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Thread: Establishing supply for preemie twins in NICU

  1. #31
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    Default Re: Establishing supply for preemie twins in NICU

    Are your babies getting any other supplements besides your expressed milk? With that kid of gain I am thinking babies can be getting to the breast exclusively pretty soon, here, no?

    If I put the pump parts in the fridge how often would I have to wash them?
    Ok, so I cannot remember where I saw the "store in the fridge" tip. But here is what is suggested in The Womanly Art of Breastfeeding, and actually it may not be appropriate due to your babies being premature, but you will have to decide for yourself. Here is what it says:

    "Unless you're pumping for a premature or ill baby, just rinse the flanges and set them aside for the next pumping, washing them at the end of the day. Hot, soapy water is fine for healthy, full term babies. If your baby is hospitalized, follow the hospital guidelines for expressing and storing your milk." *

    *from The Womanly Art of Breastfeeding, 8th Edition, page 301.

    The cold of the fridge would retard any bacterial growth, so I imagine that is where that idea comes from. But because your babies were premature and are just out of the hospital, this time saver may not be appropriate after all. But your babies sound like they are doing awesome and are no longer in the hospital, and are now (just barely) 37 weeks aka ‘term” right? So, I just do not know!

    I do think you could pump a little less often maybe? You are pumping almost twice the recommended amount for a newborn who is not nursing at all. Your babies ARE nursing-right? so I do not understand why you need to pump 15 or 16 times a day as well. You want to be careful to not overstress yourself and also be very careful about pump injury.

  2. #32
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    Default Re: Establishing supply for preemie twins in NICU

    They will be 38 weeks tomorrow. I am not nursing them very often now because my LC said it is wearing them out and they're not getting much. Plus I feel like I shouldn't offer them a basically empty breast. I nursed one of them early this a.m. before I pumped.

    They are only on my milk and have never had formula. We did use some banked milk in the NICU and my sister also gave us some milk so I am using I guess 1-2 oz of supplemental human milk since I'm not quite where they need me.

    My LC suggested pumping that much to increase my supply since it's about where they need it now but not where they will need it in a couple of weeks. I really don't know what to do about nursing them. It takes so much time and then they won't take much from a bottle because they're tired. I meet with my LC again on Wed and hopefully we can try again. She said to do lots of skin to skin and some nuzzling at breast but since they technically should still be inside of me we shouldn't be stressing them out about feeding. I did nurse them 5x/day in the NICU and when we got back the first night I nursed both, bottle fed them and pumped (DH bottle fed one, I the other) and it took so much time I wasn't sleeping. my LC thinks to get my supply up it needs to be from the pump since the babies aren't getting much they aren't helping my supply very much and within a month they'll be bigger and stronger and more able to nurse without me needing to pump.

    ETA: we sterilize the pump parts daily per hospital guidelines.

    What kind of pump injury could I get? My nipples are sore, especially at the base where they start to stick out, not the areola.
    Nursed my sweet daughter 3 years, 3 mos.

  3. #33
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    Default Re: Establishing supply for preemie twins in NICU

    Obviously, you should do what you feel is comfortable but what I did was nurse my little NICU baby for 10 minutes only and then bottle fed and only twice a day. That way she was on the breast and learning how to do it but was also getting the right amount of milk from the bottle so that we knew she was eating. She didn't have a great suck reflex and didn't transfer much milk on the breast so it was more just to show her how to do it, and then she'd eat the whole bottle (which at the time was something like 2 ounces.) The whole feeding/pumping takes so much time - trust me I know - so if you can stop pumping as much overnight that will help. Maybe when your LC thinks you have enough supply you can cut back a bit on the overnight pumping and just do some bottle feedings.

    Once one of your babies has a good suck reflex, you could try tandem nursing and that baby will help flow for the other baby (that's what happened with me.) In the meantime, try and get some rest and sleep. That will most definitely help with the pumping.

  4. #34
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    Default Re: Establishing supply for preemie twins in NICU

    I want to keep trying to get them to latch on. I tried both this morning but my bigger baby didn't even latch. He gets so upset when he's hungry he just isn't patient enough to keep his mouth open long enough. I need to try finishing at breast more. I did get some good skin to skin snuggle time in yesterday evening and DH and I wore both of them for a family walk this morning. I'm hoping all this pumping won't drag out too much longer.

    My LC said yes once my supply gets up I can cut back on the pumping.
    Nursed my sweet daughter 3 years, 3 mos.

  5. #35
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    Default Re: Establishing supply for preemie twins in NICU

    Ok. So, your babies are gaining much faster than what would be expected of a typical breastfed two-three week old. And A two or three week old baby would be considered doing well if baby can be shown to transfer 2 ounces via a before and after nursing weight check. How far below that are your babies falling? I am confused why time at the breast is being curtailed this way when your babies appear to be doing so well...

  6. #36
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    Default Re: Establishing supply for preemie twins in NICU

    What kind of pump injury could I get? My nipples are sore, especially at the base where they start to stick out, not the areola.
    This could be from too much pumping, too long pumping, pumping at too high a setting, ill-fitting flanges.

    It is forgotten that just as a poor/shallow latch can injure a mom, pumping can too. IN fact, pumping is even more potentially an issue because a pump extracts milk in an unnatural way.

    make sure your flanges fit right (the nipple should move easily in and out of the 'tunnel,' but not much areola should be getting pulled into the tunnel. Fit is a fine tuning thing and you may even need different sized flanges on each side.) Start at a low or the lowest setting and slowly dial up (or whatever) to the highest COMFORTABLE setting. Pump for no more than about 15-20 minutes per side each time. As far as how often to pump, if your babies were able to tandem nurse each time, you would be nursing about 10-12 times a day total. Few mothers are able to pump as often as even a single baby is likely to nurse. Even eping moms usually top out at about 8-10 times per day. So I really do not know how much is too much in terms of frequency. But it worries me!

  7. #37
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    Default Re: Establishing supply for preemie twins in NICU

    Quote Originally Posted by @llli*lllmeg View Post
    Ok. So, your babies are gaining much faster than what would be expected of a typical breastfed two-three week old. And A two or three week old baby would be considered doing well if baby can be shown to transfer 2 ounces via a before and after nursing weight check. How far below that are your babies falling? I am confused why time at the breast is being curtailed this way when your babies appear to be doing so well...
    The two times we've done weight checks they got between 6 and 12 ccs so they really aren't doing that well at breast. Then it wears them out and they don't gain. Their first week I was nursing them 20-30 minutes and when they started on oral feeds (they have IVs a few days and NG gavage one day) they would not take very much after nursing and we assumed it was because they were nursing well but they didn't start to gain weight until I started to limit their time at the breast. We were encouraged to limit their time because NICU requires adequate wt gain at least 2 consecutive days to discharge. They do great at the bottle and our LC said they have good suck-swallow-breathe coordination but they do wear out. Even just a burp break can put them to sleep and then they won't take more from a bottle.

    I'll have my LC watch me pump tomorrow. I am not going above comfort level any more but I know I was earlier and I"m pumping about 10-15 minutes/session (10 if it's hourly because I don't get milk after that and 15-20 if It's been more than an hr).
    Nursed my sweet daughter 3 years, 3 mos.

  8. #38
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    Default Re: Establishing supply for preemie twins in NICU

    You are doing great, and working so hard. I really hope I am not bothering you with all the questioning. Obviously you and your IBCLC have a good plan that is working very well for your babies. Since you are going to see your IBCLC again tomorrow, you can get any tweaking of your plan if needed at that point. I would just suggest that, no matter what occurred the first couple weeks, your babies weight gain is NOW quite rapid, and that would indicate that babies are getting their fill from the bottles, and that-baby being well sated- could also make a baby very sleepy at the breast or bottle.

    That is a good idea to bring your pump to the session. But try to nurse at the session as well, so if latch needs tweaking etc that can be worked on.

  9. #39
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    Default Re: Establishing supply for preemie twins in NICU

    Thank you. No you're not bothering me with questions, just trouble-shooting. My IBCLC helped me so much with my daughter 4 yrs ago and I really do trust her.

    I know their wt gain is very rapid but I don't want to restrict them especially if getting bigger will help them get the hang of nursing sooner. We will try to nurse I bet. I nursed my smaller little guy during the night and he seemed to do OK, not that I can tell, but he burped afterward and my bigger guy wouldn't even latch on. He gets so upset when he's hungry and by the time DH bottle feeds him I just get up and pump.

    They latch on but then they get more and more shallow and sort of slide off, generally. Or they don't keep their mouths open long enough for me to get them on.

    DH and I are both stressed out about my supply because we're dipping into milk my sister gave us because I'm a couple oz/day behind right now. I ordered the Making More Milk book yesterday so hoping it doesn't take too long to get here.
    Nursed my sweet daughter 3 years, 3 mos.

  10. #40
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    Default Re: Establishing supply for preemie twins in NICU

    The sleeping while eating/burping thing happened to us as well. My little NICU baby needed a nap break while she would eat and she would also get super tired on the breast. It was taking us FOREVER to feed the girls, but really, it does get better.

    Also, and I know it's easy for me to say, but try not to stress on the milk production. It only makes it harder to get what you need. I used to stare at the pump while pumping and it would totally stress me out. Once I started reading or doing something else, the milk flowed better and I wasn't as stressed.

    You are doing GREAT! And so are the babies!!!

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