+4, we tried again and they both put weight on. We were allowed home then.

We carried on using the nipple shields until they were around their due date, and then just stopped using them completely - by that time they were better at latching on and it was fine.

As for the length of time he is feeding, do you feel he's still getting milk all that time, or does he just want comfort? I would try to limit the amount of time hes on each breast, and then perhaps feed a little more often to start with and see if can go a little bit longer between feeds. As I said above, as he gets older and stronger, he'll get better and more efficient at feeding.

Good luck!

[LeBFG]

I have a question. In the first 6 months of life, DH fed really frequently. It was really hard work. By about 6 months he was finally doing the three hour routine. Do you think this was because he was prem and needed all that milk for his catch-up growth? Did anyone else recognise this pattern? He grew enormously quickly and by 9 months was a really chubby baby.

[Nikki2510]

Thanks All. Am feeling better about things now. He was 5lb4oz so a pretty good weight for his age and he is now just under 6lb I think so he is increasing in weight. We were surprised they released us from SCBU so early as they were talking about him staying in past xmas if not until his due date in Jan. But he made such good progress that they decided he could come home

I think the answer seems to be to BF as much as possible and feed/feed/feed and then top up with a bottle at night. Am trying to get him to feed 2 hourly in the daytime as otherwise he sleeps all day and is ravenous all night and won't settle. Soo, BFing as much as poss and then topping up with a bottle where we think its necessary (or where I really need a break then DP just gives him a straight bottlefeed).

I did speak to the HV again today and she thinks we are on the right track. Tried calling the BF co-ordinator at the hospital but went straight to voicemail so I am guessing she has already finished for xmas. Anyway, I feel a bit more confident now. Thanks for all your advice - its really good to know that I am not alone and actually my issues are shared by many

Have a great xmas all

[Moominsarescary]

Ds3 was born at 32 weeks snd spent 10 days in hospital. We never got the hang of bf and I expressed. Even so it could take well over an hour to feed him.

I'd say try to persevere if you can. He's a good weight and things should get easier the bigger he gets. Also keep phoning for support, even though at this time of year it may take a while to get in touch with anyone.

We were advised by nicu to not let him go longer than 3 hours between feeds.

[Valdeeves]

I've had two prem babies but my 33 weeker was very similar to your experience. I used a prem baby nipple shield with my first top.
I expressed, then breastfed, then breastfed and topped up. Now she's gone on strike at 4 and a half months so we are solely formula feeding.
I found it all really lengthy too so we cut out the middle man and bottle fed at night with expressed milk them formula. That worked for us in terms of helping with your exhaustion and it helped her take a full breast feed in the morning.

[Valdeeves]

You sound to me like you are doing really well - remember breast feeding a prem baby is a real achievement, I was very comforted when I was expressing by the SCBU nurse - she said "You are still breastfeeding - it's just you have to use a different teat right now."