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Thread: Exclusively breastfeeding preemie now that we are home

  1. #1
    Join Date
    Aug 2012
    Posts
    323

    Default Exclusively breastfeeding preemie now that we are home

    I had a 30 weeker who was diacharged from the NICU at 39w3d. We have been home two days. We have been working on breastfeeding for the last several weeks while continuing NG tube feedings and he finally "got it" about a week ago. I stayed in the hospital for the final days of his hospitalization to breastfeed on demand. He has never gotten a bottle and has been nursing on demand with no supplements for the last 5 days.

    Throughout his NICU stay I pumped milk for his NH tube feedings. By the end of his NG tube feedings he was getting 75cc every 3 hours (less when he nursed well). On average I was roughly matching or slightly exceeding this volume with my pumping efforts.

    My IBCLC has advised me to keep up the pumping at a frequency of 5x per day during the day with just breastfeeding at night. This amounts to pumping after most daytime feedings. I have found this difficult to keep up. On more than one occasion, I have nursed, gotten baby down and begun pumping only for him to let me know he wasn't quite done and wants to nurse a little more. Other times, I have pumped after a feeding only to find that he wakes up after 1 1/2 or 2 hours and has a difficult time satisfying himself. Sometimes he nurses very well and sleeps for 3 hours, so I do have time to make more milk for his next feeding, but in the mean time he has so thoroughly emptied my breasts, I don't get much and it feels kind of unnecessary.

    The rationale behind the pumping is that he hasn't yet demonstrated the he will gain adequately by only breastfeeding, and so if he isn't getting what he needs, will need supplementation but in the mean time I need to maintain my supply. The idea is to slowly wean off the pump as he proves his ability to breastfeed and gain adequately.

    He has been weighed since discharge by a visiting nurse (in addition to daily weights in the hospital). He has gained a few grams some days and stayed the same other days. But the daily weights don't reveal much of a trend and they expect him to stay the same or even lose a little as he transitions from tube feedings to breastfeeding. We go to the pediatrician this afternoon so will see what his weight has done (on yet another scale).

    Meanwhile, he is nursing well 8-12 times per day with lots of gulping and swallowing, and peeing and pooping frequently (6-8 poops and pees with every diaper). He looks hydrated. He wakes on his own when it is time to nurse but he often quickly falls asleep at the breast so I put him down or change his diaper and he wakes again and generally finishes up well. He does some cluster feeding once or twice per day but otherwise nurses, looks full and satisfied and falls right back asleep.

    I feel like we are doing great but I am anxious about the pumping. I feel like if I do pump, it makes it harder for him to nurse the next time. I know there is always milk, but he is sleepy and doesn't always seem up to working hard to get it. I definitely notice more copious swallowing when my breasts a full after he has had a longer interval between feedings and I haven't pumped. If I don't pump, I worry that my supply is tanking and I am going to have a problem on my hands. I should mention that I have tons of milk stored in the freezer. Any advice, thoughts? Thanks!

  2. #2
    Join Date
    Jun 2009
    Posts
    10,754

    Default Re: Exclusively breastfeeding preemie now that we are home

    Hi Sprocket. It is amazing how much progress you and baby are making!

    I think that whenever an IBCLC gives a mom a plan and the plan is tried, some tweaking of that plan is typically needed. After all we are talking about biological processes and human beings, not machines.

    It sounds like the pumping suggested is "just in case" pumping. It is not "You must pump 5 times a day or your production will tank" Or "You must pump 5 times a day because you do not make enough milk yet" but rather "If you pump 5 times a day, even if baby is not nursing super efficiently yet, we can be extra super sure that your milk production will be just fine. So do that, just in case."

    But the reality is that this specific plan (pumping 5 times every day but during the day only) is 1) Exhausting 2) worrying you and 3) making it harder for baby to nurse after you have pumped. Given any of those things, some tweaking of the plan would be in order.

    Ideally I would suggest calling your IBCLC and discussing the need for adjustments to this plan with her. She has seen you and your baby and is very familiar with the entire situation.

    Maybe the "tweak" that would help you is to get away from a hard number or time frame to follow and look at what is happening in the moment and pump or not pump or make adjustments to pumping (One or both sides, how long, how much taken out of the breasts) based on that. Baby just nursed a short time? Pump a little. Baby just nursed but mostly on one side? Try pumping the other side. Milk production is higher in the morning or over night? (as would be typical) then maybe put a pump session at that time instead of only pumping during the day. Concerned baby is going to wake soon? Pump only one side, or do not pump as much milk out. Baby just nursed great or cluster nursed for two hours? No need to pump. Sleep instead. Realize you have not pumped in 6 hours and baby wants to nurse right now? Pump the other side while nursing. Etc. Does that make sense?
    Last edited by @llli*maddieb; April 29th, 2016 at 11:50 PM.

  3. #3
    Join Date
    May 2006
    Posts
    24,794

    Default Re: Exclusively breastfeeding preemie now that we are home

    with the excellent post above!

  4. #4
    Join Date
    Aug 2012
    Posts
    323

    Default Re: Exclusively breastfeeding preemie now that we are home

    Thank you!! Yes this makes sense and gives me some confidence to go with my intuition here. Pumping here and there when/how it feels right makes sense Also, my baby gained 2 oz in 2 days at his first pediatrician appointment so I think that letting him regulate my supply is going to be more or less ok. He goes back this week and if he is still gaining appropriately I think I may mostly put away the pump and let him do his thing. I am amazed at how well he nurses already because my first baby (born at term) didn't catch on until she was a couple of weeks old so then it was essential to pump. Today I pumped after he slept for three hours and then nursed only on one side. Weirdly I didn't get much out of the other side and it is my big producer. And what I did get was very opaque, creamy milk like hind milk. I know I have plenty of milk though because he is nursing frequently and with big gulps and swallows, looks very satisfied after nursing and then sleeps well, my breasts get full and hard between feedings and feel empty after he feeds, and he is producing 8+ poop and pee diapers per day, and seems to be gaining.

  5. #5

    Default Re: Exclusively breastfeeding preemie now that we are home

    Hi there. My daughter was also a 30-weeker and I exclusively breastfed her once she came home at 35 weeks. I had to pump a little to relieve pressure for about 2 weeks before my supply decreased to match her intake. She is 5.5 months old now and has gained EXTREMELY well on just my milk. So it can be done!

  6. #6

    Default Re: Exclusively breastfeeding preemie now that we are home

    thanks for your good post

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