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Thread: Help transistioning NICU baby to breast from bottle

  1. #1
    Join Date
    May 2014
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    Default Help transistioning NICU baby to breast from bottle

    This is kind of long and I am sorry!! My DS was born via c section at 36 weeks on aug 3rd. He had some breathing issues which landed him into the NICU for 8 days. Meanwhile he had cpap, oxygen, a feeding tube and IV. Slowly weaned off everything and I was providing expressed milk (pumping 10 x in 24 hours). He finally started taking all by bottle and not spitting up. I expressed a desire to breastfeed several times but the response I got was you can do it 1-2 feeding per day only but he has to get the bottle afterwards so we can know how much he is getting. I was extremely frustrated because once he was discharged we had no breastfeeding established, only bottle. No one even to help me figure things out. I know he can drink from the bottle well and he actually has always latches very well. (which I am sick of the bottle because others think it is a game to see who can feed the fastest and they don't understand the faster he takes the bottle the more of a hinderance it is for me to BF). He is not an efficient eater yet and is still very lazy and it takes a long time to feed. And I am still having to pump after every feeding and supplement with expressed milk. We saw lactation consultant (not sure is IBCLC) a few days after discharge and basically I was told when he was closer to his full term age he would be able to do better and I could go "cold turkey." I wasn't comfortable with that so yesterday I went to IBCLC appt (90 minutes) and he nursed, 15 mins per side, and consumed 2 ounces. He then took an additional 20 mL via bottle and was satisfied. We've been giving him 70 mL by bottle and he is drinking 9-10 x per day so 630 - 700 mL. So I was told to go ahead and breast feed him, for up to 30 minutes then pump for 15 minutes after and give him 20-30 mL following his feed. That is fine with me but I feel like he isnt getting what he needs from me since he is so lazy. I have to constantly wake him up, wiggle his arms, thump his feet, rub his head, etc. He just is so sleepy and lazy when he starts to nurse. He does seem like in general he is becoming more alert but as soon as he starts nursing he is falling asleep.
    My routine:
    - nurse 30 mins (at least 15 per side)
    - pump 15 mins (residual I get 40-60 mL after he eats)
    - Bottle feed 20-30 mL after each nursing session.

    i wanted to mention my let down is slow. i rarely leak or spray. i never feel full or engorged. i think my milk comes out super slow.

    SO my question is: How do I get rid of the bottle? And if I am not pumping after he eats won't my supply tank? (I pump 30-32 oz right now if I don't nurse at all). Also when will he be more alert and be more efficient?
    i feel like the last 3.5 weeks have been spent with a baby or pump on my boobs or bottle. i would prefer to just have baby at boob until I return to work end of october. thanks for any help!!
    Last edited by @llli*mobaby; August 26th, 2016 at 02:59 PM.

  2. #2
    Join Date
    Jun 2009
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    Default Re: Help transistioning NICU baby to breast from bottle

    Hello and welcome.

    If you pump 30 or more ounces a day, that indicates milk production is likely normal at this point. That is amazing and a testament to the incredible work you have done so far. This is also going to make getting baby to the breast much easier.

    so yesterday I went to IBCLC appt (90 minutes) and he nursed, 15 mins per side, and consumed 2 ounces.
    Also very good news. This indicates baby is capable of normal milk transfer as far as I know. Baby took about another 1/2 ounce from the bottle but that does not mean baby needed that, or that baby would not have gotten that at the breast if baby had nursed a bit longer. Right?

    We've been giving him 70 mL by bottle and he is drinking 9-10 x per day so 630 - 700 mL.
    And baby has been gaining well, right? So overall baby is getting enough eating 2 and a 3rd ounces 10 times a day? But a breastfed baby is more likely to nurse 12 or MORE times a day. So, meals may be smaller, but more frequent. Not that 2 and a 3rd ounces is an overly large meal, it is not. But when a baby is nursing, meal size normally varies from less than an ounce to 3-4 ounces. So a breastfeeding baby does not need to eat the same amount every time and is not likely to.

    So I was told to go ahead and breast feed him, for up to 30 minutes then pump for 15 minutes after and give him 20-30 mL following his feed. That is fine with me but I feel like he isnt getting what he needs from me
    I think the hardest thing to do when trying to transfer from supplementing with bottles to nursing is to have the confidence to do it. Here is what I see. You are pumping an amount that indicates normal-good milk production. Baby has indicated they can get enough from you at the before and after nursing weight check. Your LC has given you what sounds to me like a safe and conservative plan for weaning off the bottles and getting baby to the breast while protecting your milk production. I think this plan sounds fine but I would suggest talking to LC about whether it would be ok to sometimes give the supplement before baby nurses and also if you can skip the supplement entirely at some feedings and simply nurse. Ask her how many times a day she thinks baby actually needs a supplement, or how much in bottles baby needs total. Because "after every feeding" is not an accurate number as babies nurse with different frequencies.

    As mentioned above a breastfed baby tends to eat with much higher frequency than a bottle fed baby. Let's say baby nurses 12 times in 24 hours. Maybe you can supplement at 8 feedings and nurse only for 4, as one example. Nursing only at some feedings, or supplementing before the nursing so baby "finishes" at the breast are both good ways for you and baby to learn that the breast can be 'enough." I would also suggest asking the LC if the limiting nursing to 30 minutes only is really required? This kind of limit is often helpful for mom who also has to supplement and pump - it is a time management thing. But as far as a baby is concerned, 30 minutes is not some magic number and many babies nurse for far longer at least some of the time and it is normal and fine. This is another reason to have at least a few nursing sessions a day that are "nurse only" sessions. No supplementing, and no pumping- to allow you and baby to have "normal" nursing sessions at least part of the time.

    Also I assume LC gave you a plan for reducing the amount baby is given in bottles, or you have another appointment scheduled where this will be addressed? Basically what you do is gradually decrease the amount baby gets in bottles, and as you do that, you can also reduce your pumping.

    SO my question is: How do I get rid of the bottle?
    I hope what I wrote above addressed this?

    And if I am not pumping after he eats won't my supply tank?
    Do you mean after you stop all bottles? Your supply should not tank in that case. Once baby is nursing exclusively, pumping is not necessary for maintaining normal production. Of course if you wish to pump a couple times a day just to be safe, that is not going to hurt anything. But until bottles stop, you will want to pump at least as many times a day as baby takes a bottle.

    Also when will he be more alert and be more efficient?
    Assuming baby is healthy and gaining normally and capable of normal milk transfer, I think that as you reduce bottles, baby will become more eager and efficient at nursing.


    i rarely leak or spray. i never feel full or engorged.
    This can be normal. Your pump output indicates normal production. Unless I am missing something, baby has been gaining normally by eating in a day what you can produce via pumping in a day? If so, you make enough milk, and that is what counts.

    Slow letdown- do you mean when you pump? Did the LC notice any issues with this when baby nursed?

    Have you tried breast compressions for increasing flow rate and keeping baby more alert during the nursing session? http://www.breastfeedinginc.ca/conte...agename=doc-BC

    Fennel is often mentioned as an herb that helps with slow letdown.
    Last edited by @llli*maddieb; August 27th, 2016 at 12:22 PM.

  3. #3
    Join Date
    May 2014
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    13

    Default Re: Help transistioning NICU baby to breast from bottle

    Thank you for your detailed response!! Very helpful. I'm replying but probably not in order because I'm on my phone so typing from memory
    - pumping to establish supply is NO JOKE!! Getting my supply has been a "goal" since with my first son it tanked due to latch and palate issues and no matter what we tried (and worked closely with ibclc) it just keep tanking so I've been determined. He was undiagnosed until 10-12 weeks despite several lactation appts. Hoping this work continues. I'd like to make it to a min of 6 months but a year would be optimal.
    -I just mentioned to hubs this morning we should do the expressed milk BEFORE nursing because I feel like he cries sometimes after because baby is used to finishing with a bottle. If we can reverse the cycle he may not cry after. And maybe reducing to 15 mL before nursing and see if he's satisfied.
    -I would like to nurse more frequently as he is still feeding 9-10 times and getting the expressed milk but if we can nurse for more sessions I can ditch this pump (for the most part- I go back to work In 8.5 weeks ) and have some time to do other things and be able to nurse on the go. I would be fine nursing him all day long and pumping a few times per day, for work stash (although I have 5-7 days stored already) and to ensure I'm drained.
    -I was able to successfully nurse 2 sessions yesterday without any expressed milk following. Yay!
    -it's good to know my supply shouldn't tank if I keep nursing him on demand and not pumping after each session. I'm home all week again with no responsibilities except taking DS 1 to school one day and LC appt so I've considered just staying in bed basically every day and just nursing, nursing, nursing and pumping every so often. I feel like this way would teach him quickly. Idk does this sound appropriate?
    - his weight gain has been good. He was 6lb 14oz at birth (8/3); 6lb 9.8 oz discharge (8/11); 6lb 13.8 oz at first ped/lactation appt (8/15). I have a generic baby scale, not good enough for breastmilk Intake but good for weight and he was 7 lbs 11.1 oz on 8/24 (measured by lactation and confirmed at home) and 8 lbs on 8/27 (at home scale). I haven't weighed him today. Will do weight on Friday again. But he is getting mostly milk at the boob and 200mL or so from bottle per day at this point. So he's gaining from nursing.
    - his diapers are much better after he breast feeds. IDK If this makes sense? His bowel movements are fuller after he nurses. When he takes bottle he seems to have scant / light bowel movements so I think he probably does get more than I think at the breast at times.
    - we did a 30 min limit to reduce nursing/pumping/expressed milk feeding to 45 mins. I think we are supposed to address coming off bottle and more on demand feeding when I go back Friday this week. So I think the 30 mins is just a starting point. He tired out pretty quickly after 15-20 mins so that extra 10 he didn't really do much. I do compressions when he is at the breast already to make sure he is getting what he needs since he can be "lazy" or weak still at the breast.
    - I was told to start with one feeding per day, where I feel the "fullest" and try to drop the expressed milk and then go from there. Once one feeding is complete at the breast aim for another feeding without bottle. We were able to do an late afternoon session and the 4am feeding last night. But I still pumped.
    - I pump 30-60 mL AFTER nursing still (depending on length of time between nursing).
    - the LC didn't notice an issue with let down or milk coming out. She said I may not leak or spray since I nursed #1 so the muscles may just be tighter. I leak a small amount but with my first the milk would seriously spray everywhere and I had to wear nursing pads for a long while.
    - is fennel the same as fenugreek or is that a different herb? I tried fenugreek last time and it didn't help. But I'd try it again my
    - baby doesn't fuss at breast when latching so I assume he is happy with flow?
    - sorry for all the questions and concerns. I'm not used to pumping from day 1. Starting with nursing from get go is so much easier!!
    -i feel like when a baby is in nicu moms get "programmed" to focus on output so right now my mind is set on how much comes out. I need to flip that switch and just focus on feeding my baby and worrying about weight gain and diapers vs the number coming out.

  4. #4
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    Jun 2009
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    Default Re: Help transistioning NICU baby to breast from bottle

    Hi, sorry I missed your reply for a few days. I hope things are going ok? Let us have an update when you can.
    -it's good to know my supply shouldn't tank if I keep nursing him on demand and not pumping after each session. I'm home all week again with no responsibilities except taking DS 1 to school one day and LC appt so I've considered just staying in bed basically every day and just nursing, nursing, nursing and pumping every so often. I feel like this way would teach him quickly. Idk does this sound appropriate
    This is called taking a nursing vacation and is a tried and true method for all kind of breastfeeding issues, So it sounds good to me. Since you are under the care of an IBCLC, you might want to run any tweaks in your 'plan' by her. Also I am happy to hear there is a follow up scheduled. This is good. Bring a list of your questions is my best suggestion there! It is easy to forget with everything that goes on at an LC consult.

    Fennel is not the same as fenugreek. It is a different herb. It has a reputation for helping specifically with slow let down issues. However, IMO you probably have no slow let down issue. Every indication (weight gain, what you pump after nursing) is that your milk production is in good shape, and if baby is content with the flow, that is all that is required of flow. So I see no need for any galactagogues. Spraying and leaking (or lack thereof) are not a reliable sign of milk production (or lack thereof.) Some moms experience neither, ever. I personally have experienced more with two babies than my third, and I had OP with all of them.

    -i feel like when a baby is in nicu moms get "programmed" to focus on output so right now my mind is set on how much comes out. I need to flip that switch and just focus on feeding my baby and worrying about weight gain and diapers vs the number coming out.
    .
    I 1000% agree with this. You said it perfectly.

  5. #5
    Join Date
    May 2014
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    13

    Default Re: Help transistioning NICU baby to breast from bottle

    Thanks for f/u! I think you saw my other bread we've had a rough week. But I think the clogged duct issue is clearing up so back to boob.

    LC visit I left with same recommendations for now- breast feed then pump after.
    He took 56 mL from me (in 30 mins) and we gave him 30 mL expressed I pumped 40 mL AFTER nursing him. So the milk is there- he just needs to get it. The LC said he needs about 80-90 mL when he feeds and I think she is assuming 8 feeds. I asked can I just nurse on demand and no supplement with expressed and she said he has to show weight gain etc.
    So I'm not really sure still what the plan is or how to get off pump. For now I'll just nurse and when I feel he doesn't get a good feed I'll pump. I'll offer him expressed milk and hopefully gradually can back off it. And gradually off pumping so much. I'm hoping in the next 2 weeks things are easier.

  6. #6
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    Default Re: Help transistioning NICU baby to breast from bottle

    Ok.
    I asked can I just nurse on demand and no supplement with expressed and she said he has to show weight gain etc.
    I think you jumped too fast to asking about NO supplement and pumping. It is a process to wean a baby safely off supplements as well as to wean your body safely off pumping (so supply stays in good shape.) That said, LC really should be offering you a plan for getting to exclusive nursing of some kind. IMO.

    But did LC say you can never just nurse? Because actually, Baby has shown pretty good milk transfer.

    So from what I understand, normal transfer at a nursing session can be anything from less than an ounce to 3-4 ounces at this age. From what I have read (source, Breastfeeding Answers Made Simple) a before and after nursing weight check that shows 2 ounce transfer at any age above 2 weeks is considered good transfer and a good indication transfer is normal. Baby did not hit that, but, pretty close.

    1 month old babies do not usually nurse only 8 times a day. I mean, some do, I guess. But not many. They nurse 10, 12, 15 times a day, and more.
    So yes, if baby is nursing (eating) only 8 times in 24 hours, baby is going to need to transfer more than if baby is nursing 10-12 times. But there is no reason biologically for your baby to have to do this. Because normally he would be nursing much more often than 8 times a day.

    For what it is worth your plan sounds reasonable to me. I just wish your LC was offering you something more concrete.

  7. #7
    Join Date
    May 2014
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    Default Re: Help transistioning NICU baby to breast from bottle

    Update:
    I went to lactation again because I was absolutely going crazy figuring things out, etc. I went to the one associated with my pediatrician who I saw first. We did the feed and he was transferring milk so lactation said I could switch from the pump to the breast and pump 2-3 times per day to relieve engorgemebt, etc. so I've followed this all night and pumped once and attempted again but baby got fussy so I wanted to feed him. So now we've made this abrupt switch from bottle to breast which he seems to be doing a lot better. I'm to feed on demand with no schedule and watch diapers for now. We do have appt tomorrow an for his 1 month check so they will weigh him and make sure he is doing okay and I'm sure I'll need to bring him back for a weight check in a week or so after.
    My question is: will my milk supply stay the same or increase or decrease since I'm not pumping around the clock? LC said as long as I nurse on demand things should be okay. Obviously I'm worried about losing milk but pumping and recording how much I got and figuring out bottle amounts etc was driving me crazy.
    Oh she also told me if I needed to supplement with expressed milk then limit it to twice per day and obviously pump when I do that, 12 hours apart. This is so he learns to get his nourishment from the breast.
    Hopefully this plan works. It's kinda nerve wrecking since I can't physically see how much milk he is getting.

  8. #8
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    Default Re: Help transistioning NICU baby to breast from bottle

    My question is: will my milk supply stay the same or increase or decrease since I'm not pumping around the clock? LC said as long as I nurse on demand things should be okay. Obviously I'm worried about losing milk but pumping and recording how much I got and figuring out bottle amounts etc was driving me crazy.
    If baby is getting all they need at the breast, your milk production is enough. So, if it needs to increase it will increase, and if it is ok for it to decrease, it will decrease. Nature wants baby to survive and thrive and for mom to also survive and thrive. So mom's body (barring unusual issue) will continue to make enough milk for baby given the proper stimulation. At the same time, making milk takes energy. So the trend for all nursing moms is to make enough milk, not more than enough. In many cases this does mean milk production reduces over time, which is not the same as mom is not making enough.

    Hope that helps?

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