Breast feeding preemies

[MSWR0319]

My sister had twins 5 weeks early. They are now 4 weeks old, so almost to their due date. The hospital wouldn't let her nurse because the one baby was having apnea during feeding (which they solved by laying her on her side to feed her in a breastfeeding position). The lactation consultant had to try to nurse the other once before he was discharged and then they told her not to nurse them both (they are both home now) until they are full term. Does this make any sense? I had full term babies, so I thought maybe this was a preemie thing, but wanted to see here. I am not impressed with the help she got from them about nursing, which is why I'm questioning what they told her. I had to push for them to get her a pump almost 24 hours after the babies were born. So, are there special rules for nursing preemies? They told her the babies aren't ready to nurse full time, but they could 1 or 2 times a day until they reach their due date.Why can't they nurse? Of course, one won't even latch at all now and she's starting to lose supply already. Any tips to help her would be great for latching, milk supply increase, or if they could be nursing all the time.

[TwinFoxes]

Preemies tire easily. BF tires them out, it is more work than bottle feeding. I BF my girls before they were full term, but not for every feeding because they were in the NICU (DDs were 29 weekers).

For supply. More Milk Plus helped me tons. Plus all the usual steps, staying hydrated, warm room when nursing/pumping, massaging the breasts beforehand, etc.

ETA: what does their pediatrician say re breast feeding? Reflux is a serious issue in preemies. It's painful and awful. DDs had it bottle or breast. They were in meds for months.

[missliss55]

DS#1 & DD#3 were 6 weeks early and we did have trouble breastfeeding. DD#3 was a CPAP in the beginning and we didn't know it at the time but she also had low muscle tone. The low muscle tone made it extremely difficult for her to nurse. DS#1 struggled too...no breathing problems or low tone but we just had a difficult time. Our NICU was very encouraging and our lactation consultant was great but we just had a hard time. So in the end I just pumped. I pumped for a year and I was lucky to have a good supply. I wish I could have breastfed them but in the end they got my milk so I was thankful for that.

[cono0507]

DS was 5 weeks early with a 2 week nicu stay. He had breathing difficulty and was tube fed for a week then bottle fed for two weeks because he would tire easily and not get full breast feedings. At three weeks old he started nursing full time and did for a year. A good LC helped me immensely in making the change from bottle to breast.
Disappointing they didn't give her a pump without needing all the prompting. They rolled that thing into my room two hours after my c section!

[♥ms.pacman♥]

dd was born 5-6 weeks early and had an unusually long (24 days) stay in the NICU, bc she had apnea and bradycardia episodes, in addition to feeding issues. She couldn't even take a bottle (too weak), so she had to be tube-fed with my breastmilk for the most part while she was in the NICU. i exclusively pumped during that time, on top of visiting her 3x everyday at the feeding times to *attempt* to nurse her. Somedays she could barely nurse at all, other days she had the hang of it..but nursing is very tiring for them. THough I think it's very strange that the NICU advised her not to nurse them. Luckly my hospital is very pro-BF. They supplied me with a hospital-grade pump (a lifesaver if you have to exclusively pump) and all the NICU areas had curtains where you could BM/pump discreetly.

[jerseygirl07067]

DD2 and DD3 were 5 weeks early. I agree with the PPs, they tire very easily. I would pump also to keep up my supply and would offer a bottle maybe once a day just to make it easier for them. That keeps the supply up. Though I do not have twins, so that would be very tiring, esp if you could not nurse them at the same time.

I did nurse them most of the time though, and they seemed to do okay, even though there were a few feeds where they fell asleep and missed a feeding. I remember freaking out and worrying about it, but they gained weight well. I do remember when they hit the 6 week mark things really got a lot better, and they started nursing more consistently without being so tired.

I hope she is getting enough rest, and def advise her to drink a lot and eat lots of oatmeal. That seemed to really help my supply. I remember I would notice a difference on days that I didn't eat it. I think I recall drinking Ovaltine too, the malt chocolate version to keep up my supply.

[Melaine]

Awww man it is rough. The girls were 33weeks 6days and stayed in the NICU for two weeks. I agree that it is hard to nurse preemies, they do tire out and just getting a proper latch can be a big battle. I was never told to limit BFing though....I'm surprised they don't want her to try more frequently. the problem with the advice of waiting until full term is that if they are used to bottles BFing seems like too much work. I never had a completely successful BFing relationship and was so worn out by BFing, bottle feeding, following up with formula, then pumping.....I finally dropped attempts to BF and went to pumping....then had to quit by 4 months out of just sheer exhaustion. In retrospect, I did not have the support system to BF preemie twins. Having had a really challenging time with DS, but getting through it, I think looking back I truly needed a full time pp doula with the girls. I just wasn't set up for success and I don't think the LC really prepared me either (and I saw two different ones).

[MSWR0319]

Preemies tire easily. BF tires them out, it is more work than bottle feeding. I BF my girls before they were full term, but not for every feeding because they were in the NICU (DDs were 29 weekers).

For supply. More Milk Plus helped me tons. Plus all the usual steps, staying hydrated, warm room when nursing/pumping, massaging the breasts beforehand, etc.

ETA: what does their pediatrician say re breast feeding? Reflux is a serious issue in preemies. It's painful and awful. DDs had it bottle or breast. They were in meds for months.

I haven't talked to her yet since her last appt. I'm glad you brought up reflux though because they are pretty sure (as am I, since I had two refluxers) that the little girl has fairly bad reflux. They wouldn't do anything for her in the hospital because they said meds aren't shown to work in premies any better than doing nothing??? Other than keeping her elevated, they wanted them to thicken the feedings. I know they were going to talk the pediatrician about it, but I haven't heard the outcome of that. Her DH found some article that said prevacid was like a narcotic for babies and easy to get addicted to. So now he doesn't want her on meds. Both of mine were on them and weaned off fine. I'd rather they be on meds than have acid burning their throats, but I thought maybe you could share a bit more about reflux with preemies.

[egoldber]

Have they been discharged? If so, I assume that the apnea is no longer a problem for the smaller twin.

Caveat that I did not have twins, but younger DD was a 34 weeker. She was in the NICU for 11 days. Honestly, most NICUs are not breastfeeding friendly (I know that some are) in no small part because 1) they are used to dealing with very young, very sick babies, and 2) it is much easier for them to bottle feed and keep track of weight gain that way.

As long as they are at normal weight, gaining weight, and are otherwise healthy (which I assume they are if discharged) then I really can't think why she shouldn't be nursing.

Our ped told us that nursing was the best thing to do for reflux babies because they can self regulate their intake better. I will warn that MANY reflux babies are "snackers" and that can be a very frustrating nursing experience at the best of times. And with twins I would imagine that the exhaustion and frustration would be exponentially worse!

[TwinFoxes]

I haven't talked to her yet since her last appt. I'm glad you brought up reflux though because they are pretty sure (as am I, since I had two refluxers) that the little girl has fairly bad reflux. They wouldn't do anything for her in the hospital because they said meds aren't shown to work in premies any better than doing nothing??? Other than keeping her elevated, they wanted them to thicken the feedings. I know they were going to talk the pediatrician about it, but I haven't heard the outcome of that. Her DH found some article that said prevacid was like a narcotic for babies and easy to get addicted to. So now he doesn't want her on meds. Both of mine were on them and weaned off fine. I'd rather they be on meds than have acid burning their throats, but I thought maybe you could share a bit more about reflux with preemies.

Oh gosh, it's been so long ago now (although it seems like yesterday!) They were on Prevacid and something else, I honestly can't remember the name! Reglan? They were weaned off with no problems. There's regular reflux, where you just end up with a lot of extra laundry, and then GERD where the babies are in pain. It can result in slow growth, baby not eating enough, and bad pain. It's acid coming up from their stomachs. Thickening, upright position, etc can work, but sometimes medication is necessary.

We we saw a GI in the NICU, as well as after coming home. Is that a possibility for your DN? I know not all hospitals and NICUs aren't the same, so I understand why you are worried they may not be getting good advice. I was lucky that we were at a very high quality, well respected NICU. I was woken up after my C section by a LC with a hospital grade pump. The NICU had its own LC. I would encourage her to seek out a private LC, and ask for a GI consult.

Does she she have the book "Preemies"? I recommend it to everyone. It's especially helpful when the babies are in the NICU, but even after they get home.

Good of luck to her!

ETA: I forgot to mention, I never was told to limit BF, once they were able to BF. BF was always the goal in the NICU, we started early practicing latching after I pumped when they were still too weak to feed much. It's funny, I would have assumed NICUs were pro breast feeding because my experience was positive, I got tons of support.

[Kindra178]

Does she have a hospital grade pump at home? She should be pumping all the time (6-8 times in a 24 hour period). I would keep trying the latching thing too. I didn't have preemies, but ds2 wouldn't ever latch and ds3 was tiny. I made the probably stupid decision to pump and give up on my nursing attempts. I also wouldn't worry about getting them to tandem nurse at this point.