amitymamaThe Attachment Parenting Community

twomomss · 02-23-2004, 02:09 PM

You've gotten some good advice here - I skimmed most, Cate and LittleTurtleKnits gave some good input (not to slight others - honest! there was lots of good stuff!).

Toby is nearly 4, he was a 26 weeker who spent til 1.5 weeks before his due date in the NICU, and he was only recently weaned (which I only did b/c it was easy to distract him, and b/c he was mostly playing with my boobies rather than eating which I just found irritating LOL).

Toby first suckled at my breast at 32.5 gestational weeks. He nursed once a day til he came home. At that point, I *GRADUALLY* (repeat, gradually) upped the nursings and decreased the bottle feeds. It took a few months after homecoming for him to be completed nursed.

Firstly, I would not worry too much about bottle vs. breast in the NICU. What you want most of all for there to be one or two solid nurse sessions a day until they come home. Preemies are highly inefficient at nursing - it takes a lot of energy (i.e., calories) for them to BF. So your goal should be a bit of practice for the three of you, and some good nipple stimulation for you, until they get home. I was never able to get any noticeable breast consumption while Toby was in the NICU - ie.., weighing before and after nursing, the scale never noticed much milk consumption. Either he wasn't consuming much, or more likely - it's just a lot of work for preemies to nurse- so they use up calories as they consume them at the breast.

A long way of saying - do NOT worry too much at this point about them getting bottles. Preemies do not act like full term babies as far as "nipple confusion" goes - and a big job of theirs at this point is to grow and get big and healthy enough to come home. There's loads of time after that to convince 'em to nurse full time.
The whole nipple-confusion "worry" is based on behavior of regular full-term babies, not preemies. Preemies are not simply little full term babies - they act differently, and developmentally - in my opinion nipple-confusion is a later worry than one that occures during pre-term baby developmental phases.

Once they get home - go from the once a day nursing, to three times a day for a few days, to four times a day for a few days, to 5 times a day for a few days...etc. Continue to do some bottlefeeds.

It took immense patience to get Toby nursing full-time, but it is possible. Partly, we lucked out - Toby was definitely "into" nursing. Partly, it was a whole lot of hard work - it is probably my hardest, biggest accomplishment in my life. (This from someone who has run two marathons and written a dissertation....getting Toby to nurse full time was a lot more work and took an immense amount of patience).

Toby was an incredibly pokey slow nurser for MONTHS. He would nurse for an hour and 15 minutes, and then want to start again 45 minutes later - he was on a two hour schedule of eating, where he was nursing for more than half of it. It was exhausting. As a 26 weeker, he was on the other end of the pokey, inefficient scale - yours are on the same scale, but you can expect them to be a little better

And as for visiting every day- it's worth it. Ask the hospital social worker if they can give you parking vouchers, or maybe meal vouchers. (We got free parking; we went to another hospital for a Toby surgery a few months ago and got free meals too).

La Leche wasn't much help for me, tho I wouldn't rule them out. The ones in my area didn't have much info re. preemies - they kept telling me all the full-term stuff re no bottles etc. and that just wasn't feasible (or correct in my opinion). I DO think that there's a lot of variability in terms of what different La Leche folks say/know/do - so by all means, pump them for info.

And lastly - find your own lactation consultant. The one in the hospital where Toby was born was phenomenal, and she worked really well with both the regular nursery as well as NICU babies. You can hire your own. It'll pay off in the long run.

Kudos to you for doing such a good job - and keep us posted

-- Sara

craftymama · 02-23-2004, 05:04 PM

I just wanted to say what you are doing is an amazing gift to your sweet babies. I have no idea exactly what you are going thru but I know it is must be incredibly hard to see the light at the end of the tunnel right now. They WILL get it. You will get through this.
Kaliana (now 1.5) was not a preemie but born weighing in at 4lbs 4 oz. due to part of my palcenta dying. She wouldn't stay awake to nurse for anything. I could get her latched on but only part of the time and that was it. I could squeeze it in her mouth and it would just fall out. SHe just didn't have that sucking motion. Her mouth was so tiny and she just wasn't mature. THe nurses told me to try no more than 20 min at a time (it was a very pro bf hospital) after 20 minutes both mom and babe get so tired and stressed out. AT this point it is important to keep your little ones stress levels down. SO for a month my little one got EBM in a bottle non-stop with the occasional succesful nursing of 5 minutes. Eventually by time she was 2 months old we were rid of the bottles. Just had to wait until she was awake enough to nurse. I know there are a million tricks out there to keep a nnursing baby awake and I was successful using those with my 34.5 weeker son Riley (5lbs 9oz) but for some reason my little girl just didn't get it. So to make a long story short. Each baby is different and eventually your sweet babies will be able to do it. THat is why they have a special mom like you who knows what is best. Trust yourself. Don't think for a minute you are doing the wrong thing. What is most important is that your children are nourished and gain weight. And I so understand the pain of doing the weigh ins before and after feedings. It is just so hard and I am just so sorry for what you are going through.
I tried the supplemental nursing system and for me it didn't work because I was just so stressed but it has helped so many people I know. I did have a bit more luck using the finger feeder by medela. You may want to see if someone in your local Breastfeeding Resource Support center can help. Talk to the lactation consultant even if she isn't that experienced with preemies sometimes it just helps to have someone around who is pro bfing. I had to talk to a couple til I found someone that was really helpful and they have contacts too. We rented a Lactina Plus from a local pharmacy for $50 a month and was reimbursed by insurance because we had her doc write a prescription for it.
For me the nights were the hardest part was the nights. Waking up every 2 hours to pump was exhausting. One of the most helpful things for me at night was to put a cooler with ice next to my bed and have bottles ready to be pumped into by my bed. That way I didn't have to get up and go down to the kitchen. Most important...I had a great support system. Surround yourself with positive people. I had a terrible time with the nurses at the hospital. I felt like an inadequate mom and like she wasn't mine. It will get better that lucky day you are all together.
Sorry for such a jumbled long-winded post. I will keep your family in my thoughts. Please take care of yourself and don't forget to drink more water than you think you might need.
Oh and when i was at the hospital I was told by LC to just rinse pump parts and bottles in really hot water. It worked okay for us and my daughter was pretty sick with jaundice.

P.s. It is definately true about taking a lot of calories for the babies to nurse and that is why it important to not try for an outrageous amount of time.

Glitterbeam · 02-23-2004, 05:17 PM

Mama, I only have one child and she wasn't a preemie so i don't have any advice. I just want to say I think you are awesome! Breastfeeding is hard normally and you are super-mom to have 3 other kids and be doing this too. I hope it gets better really soon for you.

twomomss · 02-23-2004, 05:28 PM

they look SO good in the pictures!

and don't worry about pacifier use at this point either- they're still figuring out how to coordinate suck/breathe/swallow, and any sucking they do is good.

--Sara

elliebelly · 02-23-2004, 05:55 PM

cheryl:

forgive me if i repeat. i haven't read all the posts, as i'm short on time, but i wanted to say two things:

first, i fed a heart baby, which isn't the same thing, but a lot of the same problems, especially dealing with the nurses in the nicu, who weren't real happy i was breastfeeding. if i can help you at all, i'll be happy to call you and talk about anything you need, just pm me your #

one of my best friends, a surgeon, bf'd preemie twins. with one breast! (she's a cancer survivor). it was very hard at first, but she snarled at the nurses a lot and had lots of help at home -- she still has full time help (4 kids, the twins are 3). i think there's a lesson in the having lots of help thing.

hugs honey! please, please let me help if i can.

joyce

Mama2miracles · 02-24-2004, 12:15 AM

Thank you all - I'm pretty wiped out right now - so I just want to say thank you and I"ll print this thread out for reference - so much good advice here - I really appreciate all of you taking time to respond. I"ll need to read through it all again later for sure.

There was a supportive nurse today (YAY!) who helped me get Megan latched on THREE times AND let me have her earlier than "schedule" when she was awake and looking interested - so I got three nursing sessions with her today. Megan took 5 CC's, 25 CC's and 10 CC's - so she's starting to get the idea.

She also had me do skin to skin once with Maribeth and try to nurse her again later (she didn't do much for nursing) - but I'm feeling a lot better today. Plus the nurse let them nurse (or tryO until they were tired and then tube fed them the rest instead of taking them away after 5-10 min attempted breastfeeding and then bottling them (like the nurse yesterday). This nurse will be on tomorrow.

Oh AND she let me hold both girls at once ( a first!) and co-bedded my two girls - so they at least have each other now. Maribeth is small - but this nurse said that she'll stay warm o.k. with her sister - where if she was a single baby - she would still be in the incubator.

This nurse also has put in a request to have a social worker talk to me to see if there's anything that can be done about help with parking and so on.

Also I picked up my mom and Melissa at the airport tonight - so all my older three kids are home together again!

I still need to call LLL - didn't get to that today, contact the hospital lactation consultant, sign up for the apmultiples yahoo group and so on - but I'm definately feeling better today. I'm encouraged by the SNS idea also - I can do that when they come home no matter what happens in the hospital.

kas · 02-24-2004, 05:29 AM

yay cheryl!! i think the sns is a definite plan for you, mama. and i agree that *any* daily bf sessions done in the hospital nicu is a plus. these babies are going to THRIVE on your milk, you'll see

twomomss · 02-24-2004, 08:04 AM

And now you know that nurses are different and have different approaches, so if one you don't "match" with is on deck when you're there, all you can do is manage the interaction, and know that a different one will be on shift the next time (or soon).

Honestly - it sounds like the BFing is going VERY well - you should feel proud.

Keep at it - Sara

Mamax4 · 02-24-2004, 10:16 AM

Wow. You made me cry.

What a difference an understanding and compassionate nurse makes. It's wonderful your girls can be snuggled together like that. What good medicine. I am also glad your other children are together. You've been through a lot, Mama. You're so proactive--I am sure the nurse saw your dedication-- and bless her for helping your heart get what it needs.

What a lovely family you have. Many blessings to you.

Laurie