Nursing a preemie
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|Tue, 08-04-2009 - 3:09pm|
I know there are a few preemie moms here who can probably add to this, but I just wanted to post a successful preemie-nursing story for those looking for encouragement. Sorry, it's long, but I wanted to include a lot of details and am happy to answer any questions.
My DS was born just shy of 32 weeks. Generally, babies don't have the whole suck-swallow-breathe reflex working before 34 weeks, so for his first two weeks I pumped (and pumped and pumped). After a few days of IV nutrition (called TPN), Noah was given an NG tube and fed breastmilk.
It was difficult to use a pump to bring in my milk - it took probably 4 days or so before I got any measurable colostrum and over a week for real milk, but NICUs are very supportive of BFing (in my experience), and the nurses would help me collect little droplets of colustrum with a syringe to feed to Noah in those early days. And very tiny babies really don't need that much milk, so even with production, uh, challenges, I was able to pump enough for him and also build up a little freezer stash.
Weight gain is very important for preemies, so a powder called Human Milk Fortifier was mixed in with breastmilk for his feedings, which increased the calories from 20/oz to 24/oz. I stressed about this for a bit b/c in my mind the fortifier was no different from adding formula, which I wanted to avoid, but the truth is that weight gain is so incredibly important for preemies, and I am glad the nurses and nutritionist helped me understand why it made sense.
Before Noah was big/old enough for nipple feedings, I was encouraged to try non-nutritive suckling and kangaroo care. Both are good for baby and also for increasing milk production. And both also gave me sweet snuggly time with my boy. :)
Around 34 weeks gestation, we started trying to nurse for real. At feeding time (he was on a 3hr schedule), I would try to nurse. There was an LC in the NICU much of the time, and she coached me a little with techniques to keep Noah awake enough to eat and also ways to get that tiny mouth to open enough. (I'm a 34A and his head seemed tiny next to my boob LOL.) I often tried a nipple shield, which - though it may hinder milk production if used too long - is sometimes the only way to get such a small baby onto the nipple. After our nursing attempts, Noah would get his usual feeding volume by NG tube.
I was trying hard to avoid bottles, having read all the BFing literature that says no bottles, no pacifiers, etc. (BTW - I had long since given up the no-pacifier idea, when his nurses helped me understand that the NICU can be a stressful environment for preemies, and there are few things as soothing as a nice binky.) After about a week of unsuccessful nursing attempts (he just wouldn't latch and suck), Noah's nurses started suggesting I might want to give him BM in a bottle. I resisted for a bit, but one night around 2am, with Noah frantic and hungry and me crying b/c I couldn't get him to latch, I called my DH and we decided to try a bottle. Noah gulped down the milk, and I was sad but a little relieved too.
At that point, Noah was just a "feeder and grower" in NICU-speak. We continued the bottle feeding, and I continued kangaroo care and trying to nurse. At about 36.5 weeks, Noah was discharged from the hospital.
As it turned out, I needed to keep giving Noah some bottles anyway b/c he was still small enough to need higher calorie nutrition, so I was continuing to try nursing, still pumping 8x's per day, and mostly bottle feeding (every other feed was fortified with Neosure).
A few weeks passed - Noah's due date came and went. Pumping was getting tiring, especially once my DH was back at work, grandmoms had gone, and I had a baby who wanted to be held and played with. I very much still wanted to nurse though and had committed myself to pump for three, then six months, if I could. I would bottle feed him mostly, but still try to nurse at least once or twice a day, sometimes with and sometimes without the nipple shield.
Well, one night around 4am I was holding a screaming baby while I heated a bottle for him, and I decided it couldn't hurt to offer him a breast. He latched on and for the first time, had a real feeding at the breast. He was almost exactly 3 months old - one month adjusted.
The next day I called the pedi to come in for a weight check, explaining that I wanted to try to transition him to nursing more. I kept going for weight checks every few days for about two weeks. Over the course of about 6 weeks, I weaned him off bottle feeds, replacing one feeding at a time with a nursing session. I also offered to nurse on demand, so if he fussed when it was not a feeding time I still offered a breast.
Eventually we got to the point that Noah was exclusively breastfed, except for one 2oz bottle every day, so I could sneak in his vitamins.
He nursed very happily until he was 23 months and I weaned him b/c I was pregnant again!
The point I want to make is that nursing a preemie is not at all your by-the-book how-to-nurse story. It takes a lot of time and patience. I don't know if I'd have been able to last so long if I had other kids or a job or a DH who wasn't 100% on board, so go easy on yourself while trying to do this. If it works though, it is 100% worth it. My "baby" is a very healthy 2yo now.