nursing a preemie...(update #15, 19)

[♥ms.pacman♥]

..does it get easier?? any BTDT advice??

i have been having a rough time lately nursing my DD (born a week ago at 35 weeks gestation). In the very beginning, she was doing GREAT..immediately after birth she was able to latch on and suck with no problem at all. her breathing and everything was fine and she went to the regular nursery..but then a few days later was transferred to NICU because of apnea/bradycardia episodes. Also, she seemed to have a lot of trouble eating...she would nurse like a champ for like 20 minutes one time, then the next couple times, nothing..she would be too tired, it seemed. In the NICU, they put in a feeding tube, and now she's on a schedule where every other feeding (so 4x a day) i either try to nurse her or they try to feed her a bottle of BM.. if she does well at nursing/bottlefeed, they won't give her as much through the tube. she is getting breastmilk exclusively for the past few days, which i think is helping a ton. but the frustrating thing is, there doesn't seem to be any real progress in terms of her being able to nurse/bottlefeed on her own. Yesterday morning she did great, was able to nurse from both sides for a total of 15 minutes. the next time we went in the afternoon and i tried to nurse her..sound asleep.the next time we went in the evneing, i was more hopeful bc she seemed more alert and awake and was fussing already, indicating she was hungry. i got her to latch on and suck for like 5 mins or so, but then she apparently decided she was done and then begins the snoozefest. then this morning when we visited her, same thing..5 mins of nursing, then conking out. the nurse also told us that at her middle of the night feeding when they tried to give her a bottle she would only take about 10 ml, the rest they had to tube feed. argh.

anyway, although my DD's episodes of A's and B's seems to be fading away and she does seem to be regaining her strength (she's almost back to her birthweight of ~6 lbs), before she can go home she obviously has to be able to breastfeed or bottle feed all her feedings, and that just seems light years away at the moment. what boggles me too is how come she could do so well nursing at one feeding and then not at others.

sorry for the rambling. DD has been in the NICU for 5 days now and while she's definitely been improving it can get so hard at times.

[scriptkitten]

i had 34w preemies so i relate. they were completely unpredictable. they came home after 18 days but it wasn't until day 16 that i knew they'd be home soon. its 1 step forward, 2 steps back with their progress sometimes.

keep at the nursing, otherwise it will be so much harder when you get home.

hang tight, mama!!!! you're doing great!

[egoldber]

Nursing in the NICU is hard!!!!!!!!!!

If you want inspiration, here is my preemie breastfeeding success story.

But nursing well at one feeding and not at others is sooooooo normal. Really. I know it's frustrating, but just do the best you can. She is still small and getting tired at the breast. With my younger DD (a 34 weeker) it was like she "woke up" when she got to about 39/40 weeks actual gestational age. This is really common.

Have you worked with the NICU LCs? It can take awhile until they are alert enough to do every feed. And while you would like her to come home nursing, getting her home faster, even if it is on the bottle for some feeds, will be easier. It is sooooo much easier IMO to nurse on demand than dealing with nursing in the NICU.

[chottumommy]

I didn't technically have a preemie but my DS was born at 37 weeks and weighed 6lbs 19ozs. His weight dropped to 5 lbs 20oz when we were home and it took him 3 weeks to regain his birthweight. He was also in the phase of feeding for 5 mins and then a 30 min snooze. I was basically feeding him round the clock with only breaks for the bathroom and diaper changes for about a week. I don't think I slept for more than 2 hours at a time. I could not have done without my mother and DH. I pumped after every feed to up my supply and give him a bottle after the feed which somehow was easier for him to suck from.

Once he reached the 40th gestation week he sort of woke up and started feeding for a 15-20 min stretch. He started putting on weight quickly at about 1.5 oz a day and went from 3% to about 40% in 2 months and stayed there till he was 10 months.

You're doing great and while it seems like it is never ending, take it one day at a time. It will get better.

[twowhat?]

Hang in there! No BTDT but I remember at the beginning, mine would fall asleep very quickly easily when nursing, and they were full term. I guess it is just so soothing for babies. I very clearly remember both DH and I ticking the backs of babies' necks or feet, even taking off their clothes to encourage awakeness so that they would nurse long enough. Then it did get better.

The 1 step forward, 2 steps back completely makes sense. Just try to nurse her as often as you can. She's gaining weight well, so you're most definitely succeeding

[sariana]

My son was born at 32 weeks and could not nurse for a couple of weeks. He had to "learn" how to coordinate the suck, swallow, breathe and all that. He was fed mostly by gavage (tube) for the first week, and then we gradually introduced bottles more and more often. (At first he would tire too easily and expend more energy than he was getting.) Except for one feeding, he also got my pumped BM, with a human milk fortifier for the first couple of weeks.

He came home after 18 days in the NICU (yes, still more than a month before his due date) at just under five pounds. He still needed bottles to supplement after nursing (still with pumped BM), but gradually he was able to nurse exclusively, except for one bottle a day to take his vitamins, for the iron.

He continued nursing until about 13 months. He grew SO quickly between about 2 months and four months. Once he got the hang of it, he was a champion nurser.

So don't give up. It just takes a while for everything to "click" and work together.

DD was a 36-weeker and NEVER would take a bottle. Little brat. She nursed until about 12 months or so.

Right now patience is your best friend. Good luck to both of you.

[DrSally]

I'm sorry, I didn't have time to read through your whole post, but wanted to post a few quick tips based on my experience (DD 36 weeks). I was frustrated too b/c I was still nursing DS and figured my milk would be right there and easy to get. Um, no. Latch was difficut and the LC said that she would just stop and zone out at a certain point b/c she would get tired out (also had bad jaundice, which made her more lethargic).

Here's what I did, and I only had to do it for 2 weeks before getting back to EBFing.

Gave her 1-2 ounces from a bottle so she wouldn't be ravenous, could start nursing more calmly. Nursed as long as she could go, finished her off with pumped milk or formula in a bottle (usually 1-2 oz), and then pumped myself to keep my supply up. I wasn't very successful in pumping each time. REally unsuccessful, actually, with a toddler to run after as well. But, after 2 weeks, she was full with the nursing alone and I was able to drop pumping/bottles. I knew it would get better and be a temporary solution, since I had supplemented DS in the beginning too. I think just having that perspective helps to get you through that rough patch.

[♥ms.pacman♥]

thank you everyone for the replies!

the whole "one step forward, two steps back" thing is SO true. in the NICU it seemed like whenever one thing would resolve itself (e.g. the spitting up, reflux etc went away once DD was off formula) then something else would pop up. i guess what is hard too is that i never imagined a NICU stay this long, given her size/weight and how well she was doing initially. in addition to being able to nurse/bottle feed, in order to be discharged she has to go for 5 days straight without any episodes of As & Bs and she is still having them so it's gonna be awhile.

about bottles, i totally wish she would take one, that would have made things much easier and would have made tube feeding unnecessary. at this point she doesn't really nurse from bottles either, so that makes things harder. i would have no probs with her nursing from a bottle but right now it seems she doesn't have the energy to do even that (or maybe she's just being a drama queen ).

with my DS (who was born at 38wks) i do remember have the issue of him falling asleep at the breast..in the first couple weeks I remember having to change his diaper, burp him and take his clothes off in order to keep him awake while nursing. so i was prepared to deal with all that...though with my DD, the tiredness/sleepiness is on a whole 'nother level. i saw a few LC's while in the hospital and afterwards when she was in the NICU and after trying various things they eventually just told me that at this stage she probably just doesn't have enough energy/coordination to nurse well. like, right now, out of 8 feedings per day, she can do 1, *maybe* 2 decent (e.g. 10-15 mins total) nursing sessions. with my full-term DS, while it was a little bit of a struggle initially to keep him awake and all that, i was able to exclusively breastfeed him (no bottles) for every feeding from the beginning. just comparing the two, the experiences are like night and day and it just makes me realize how far we have to go still and i guess that is what makes things so overwhelming right now.

and thanks Beth for posting the link with your success story..that really does make me feel better. and actually this last time i visited her in the NICU i tried nursing with the nipple shield and i think it did help somewhat, so I'm going to keep trying that.

thanks again everyone for the support. i do agree i just have to be patient with this kind of thing, which is easier said than done.

[egoldber]

about bottles, i totally wish she would take one, that would have made things much easier and would have made tube feeding unnecessary.

My DD would never take a bottle either. She preferred to nurse, always did. But she did not have the strength to fully nurse either. But it was so exhausting and frustrating trying to do it and the nurses would often end up tube feeding her as well.

Basically, I begged my pediatrician to get her discharged so I could take care of her at home. I was nursing and then offering a bottle and then pumping, and it was easier for me to do that at home. So he talked to the NICU docs and swore up and down we were responsible parents (the upside of having an established relationship with a ped) and they would look out for her. And they did. But it was almost an AMA discharge

But OTOH, she was not having As and Bs either. She was just not eating well. This is the thing with these near term preemies. They can be little and do just fine and go home right away. Or they can be a little tricky and have some small issues that take time to resolve. You just need to be patient and wait it out, but it is soooooooooo exhausting both mentally and physically.

Ask for help from anyone and everyone!

[Dr C]

Sounds to me like she is acting like a typical 34-35 weeker. Some 35 weekers act like 36 or 37 weeks and some act more like preemies. But in any case, what you describe sounds pretty normal to me!!

The upside of your story (besides that she is basically healthy and just needs to grow a bit stronger so she has the energy to nurse) is that she does just as well taking milk from you as she does from a bottle. That's FANTASTIC!! Many LC's I have worked with have told me not to fear the feeding tube--that way they don't get too attached to the bottle and have an easier time feeding at the breast. And the feeding tube buys you time, giving her the calories she needs to grow stronger so she can nurse better.

So hang in there, mama. She'll get there.