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Thread: How to transition from pumping to breast?

  1. #1

    Default How to transition from pumping to breast?

    I had a 34 wkr April 25th. I immediately started pumping that day and he was given breastmilk via NG tube along with TPN etc. He started getting fortifier added to my breastmilk as well a week later? I was pumping 7-8x a day and pumping about 8oz each time. I have a ton of BM stored already When he was just a few days old I was able to "try" to nurse him and he amazed me and latched quickly and we did that for a few minutes. I wanted to try and nurse him multiple times a day but of course the concern of weight gain etc and in order for him to go home he had to be taking feeds from a bottle at each feeding. So if I nursed him and then attempted a bottle and he fell asleep- he would have been tubed the rest and we wouldn't be able to "count" that. So I decided to not nurse him and just give him the bottles so we could go home. He came home in 14 days at 36 weeks.

    We have been home for 3 weeks now and the breastfeed-adding fortifier-pumping routine has left me exhausted! We also have 3 other children and like most have said the routine leaves like 1 hr before next feeding! The first week home he gained 11oz! So the pediatrician said we could stop giving him the fortifier at each feed if we wanted- to start nursing more. The 2nd week home he gained 10.5 oz and that was with a couple nursing sessions in the day and fortifier at night So then if I wanted to start just nursing exclusively I could but then just give him a bottle if he is acting like he didn't get enough. Well- that routine is still leaving me so busy!

    Here are my questions- I am nursing 10-15 min each side and have no idea what he is getting obviously. He often acts hungry again so we give him about 60cc of EMB- he either takes it all or doesn't. My breasts are still full because he isn't emptying them completely when he nurses so I still pump about 10 min after wards to relieve them. The first week I started this I had a plugged duct and felt like I was getting mastitis-(Which never seemed to show up but I had pain and a red line- and all that has gone away so has the plug) But it has left my right breast pumping about an oz less then the left. Is that from the plugged duct? its been almost a week now and it hasn't regained the oz.

    Also- How do I begin to phase out the pumping? I am worried that if I stop pumping I will be left with plugged ducts and engorgement- then my supply will decrease as its not being "used" and I worry that I won't be able to increase the supply when he starts taking more because it decreased. SO I am afraid to stop pumping and just go on his cues. The other idea is that if I don't give him a bottle of BM afterwards and still pump...and if he acts hungry again, to just nurse him, My breasts won't be as full because I pumped.

    I would love to be able to exclusively nurse him but the worry about losing my supply scares me- Since he is probably only eating 1.5oz each side right now-if he even gets that- so that leaves each side with 2.5oz of milk (well right side with less since its not producing as much?)

    I would just love a solution on what to do now.

    I hope this isn't too confusing and my questions are clear. Sorry its long too. I have been hoping to find help to make this go easier

    One more piece of information- I find even when giving him just a bottle- we will put in 3-4 oz of BM- he takes the 4 oz and sometimes still acts hungry! Other times he will only take 3oz. Sometimes he even wants to eat like an hour later! (and this isn't just with nursing) We joke that he is just a little piggy, but this just seems like so much milk for a little guy. He is currently 39 weeks 2 days--5 weeks old. His last weight was 6lbs 10.5 oz (as of last Wednesday) and his birth weight was 4lbs 13 oz.
    Last edited by @llli*momma2monkeys; June 1st, 2010 at 03:42 PM.

  2. #2
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    Default Re: How to transition from pumping to breast?

    I'm so sorry to hear you're having trouble. I'm not sure how much help I can offer -- I've never had a preemie and I EP'd. So glad to hear he's nursing though, that is awesome!

    I would say not to worry too much about your supply, especially if you put him back to the breast when he seems hungry - it should regulate itself to what he takes. I'm sure right now it's pretty tiring and pretty scary too because you're going from known measurements to times. Maybe it's just a growth spurt of some sort? I'm unfamiliar with how that works in a preemie but I think for a full term they hit a spurt around a month.

    Does he stop after 10-15 minutes or are you doing that? If it's not him what happens if you just let him nurse until he quits? I think the 10-15 is a rule of thumb, not a necessary cut off point.

    For example, you know how you're supposed to feed for a few ounces / minutes, burp, then feed again? Yeah, we tried that with our daughter. She would FREAK. Hated it. Made her actually take less. We found letting her drink the whole bottle (even when she was a couple months and taking 6-8 oz in a bottle at once!) that she would contently do so and THEN burp. And I'm talking "deep, from the depths of your toes" type of burp. I used to even think it was my husband burping, not her!
    Momma to K 05/24/07 (due 05/31/07)
    Momma to I, 06/04/10 VBAC'd (due 05/31/10). Read about it here

    Exclusive Pumper to first for 18 months.
    I got my VBAC!

    Struggling with nursing but one way or another breast milk is all they get.

  3. #3
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    Default Re: How to transition from pumping to breast?

    I was hopeful that you would have gotten another response by now. I do not have a preemie but may be able to help.
    I am nursing 10-15 min each side and have no idea what he is getting obviously. He often acts hungry again so we give him about 60cc of EMB- he either takes it all or doesn't. My breasts are still full because he isn't emptying them completely when he nurses so I still pump about 10 min after wards to relieve them. The first week I started this I had a plugged duct and felt like I was getting mastitis-(Which never seemed to show up but I had pain and a red line- and all that has gone away so has the plug) But it has left my right breast pumping about an oz less then the left. Is that from the plugged duct? its been almost a week now and it hasn't regained the oz.
    If you want to know how much LO is getting you can rent a scale and weigh baby before and after a feeding. In general though we say watch the baby and not the scale. Meaning is baby growing properly and having enough wets/poos? If those two things are present you can assume LO is getting enough milk. Sometimes with babies who were born early you have to make an extra effort to keep them sucking on the breast b/c they get tired easily. There are methods to keep them awake at the breast.

    I do not know if your breast is pumping less b/c of the plugged duct but do know that it is not atypical for the breasts to produce different amounts for any person.

    You should know that if when you pump to relieve your breasts, if you are pumping and emptying them, you are telling your body to keep making that amount of milk. If you pump only a bit to relieve the pain then your body will regulate and that engorgement will be relieved.

    How do I begin to phase out the pumping? I am worried that if I stop pumping I will be left with plugged ducts and engorgement- then my supply will decrease as its not being "used" and I worry that I won't be able to increase the supply when he starts taking more because it decreased. SO I am afraid to stop pumping and just go on his cues. The other idea is that if I don't give him a bottle of BM afterwards and still pump...and if he acts hungry again, to just nurse him, My breasts won't be as full because I pumped.
    Don't worry too much about your supply. Your baby will get stronger the bigger he gets. Certainly when he is strong he will be able to tell your breasts how much to produce by how much he eats. In fact that should be happening now but as I said I don't have experience with a preemie. I would however assume that since you were told it is okay to go to breast only that this is not a significant worry at this time. Since you have a ton of milk stored already this should help relieve some of your worries. To begin phasing out pumping you might try only keeping your first morning pump. This usually produces the most milk. You must remember that with early babies sometimes they are extra sleepy so you might have to help them with their cues. This means waking them up every two hours to feed if he isn't doing that himself. You don't want your breasts to feel "full" all the time. I remember when mine stopped feeling full I had a small freak out. But then the ladies here told me that my body was just regulating itself to a supply and demand regimen. I have been fine and it feels so much nicer

    Since he is probably only eating 1.5oz each side right now-if he even gets that- so that leaves each side with 2.5oz of milk
    I'm wondering where you are getting these amounts from?
    I find even when giving him just a bottle- we will put in 3-4 oz of BM- he takes the 4 oz and sometimes still acts hungry!
    What are you using to determine LO is still hungry? Sometimes BF babies will drink from a bottle even when full, in fact many do.
    Baby Girl "Piper" born Feb 12th, 2010. She is a true blessing!

    And a baby who is now an Angel in Heaven Feb 7th, 2008.

  4. #4

    Default Re: How to transition from pumping to breast?

    Quote Originally Posted by @llli*Krystal View Post

    Does he stop after 10-15 minutes or are you doing that? If it's not him what happens if you just let him nurse until he quits? I think the 10-15 is a rule of thumb, not a necessary cut off point.
    No, I don't stop him. I let him quit. I was just guesstimating the time he is typically nursing. Which I know that 10-15 min is a rule of thumb and typically he does just that-sometimes less, sometimes more.

    When he quits nursing one side, I will burp, change a diaper and then put him on the other side. It helps wake him up too.

    I questioned the growth spurt as well since its around 1 month and thats what he is, but with my first preemie, we really went off her adjusted and real age since it was a 3 mo diff...where as with 6 weeks early- its not as much of a drastic difference, So I wasn't sure.

    Thanks for responding!
    Bree momma to:

    Haley & ~i~ Ashlyn- ID twins
    Born at 25wks 4d on 5/26/02 Ashlyn passed 5/27
    1 pound 14 oz each
    Haley had a 3 mo NICU stay -EP for 18 mo

    Easton
    Born at 34 wks on 2/13/04
    5lbs 9oz -4 week NICU - EP for 12 mo

    Hudson
    Born 39 wks on 1/19/07
    8lbs 8oz - exclusively BF for 14 mo

    Madden & ~i~ Quinn-- Frat b/g twins
    Born at 34 wks 2d on 4/25/10 Quinn passed at 20 wks
    4lbs 13 oz- 2 wk NICU stay-
    Trying to transition to BF

  5. #5

    Default Re: How to transition from pumping to breast?

    Quote Originally Posted by @llli*redpowerlady View Post
    I was hopeful that you would have gotten another response by now. I do not have a preemie but may be able to help.


    If you want to know how much LO is getting you can rent a scale and weigh baby before and after a feeding. In general though we say watch the baby and not the scale. Meaning is baby growing properly and having enough wets/poos? If those two things are present you can assume LO is getting enough milk. Sometimes with babies who were born early you have to make an extra effort to keep them sucking on the breast b/c they get tired easily. There are methods to keep them awake at the breast.

    I do not know if your breast is pumping less b/c of the plugged duct but do know that it is not atypical for the breasts to produce different amounts for any person.

    You should know that if when you pump to relieve your breasts, if you are pumping and emptying them, you are telling your body to keep making that amount of milk. If you pump only a bit to relieve the pain then your body will regulate and that engorgement will be relieved.



    Don't worry too much about your supply. Your baby will get stronger the bigger he gets. Certainly when he is strong he will be able to tell your breasts how much to produce by how much he eats. In fact that should be happening now but as I said I don't have experience with a preemie. I would however assume that since you were told it is okay to go to breast only that this is not a significant worry at this time. Since you have a ton of milk stored already this should help relieve some of your worries. To begin phasing out pumping you might try only keeping your first morning pump. This usually produces the most milk. You must remember that with early babies sometimes they are extra sleepy so you might have to help them with their cues. This means waking them up every two hours to feed if he isn't doing that himself. You don't want your breasts to feel "full" all the time. I remember when mine stopped feeling full I had a small freak out. But then the ladies here told me that my body was just regulating itself to a supply and demand regimen. I have been fine and it feels so much nicer


    I'm wondering where you are getting these amounts from?

    What are you using to determine LO is still hungry? Sometimes BF babies will drink from a bottle even when full, in fact many do.
    thanks for responding!

    He does have plenty of wet and poo diapers. I have considered getting a scale, just to get an idea or guesstimate on what he may be getting at breast to just ease my mind.

    I have heard of breasts having different amounts but mine never have before- up until this plugged duct issue. (thats including the other children I pumped for) Thats why I give amounts further down in my post of a guess on what he may be taking. Given I get the same amount from each breast everytime I pump. So after he eats from one side and I pump- that side will have significantly less then the other- thats where I get the guesstimated amount he may have received.

    I realized that because I was still pumping, my body was still producing that amount, I was just worried if I slowed down/stopped pumping, it would only produce what he was eating and make my body think that I was weaning?, so I was worried that it would be harder to build the supply back up once it went down.

    He is waking every 2.5-3.5 hrs to eat on his own-

    Once I assume he is full..about 10 min later, he is chomping at his hands, rooting at our necks and fussy. We have tried doing a paci and he is content for a few minutes then cries. So we assume he is hungry still.

    This has been so much harder to figure out this time. Since the first two were preemies- I just exclusively pumped (nursed the 2nd off and on, but was easier to give him EBM and we got thrush) and then the 3rd was full term and he only nursed..(even then when I pumped I never did pump very well like I have the other times- the amounts were much less-assuming because I didn't build the supply in the beggining?) So this time, I just feel like I am in a very grey area on what steps to take next.
    Bree momma to:

    Haley & ~i~ Ashlyn- ID twins
    Born at 25wks 4d on 5/26/02 Ashlyn passed 5/27
    1 pound 14 oz each
    Haley had a 3 mo NICU stay -EP for 18 mo

    Easton
    Born at 34 wks on 2/13/04
    5lbs 9oz -4 week NICU - EP for 12 mo

    Hudson
    Born 39 wks on 1/19/07
    8lbs 8oz - exclusively BF for 14 mo

    Madden & ~i~ Quinn-- Frat b/g twins
    Born at 34 wks 2d on 4/25/10 Quinn passed at 20 wks
    4lbs 13 oz- 2 wk NICU stay-
    Trying to transition to BF

  6. #6
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    Default Re: How to transition from pumping to breast?

    Hi Mama!

    Going from bottles to exclusively nursing with a preemie is this strange sort of leap of faith. My son was born at 29.6wks and it took us almost 2mo after he came home from the NICU to drop all the bottles. I rented a baby scale and weighed before and after each feeding, and recorded it so the Dr could see it as weight gain was a big thing for my little man in the beginning. If he took 2+oz I didn't feed him a bottle after. But I wore him in a Moby Wrap to keep him close to me and tried to nurse him again as soon as he seemed like he wanted to.

    It sounds like you have a great supply of milk! So I recommend backing off on the pumping slowly, so you don't have any problems. You could decrease the amount of time your pumping, and then skip one pumping session and let your body adjust, then skip another, etc.

    While you're nursing him, you could do breast compressions to help him get more milk.

    Can you describe his fussiness a little more? Is it just after he eats? Both from nursing and bottles? When you put him back to the breast, a short time after eating, does he latch and suck vigorously? Is he spitty? A few of the things you mentioned sounded maybe like reflux to me, so just wanted to explore that a little.
    Mommy to:

    Emmalynn Marie
    Born at 37 weeks on 12/22/06
    5lbs 1oz 19 1/2in

    Owen Charles
    Born at 29 wks 6 days on 01/17/09
    2lbs 14oz 15in
    In NICU for 2 months


  7. #7
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    Default Re: How to transition from pumping to breast?

    I had a preemie in February. She's my second. I never got DD2 to latch on due to her NICU time, I think. But, I EPed for 2 1/2 years for her. Any way after that, I was so desperate this time I really worked at it.

    Ok, first of all she was due around April/May. So as most people said I was really hoping by her "due" date she would be strong enough to do it on her own. I tried in May, but at the end of the day she seemed still hungry and took a bottle. Grr. I wish I would of worked harder then to get her exclusively at the breast but didn't.

    But, here is what I did from the beginning. I told the nurses in NICU, I would be there at EVERY feeding, I always offered her the breast before giving her a bottle. She would suck for a while each breast every time! I would take 20-30 minutes each feeding time. A few times though the nurses had given her a bottle before I got there! I was really upset about that. They said they didn't know I was coming. Uh, I SAID I was! Any way...that being said. Once we got home, again nurse first before each bottle. BUT, she really loved that bottle boy. She likes to be a FAST eater! And she could suck a bottle down fast. We had to switch to those playtex drop in bottles that helped a lot in the nipple confusion.

    Then came June.......she didn't want to take the breast at all! Started screaming and scratching me! So I said ok sister, no more bottle then! And I didn't give her a bottle all day after that. It took me a week, of her fighting, screaming, pinching me, pulling her own hair out, etc. I would still give her a bottle of pumped milk at night though cause she had exhausted herself so much during the day fighting with me about nursing. But, after a week she took to the breast kindly, and wasn't upset. I still was giving her a bottle of milk in the night though. But, then one night she nursed and nursed before bed. And she's been good about it ever since, and hasn't had a bottle since! I have been able to give up the pump too! UHG after eping for 2 1/2 years for DD1, you don't know how good it felt to give that up!

    Any way....long answer, just do your best every day. It may take longer then you thought.

    I thought we would be done with the pump with in 2 months of her birth.......that came and went and it didn't happen. But, it did happen at 4 months for her.

    So it may not come when you expected it to, but keep on offering the breast every single time first. And I think you will be able to do it.

    Also I bought the book the Womanly Art of Breastfeeding and that was a GREAT encouragement to me!

  8. #8
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    Default Re: How to transition from pumping to breast?

    You've got some great responses, but I wanted to share my experience just to reinforce that you're not alone in this!

    My DD was born at 36 weeks which I know is close to full term, but she still had a lot of issues. She wanted to nurse but couldn't get it down at first so we had to finger feed (put your finger in her mouth to suck on and use a syringe to give the milk) and teach her to nurse with a shield (I even had to put milk in the shield with the syringe to encourage her). I was pumping every two hours and it was exhausting!

    I had so much milk in the beginning and the pumping seemed to emphasize things a bit. Her nursing made a big difference in helping my body to figure out what she needed.

    Once she got nursing down, I felt really strange about slowing down on the pumping. I ended up just pumping after her morning feeding and at night if I got a chance. It feels so strange giving it up even though you know they're eating fine but it will get easier with time. HTH!
    Married to my best friend.
    DD born 8/14/10 at 36 weeks.


    Cloth Diaper addict!

  9. #9
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    Thumbs up Way to go!

    First off, CONGRATS!!! Determination seems to be the biggest hurdle in making BFing succeed. It's very difficult to stick with EBFing a preemie, what with all the pumping and difficulty latching and all. You are doing GREAT! The fact you've stuck with it thus far is AWESOME!!!!! Way to go, mama!

    I know you've got plenty of responses, but my Kyla-bear is a NICU graduate, so I thought I'd share our experience.

    Ky was born at 34 weeks as well. The inner-city hospital where she was born was REALLY trying to sway me away from breastfeeding- even the LCs there were trying to push formula. "Oh, you're supply's not there, you'll have to supplement." I had one LC spend 30 min teaching me how to properly bottle feed (while I was using every last ounce of strength I could muster to not slap her and say, "Look, lady, I'm not an idiot, and I've bottle-fed plenty of babies before!)

    Ky was in the hospital for almost 3 weeks. Quotes from hospital staff- LCs, neonatologists, residents, and nurses, follow paranthetically.
    They did not like me holding her ("she'll get too cold!")
    ...and were totally against kangaroo care ("They do that in 3rd world countries!").
    I was not allowed to put her to breast but 8 times a day, at 3 6 9 12 AM & PM ("We have a schedule we have to follow in the NICU" or "You're gonna tire her out and she won't gain weight.")
    I asked about nipple confusion ("That's not real!")
    ...and they suggested I supplement with formula ("...because we can't measure the calories in breast milk.")

    It's interesting to note that over 1/3 of the NICU babies there were unfortunately born addicted to drugs, and we were one of only 4 families that went to visit our little one more than once a day. I was also one of 2 nursing mamas in the NICU.

    She spent three weeks to get back to her birth weight. This was probably due to the fact that I had to wait for a nurse to take her vitals before I could feed her- which sometimes took 45min- 1hr. I was there for two weeks before I found out the the flanges on the breast pump were too small, and were hindering my supply. (I didn't know until I became a mama that nipples, not just breasts, come in all shapes and sizes.) They would not allow me to finger feed or use an SNS, their solution was formula. I was sent home with over $100 worth of formula, which I'm proud to say was never opened, except as a joke by my DP and I to see how it would work as creamer in our coffee- LOL! (verdict- It was disgusting!)

    I was loaned a Medella pump compliments of Uncle Sam through the WIC program. I would put her to breast, give her a bottle, and pump, to the point my breasts were bruised. The most I'd ever get in one pumping session was about 2 oz total. I got sick of it after about 2 months. I had lots of travel plans for the holidays, and I'd be raging mad if I had to deal with the breast-bottle-pump-repeat routine while putting up with extended family.

    So, what finally worked for me was just forcing her to take only from the breast. I had a bit of EBM in the freezer stock-piled just in case. Kyla would scream bloody murder the first few days. I think she was conditioned to think.... "bottle makes me full! If I work on the boob long enough I'll get a bottle and that's so much less work for me!" I had to make what I call a "nipple sandwich" by using my index and middle fingers to compress my breast down a bit to make it easier to get in her mouth. I cooed at her every time she got a good latch, and just went longer and longer on the breast each time, putting less and less in a bottle, if I used a bottle at all. Every time she fussed, I'd put her to breast. Within a week, she was no longer taking a bottle.

    Now she's pushing 12 lbs (we find out for sure at her pedi visit next week) and nurses so well nobody would ever assume we went through so much trouble. During the day she feeds anywhere from 45 min- 2.5 hrs apart, but she sleeps through the night, with the exception of one feeding. When I hear her start to fuss at night, I roll over and let her latch on and we fall right back to sleep. So much easier then the breast-bottle-pump routine, where I was LUCKY to get 45 min of sleep between feedings.

    Good luck, dearie!

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