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Thread: Thinking I'm going to have to EP- questions

  1. #1
    Join Date
    Oct 2010
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    Default Thinking I'm going to have to EP- questions

    I've been posting in the preemie forum about my preemie iwth a heart condition who won't latch on for more then a few minutes. I've seen a IBCLC (sorry if the initials are wrong) several times, and talked to a LLL leader....and we're running out of options. She has very little suck reflex (no interest at all in finger sucking, pacifiers, etc.), a dysfunctional suck when she does suck, according to both the LC and the LLL leader, and still tires easy. She is on a medication for her heart that blunts hunger and makes her smooth muscle tissue relaxed as well as making sleepy. We lessened the dose, and it's better, but hasn't helped the latch issues.

    I DON'T want to EP...but I know a sick baby needs my milk more. So I'm considering it. I'm exhausted to death with pumping every 3 hours then spending 1/2 hour giving her 2 ozs (all she'll take- ped wants to add human milk fortifiers b/c she's only putting on about 1/2 oz a day). I'm also finding myself getting resentful and angry at every feeding- when I try to latch, because she won't, when I don't, because I'm having to bottle feed. I breastfed six other children for at least 12 months and this is devestating to me. I"m crying all the time. I feel like she won't know who I am, like there is no difference between me and dad, or anyone else, like she won't bond to me...and I'm frustrated she's making it so difficult...which I know is ridiculous- she's a six week old (3 weeks corrected age).

    Anyways- questions:

    1. Do I have to pump this much at night? Can I drop a night pumping?
    2. Her poop is green. I know this means not enough hind milk. I'm pumping at least 20 minutes. I took her to the ped because it started all at once and he said it could be the kids' cold in her bowels...but it's not getting better. I'm doing breast compressions at the end of a pumping. Is my milk just not good enough?

    I'd like to think maybe when she's older we could get her on the breast eventually...but I can't look at it that way. Right now I'm trying to face what is. I can't keep pumping and hoping she'll decide to latch on because there has been absolutely no progress. The SNS didn't work out for us. I'm trying a different bottle and some exercises to try to improve her suck.

    3. How did you deal with the grief. I feel so absolutely devestated and like such a failure. I couldn't keep her in full term, couldn't keep her healthy and now can't do this as well.
    ~Sara
    Happily married since 6/98
    Mom to 5 boys, 2 girls- Madeleine Claire born 3/29 @ 34 weeks 6 days

  2. #2
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    Jun 2006
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    Default Re: Thinking I'm going to have to EP- questions

    I'm so sorry you are going through this. EPing is so exhausting, but you are right. Your baby most of all needs your milk. 6 weeks is still so new, even for full term standards. It is by no means hopeless but you're right. Perhaps you need to take a breather for a moment. I know with my second, who was EPed for 3 weeks (a walk in the park compared to my 2 month EPing preemie!) I didn't push myself. I knew it would happen eventually and if I was tired and sad one day I just bottle fed without trying. But he did eventually get it. And a preemie has so much more work to do.

    I don't think the green poop is an imbalance. Give it some more time and see if it clears up. But your milk is most certainly good enough!

    The grief. Well that's a tough one. Have you considered getting some PPD counseling? A preemie, especially one that can't nurse, is extremely hard on the emotions. I know how you feel. For a long time I blamed myself for my daughter being born at 33 weeks. Like if maybe I had worked less or been more careful I would have been able to hold my baby in. But the reality is, it's not your fault. You are doing an amazing job and giving her the best gift you possibly can. And there is no one more important than mama, even if the milk comes from a bottle.
    If you obey all the rules, you miss all the fun. - Katharine Hepburn

  3. #3
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    Mar 2006
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    Default Re: Thinking I'm going to have to EP- questions

    Well, what your are describing is normal to EP, especially the first 12 weeks. I have to EP for a baby with a physical birth defect that interfered with breastfeeding...he wanted to, and we tried, but in the end, he couldn't nurse, no matter what I did, no matter what knowledge I have.

    I would NOT drop a night session yet. You need to be pumping as much as you can for the first 12 weeks. You are establishing prolactin receptors that will carry you long-term. So, I would say pump 120 minutes in 24 hours, broken into 8-12 sessions.

    I get how time consuming this is. I pumped, fed my baby with special feeders, which took at least 30 minutes, then repeated for long, long months. I was exhausted. I had to take a leave of absence from my work. The rest of the activities my family was involved in stopped for some months when I was pumping every 2-3 hours.

    But..you won't have to do that forever. After 12 weeks, I went to 3-4 hours. But I kept one session between midnight and 5am for a while, and then I dropped it, probably around 4 months, but...I would stay up until midnight and get up at 5 to pump. Eventually I dropped to every 6 hours and stayed there for the rest of the first year.

    To see about fixing the green poo, mix your bottles from the day and then divvy them back out into your feeding bottles. It balances the fats.

    You won't have time for counseling with all of this. I tried. And there is no time. But the grief...it hurts. I cried so, so, so much. It still strikes me at times, what we missed out on. It's way worse when you know what you are missing, how much easier it is to BF. It gets better. And it helped me to reach my goal of no formula, to pump for at least 12 months (my next is 18 months or until the freezer milk is all gone). Then I could say I had succeeded, not at something I wanted to do, but something that I had to do, that is actually incredibly difficult, as 9 out of 10 women who try to EP don't succeed.

    She will know who you are. There are some differences to our relationship as compared to my other babies, but I know there is a bond. He runs to me, he prefers me to anyone else. I don't think he knows or cares about the milk, but it's been OK. Yes, you know what is missing, but what will grow from this Is OK and adequate.

    They got all over me over weight too, as cleft babies are notorious for FFT. If you have extra, make sme double cream bottles. Skim off the top inch or whatever from the bottle after letting it stand. You will get all the cream and fats. Add that to another bottle and feed it. Extra fat I did that for a week or so, long enough to get them off my case and so I could get ahead of him and then we were fine.

    Drop the pressure by latching her once a day to help her remember and maybe when she is bigger you can go back. Or, and this is what I wish I had done, was always finish at the breast. Even just a minute trying to latch. Because then it reminds baby that comfort comes from you. I wish I had done that. I pinned my hopes on breastfeeding him post-palate repair at 9.5 months, but when we got there, he refused absolutely to even try. And so. Here I am 16 months later still pumping.

    It will be OK. I so know how you feel.
    Susan
    Mama to my all-natural boys: Ian, 9-4-04, 11.5 lbs; Colton, 11-7-06, 9 lbs, in the water; Logan, 12-8-08, 9 lbs; Gavin, 1-18-11, 9 lbs; and an angel 1-15-06
    18+ months and for Gavin, born with an incomplete cleft lip and incomplete posterior cleft palate
    Sealed for time and eternity, 7-7-93
    Always babywearing, cosleeping and cloth diapering. Living with oppositional defiant disorder and ADHD. Ask me about cloth diapering and sewing your own diapers!

  4. #4
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    Default Re: Thinking I'm going to have to EP- questions

    Excellent advice above. I just want to add that you should not beat yourself up over any of this. This isn't a failure of your will or dedication or love. This is just an unkind quirk of fate.

    I definitely agree that if you can put the baby to the breast once or twice a day, you have a better chance of keeping your options open for the future, when it comes to getting baby to nurse more or even exclusively. No guarrantees, of course!

  5. #5
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    Default Re: Thinking I'm going to have to EP- questions

    Quote Originally Posted by @llli*mommal View Post
    Excellent advice above. I just want to add that you should not beat yourself up over any of this. This isn't a failure of your will or dedication or love. This is just an unkind quirk of fate. e!
    This is true. You would not have chosen this. It's not like you are this mom I ran into who has chosen to EP to deliberately limit her intimacy and attachment with her child (yes, this is true, and it floors me still). You don't want this. But do the best you can with what you have. And it's totally OK to mourn. I grieved like someone had died. When BFing is your go-to, and you no longer have it, and you know what you are missing, it's normal to be very sad about it. And it's worse when it's not your fault. You tried and tried. But you always wonder what if. Let that go and see what you need to do now to succeed.

    I have lots of pumping things in a box in my closet. Is there anything you need? Extra connectors? Bottles? Anything?

    And I still wonder if a Haberman feeder would let her get more milk faster. If you want to try one, I'll see if I still have any. Most wore out and we transitioned to a regular bottle around 11 months, but I might have 1-2.
    Susan
    Mama to my all-natural boys: Ian, 9-4-04, 11.5 lbs; Colton, 11-7-06, 9 lbs, in the water; Logan, 12-8-08, 9 lbs; Gavin, 1-18-11, 9 lbs; and an angel 1-15-06
    18+ months and for Gavin, born with an incomplete cleft lip and incomplete posterior cleft palate
    Sealed for time and eternity, 7-7-93
    Always babywearing, cosleeping and cloth diapering. Living with oppositional defiant disorder and ADHD. Ask me about cloth diapering and sewing your own diapers!

  6. #6
    Join Date
    Oct 2010
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    Default Re: Thinking I'm going to have to EP- questions

    Quote Originally Posted by @llli*aprilsmagic View Post
    This is true. You would not have chosen this. It's not like you are this mom I ran into who has chosen to EP to deliberately limit her intimacy and attachment with her child (yes, this is true, and it floors me still). You don't want this. But do the best you can with what you have. And it's totally OK to mourn. I grieved like someone had died. When BFing is your go-to, and you no longer have it, and you know what you are missing, it's normal to be very sad about it. And it's worse when it's not your fault. You tried and tried. But you always wonder what if. Let that go and see what you need to do now to succeed.

    I have lots of pumping things in a box in my closet. Is there anything you need? Extra connectors? Bottles? Anything?

    And I still wonder if a Haberman feeder would let her get more milk faster. If you want to try one, I'll see if I still have any. Most wore out and we transitioned to a regular bottle around 11 months, but I might have 1-2.
    Thanks so much for the offer! The LC actually tried a Haberman and it didn't go any faster. We're meeting with an OT who specializes in infant feeding issues Tuesday in the hopes that, even if we can't get her to breast, we can get her to suck more effectively. Has anyone done infant OT? The LC consulted with the NICU specialist LC and she said that some preemies just get "stuck' when it comes to the whole "suck-swallow-breathe" thing. I'm still nursing her, with the nipple shield, at least once a day, usually in the evening when she's most alert, for comfort. She will take the breast for comfort, just not consistently and she won't stay on for more then 5-10 minutes, so maybe someday....if I can hang in there....

    I went ahead and did the fortifiers since her weight gain is slowing down and we seem to be having some reflux issues (all of my kids have). Until she doesn't have to work so hard to eat, it would be nice to not feel obliged to increase her feeds so quickly.

    Someone told me that a preemie's corrected age was only until 37 weeks, which would make her corrected age 4 1/2 weeks. But if you correct until 40 weeks, which is what I found on the AAP site, then she's only 2 1/2 weeks. I can't help but feel that makes a difference in her feeding issues and that there might still be a chance.....

    Oh, does anyone know about the Medela Pump in Style? Is it a hospital grade pump? My insurance covered it, but I found it didn't seem to have much suction, so I tried the Symphony in hte NICU when she was there. My milk production seemed better so I rented one, but since my insurance already bought a pump it's not a covered expense and it's expensive to rent and pay for the domperidone.
    ~Sara
    Happily married since 6/98
    Mom to 5 boys, 2 girls- Madeleine Claire born 3/29 @ 34 weeks 6 days

  7. #7
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    Default Re: Thinking I'm going to have to EP- questions

    Hi mama. Just jumping on to say that a pump in style is NOT a hospital grade but, if you are EPing at least at first you want want to stick with the Symphony and use the PIS here and there, like in the car etc or as backup
    Mommy to Maxwell 10-9-07 weaned with love (a party and a remote control monster truck) on his 4th birthday
    My Boy 3-16-10
    And my sweet pea Sam 2-12-11

    Watch Your Language

  8. #8
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    Default Re: Thinking I'm going to have to EP- questions

    and - getting her to comfort nurse for 5-10 mins a day is HUGE!! that's an awesome sign you'll be able to get her back to hte breast eventually. really really super. good job!
    DS1 6/7/11
    DS2 10/29/13

    Nursing, pumping, cloth-diapering, babywearing, working professor mama with the awesomest SAHD ever.

  9. #9
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    Default Re: Thinking I'm going to have to EP- questions

    Yeah, you won't be able to rely on the PISA. And it is NOTHING like a hospital grade.

    I couldn't get my insurance to cover anything for Gav at all, even with letetrs fommthe cleft team, ped, 2IBCLCs, all saying jt was necessary. I spent $150 every 6-8 weeks on Habermans, plus the rental at $900/year. Ouch. I wish I had just bought my Limerick at the start, as I'd have saved money. Just plan on spending it, mama. It cost us $2000 for me to EP for the first year.

    Keep working on the comfort nursing. That will help keep options open.
    Susan
    Mama to my all-natural boys: Ian, 9-4-04, 11.5 lbs; Colton, 11-7-06, 9 lbs, in the water; Logan, 12-8-08, 9 lbs; Gavin, 1-18-11, 9 lbs; and an angel 1-15-06
    18+ months and for Gavin, born with an incomplete cleft lip and incomplete posterior cleft palate
    Sealed for time and eternity, 7-7-93
    Always babywearing, cosleeping and cloth diapering. Living with oppositional defiant disorder and ADHD. Ask me about cloth diapering and sewing your own diapers!

  10. #10
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    Jun 2006
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    4,611

    Default Re: Thinking I'm going to have to EP- questions

    Corrected age is to 40 weeks. So you're right, she is only 2.5 weeks. And that makes a huge difference. You must keep reminding yourself that she is so new and was rushed into the world before her body was ready. So she needs more time than a full term baby. And at 2.5 weeks even full term babies are still struggling to nurse. It is most certainly not hopeless and the fact that she is latching at all is huge. My daughter didn't latch for the first time until she was 7 weeks old. Not even for comfort. She went on to nurse exclusively and refused a bottle at 6 months!

    The fortifiers did not agree with my daughter. She stopped throwing up as soon as they stopped giving them to her. If weight gain is slow, I would be more inclined to double up fat from pumped milk. Meaning let the pump milk separate and take the top layer - the thicker part of the milk - and put it into another full pump session. It means a little more pumping but less chance of reflux and more opportunity for her to absorb the good fat and gain some weight. Because that's another factor. If she is not gaining well she will probably be more tired and sluggish and less likely to work at nursing directly. Especially when coupled with the medication she is already taking.

    You are doing a wonderful job mama! It is not easy to have a preemie and especially when they are sick. You are doing such an amazing thing for her. Be proud!
    If you obey all the rules, you miss all the fun. - Katharine Hepburn

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