not pumping as much
My preemie son was born at 31 weeks at 2lbs 15oz. He is now 6 weeks old and the doc is happy with his weight gain, but what I want to know is, how soon can I begin breastfeeding exclusively? (When discharged, I was "allowed" to breastfeed once a day and give fortified breastmilk for his other feedings). I asked my doctor but he told me to continue this routine to not stress out the baby. I want to respect his call, but it seems like my baby is beginning to prefer bottle over breast, and I want baby to get used to more breast time.
In the beginning, I used to be able to pump 5-7oz of milk at each session, nowadays I'm lucky to get 2oz of milk. I've been having trouble with clogged ducts, which is probably why my supply is decreasing. plus the fact that I have two older kids and a husband who's job takes him away 1/2 the week - who has time to get enough rest for an adequate milk supply?
I want to begin breastfeeding exclusively so I can stop pumping and *hopefully* end my clogged duct problem. Is it okay to stop offering fortified bottles now that my baby is home and growing well?
Re: not pumping as much
I think that stopping the bottles is okay if your baby is nursing well, getting at least 2 oz per feeding on average. Do you have a lactation consultant, preferably an IBCLC, available? She could check you and the baby out, and figure out if things are going well. If not, maybe you could rent a professional baby scale, and do some weigh-feed-weigh tests (weigh baby, feed baby, weigh baby again, making sure baby is wearing same clothes/diaper throughout) to determine how much he's taking in at a feeding.
If you feel like the baby is getting hooked on bottles, a supplemental nursing system like this one may help you keep the baby at the breast for all feedings, eliminating the need for the bottle. (You would want to nurse the baby first, ensuring he got the maximum directly from the breast, and then give the supplement at the breast.)
He's really still a week from being a full-term baby, so I'd be cautious... But maybe some of the moms who have experience with preemies will weigh in with some more informed comments!
Re: not pumping as much
Congrats on your son! My little man was born at 29.6wks and was 2lbs 14oz. During his 53day NICU stay we had 1 full feeding done at the breast - other than that we were sometimes allowed to try to latch and let him have a few sucks but it wasn't even every day. I was also told to continue pumping and bottle feeding him my milk, but once he left the NICU we didn't fortify my breastmilk. Shortly after he came home we were at a Dr's appt and I asked about replacing bottles with breastfeeding and the Dr basically told me I wouldn't be able to do it, ever, that he would need at least half his feedings by bottles. He also didn't want me to stress him out too much and cause him to not gain well. I was heartbroken because I knew the benefits of exclusive breastfeeding from nursing my daughter. So, I will share what I did, but of course, I'm not a Dr.
First off, I worked with certified lactation consultants at our hospital, during and after his NICU stay. They would help me get him to latch and we would do before and after feeding weights to see how much he was taking in. I rented a baby scale from a local pharmacy and once he was about at his due date I started trying to nurse him at every, or at least every other feeding. I think we tried for less than 10mins each time at that point, and then I'd bottle feed him and pump. It was so time-consuming - I too had another child at home. Once he started latching consistently, I began weighing him before and after feedings. At first, if he took over 1oz, I didn't bottle feed him afterwards. I weighed him wearing the same thing (often just a diaper as I think skin to skin feeding helped) and I kept the scale in the same place to help with accuracy. Over time I just decreased the bottles to like every other unless he didn't nurse well. I figured I would keep him close and watch for signs of hunger and nurse him whenever he seemed to want to, because I wanted to go to an on-demand nursing schedule rather than the 3hr NICU schedule. I decided to stop weighing with each feeding (and weighed once a night) and stopped bottles - not all at once, but over time. I wore him in a Moby Wrap, usually he was in just a diaper and my chest was bare, and as soon as I thought he might want to nurse, I would try latching him. Sometimes it was after 1.5hrs and sometimes it was longer. I watched his weight gain closely and kept track of it and showed the Dr's when we would go in for appointments and they were fine with his weight gains so I did less and less bottles. It was a little under 2 months from him coming home and we were breastfeeding exclusively. He actually gained better breastfeeding exclusively than doing bottles.
As far as milk production, there are things you can do to increase it - try posting in the Increasing Your Milk section and some mamas can help you there. You could also try breast compressions and hand expressing to help with the clogged ducts. This is a great website with info on those two things. http://newborns.stanford.edu/Breastfeeding/
Hope this helps a little. I'm happy to answer any more questions - I'm on vacation though so am checking in every few days, but I'll keep an eye on this thread.
Good luck mama!
Re: not pumping as much
You've got excellent advice already. It's definitely possible to go to exclusive breastfeeding with a preemie.
My DD was born at 30 weeks, we brought her home after 7 weeks in NICU.
During the last few weeks of her NICU stay, we'd try BF at one feed a day, she'd tire easily, and would most of the time have a full feed top up of EBM.
When she was almost ready for discharge, we began trying 2 feeds BF a day, but she was still getting topped up, though not a full feed. It became a bit of trial and error. If she was settled after a BF attempt with lesser volume EBM top up, we'd see if she'd last till the next scheduled feed. If not, we'd give her a bit more top up.
When she came home, I'd roomed in with her for 2 days, with BF at every feed, plus EBM top ups after. Then at home, we kept the day time top ups for about a week, then I just stopped them altogether, and went to fully BF during day feeds. Her feeds went from 4 hourly (hospital timetable) to around 3 hourly. Sometimes 2 hourly, but that was fine.
We never fortified the breastmilk as that doesn't seem to be common practice here. Even when in NICU if they're gaining weight steadily.
As others have said, get in contact with a lactation consultant if you can. Hopefully if you can make the leap of faith and drop some of the top ups, your supply will increase anyway with the extra nursing sessions.
I found its more about going from the culture of timed feeds and schedules to working with your baby and feeding them when they're hungry rather than when it's a set time. It's a total leap of faith when you've become used to the structure of the hospital routine.
They will tire easily, but if you can try BF at every feed, or at more of the feeds, it will help a lot.