This is such a random, specific post that I hesitated to even write it. But I know there are preemie moms like me out there who have a desire to nurse but are struggling to make the transition from tube feeding. When I was searching for tips on how to get a preemie to breastfeed successfully year ago there were none. So I’m hoping this will encourage a new preemie mom out there. And maybe even be an encouragement to any new mom trying to breastfeed.
The Importance of Perspective
I know breastfeeding is a sensitive topic so let me stop and say a few things:
I’ve actually had two premature babies, but I was not able to successfully breastfeed my first preemie (a 29 weeker). She was very sick and weak and had severe reflux. The combination of those things eventually resulted in a g-button (feeding tube) at six months and intensive therapy until she was four.
When Louise (our second preemie) was born I had such a strong desire to breastfeed. I also felt I had a chance to do things differently when it came to breastfeeding a preemie and use what I learned the first time around. I also knew it was also my last baby and I wanted to experience the joy and connection of nursing one last time. (I breastfed my two full-term babies to a year.) I know that may sound weird to some, but it was very motivating to me.
But I also think fed is best.
Watching my first preemie fail to thrive was one of the scariest things I’ve experienced in my life. You simply cannot make a baby eat (breast or bottle) if they refuse. And when their bodies reject the formula you’ve pumped in them through a tiny tube (because they throw it all up, which my daughter did all day long), there is not much else you can do to get them to grow.
In other words that humbling experience gave me perspective: I think breastfeeding is wonderful, but I also think a baby who is healthy and growing is the most important thing. If at any time I felt like Louise (my second preemie) was not succeeding at breastfeeding I would not have had any hesitation to switch to full-time bottle/formula feedings.
Also, most NICU’s have donated breastmilk they will use if you can’t pump or don’t plan to breastfeed. Louise received the donated milk when I had to be readmitted to the hospital with fever. I was nervous about it, but in the end so glad they offered it (and so thankful for the mothers who donated it!). So know that’s a viable option.
Not all preemies are the same.
I truly believe one of the reasons I was able to successfully transition to breastfeed exclusively with Louise (ironically born earlier at 28 weeks) was because she had a much easier NICU journey than my first preemie. Within a few weeks she became what doctors called a “feeder and grower.” Not having a lot of other health issues (besides her lungs) allowed me to focus on her feeding.
A solid support system is crucial for successful breastfeeding of preemies.
My flexible career, childcare to watch my older girls so I could be at the hospital to practice, a husband who cleaned pumping parts and labeled the milk and who would get up with me in the middle of the night, all these things helped me in my breastfeeding journey. Of course, I’ll never forget friends who baked lactation cookies (because preemie moms don’t have time for that!) and drove me to the hospital when I wasn’t allowed to drive. There is absolutely no way I could have succeeded at breastfeeding a preemie without this support. I am fully aware that not everyone has what I had.
Pumping for a preemie is not for the faint of heart. I’ll never forget when the postpartum nurse rolled in that yellow Medela pump hours after my traumatic C-section. I just wanted to cry.
But the nurses reminded me how important even just a few drops of colostrum were to a tiny baby struggling to breathe. It was literally the only thing I could do for her.
The first time I pumped I got less than 1 ml of colostrum (see photo above) which is almost nothing, but the NICU nurses were SO excited about it. Their enthusiasm encouraged me to keep going, despite me feeling like I was dying from the postpartum pain I was in. (I ended up having a terrible post pregnancy complication.)
From her birth until she was discharged three months later I pumped every three hours on the dot, although I did skip one middle of the night feeding to get a six hour stretch of sleep. (The lactation consultants discouraged this regularly but this mama needed some sleep!) Having breastfeed two other babies, I knew I had a good milk supply and could do this: I know not everyone can.
Pumping is exhausting, humbling, and when you’re in a cold hospital corner with only a cotton curtain separating you from everyone else, it strips you of a bit of dignity.
In other words, it is a huge sacrifice of your personal space and time and really your body because most preemie moms have experienced a traumatic birth of some kind. (You can read our birth story here.) But consistent pumping – and keeping up your supply until your baby can do so himself – is crucial for eventual exclusive breastfeeding of preemies. If your goal is to breastfeed your baby, these sacrifices will be so worth it in the end.
If you can keep up with the pumping while your baby is in the NICU, you will have a much easier time transitioning to breastfeed when it’s time because you will have a solid milk supply.
Tip: If possible I recommend renting for the hospital grade pump (many insurances will cover it) to reduce the time and strain on your breasts. I kept mine for a whole year.
Breastfeeding in the NICU
I started the “lick and cuddle” phase much earlier than I did with my first preemie. Now that phrase slightly grosses me out but that’s what they called it in the NICU. It’s when you hold your baby skin to skin and let your baby nuzzle up to your breast and start to familiarize herself with it.
I started this phase at 32 weeks, which seemed so young considering most babies don’t start trying to nurse for eight more weeks but the nurses encouraged it. I really think having that extra practice before I officially started trying to breastfeed helped in the end.
I continued this lick and cuddle phase 1 -2 times a day for the next few weeks. Honestly, I didn’t love this phase because I really just wanted to enjoy holding my baby without any pressure. (Again, anxiety from my first preemie!) And she was still hooked up to oxygen and the nose tubes got in the way. But I was encouraged by the nurses and lactation staff to keep doing this. So I did.
Asking for help is key. Even when you don’t think you need it.
Around 34 weeks I started trying to get her to latch on and nurse for a few minutes. Sometimes she would. Sometimes I couldn’t get her to latch on at all.
Around 36 weeks, at the encouragement of nurses, I made it a point to be at the hospital for two feedings a day. It was brutal on my family and my girls. But, again, I think it was vital for her success in breastfeeding.
For the two feedings I was there I would try to breastfeed for 30 minutes, timing how long she was actually sucking. Then nurses would estimate how much she consumed and tube fed her the rest. There were some feedings where she wouldn’t latch on at all and would be tube fed the entire amount. I would pump after both partial and full feedings.
If I hadn’t been there for two feedings, the nurses would have bottle fed her, which is not a bad thing. I just wanted her to get a solid foundation of nursing before they started doing that.
I truly believe being there for two feedings a day was vital in her nursing success. I realize this is not realistic for working moms, recovering moms, and moms without childcare. But if you can swing it when you can I think breastfeeding will be easier when you get home.
Over the next few weeks she started nursing for longer sessions and eventually worked her way to two full nursing sessions a day, sometimes three.
Tip: Make sure your preemie baby learns to take a full feeding. If she falls asleep after 5 minutes, that is not a full feeding. Keep her awake by undressing her, dabbing a wet cloth on her head, or sitting her upright.
At this point I was okay with the nurses feeding her a bottle for the other feedings because I felt confident she could nurse. So between 36 weeks and 39 weeks I breastfed her for the two feedings I was there and the nurses would work on the bottle with her for the other 6 feedings.
That last week before she was discharged (right at 40 weeks) I was at the NICU for 3-4 feedings as I was nervous about bringing her home and reliving the same experience we had with my first preemie. I know this isn’t realistic for everyone; thankfully I was able to arrange childcare so I could.
**I truly think achieving multiple full feedings in NICU before she came home was one of the keys to her breastfeeding success.**
If I had waited until Louise was discharged to focus on breastfeeding I don’t think she would have been as successful. With three other children at home, I wouldn’t have had the undivided time to focus on her feedings and I wouldn’t have had the help of the lactation nurses and NICU nurses.
Breastfeeding at Home
I thought one of the benefits of a NICU baby was that they come home on a perfect three-hour wake, feed, play schedule. Wrong! A few days before she was discharged her neonatologist told me when we got home I needed to switch to “on demand” feeding. This totally threw me off! But looking back at my experience with my first preemie I felt he was right.
As much as I love a “flexible routine” for full-term babies, preemie babies are wired differently. He explained it to me that preemie babies like her have been tube fed every three hours on the dot, whether they are hungry or not. They have to learn to be hungry and ask (i.e.) cry for food. On demand feedings helps them learn these hunger cues and how to resolve them by taking a full feeding.
As much as I was scared that on demand feeding would mean waking up at every hour of the night, it didn’t turn out that way. In fact the opposite was true. She kept her in NICU feeding rhythm for the most part but I was allowed to let her go four hours without waking up to feed her.
We stayed close to home (because: preemie baby and germs don’t mix) so that allowed ample time and privacy to continue nursing. I breastfed her full-time except one feeding my husband gave her breastmilk supplemented with extra calories via a bottle. (Recommended by her doctor for weight gain.)
She also slept in our room for the first year which made it easy to pull her out of the bassinet and nurse her at night.
I breastfed 6-7 times a day until she stared sleeping through the night around 8-9 weeks. I hate the pump so much that I preferred to breastfeed. Eventually I dropped the extra calorie supplementation and breastfed exclusively for a few months.
When she was about 6 months old she got pneumonia and had to be admitted to the ICU. She was too weak to breastfeed and had to be tube fed again.
I almost gave up breastfeeding at this point but I somehow willed myself to keep pump in the cramped ICU room for a week. Thankfully when she recovered she took to breastfeeding without any problems.
But because she lost weight in the ICU I had to start supplementing 1 bottle of formula a day in addition to my normal breastfeeding routine. I probably could have pumped more to increase my supply but I was just so done with the pump at this point.
As much as I felt like they were a tad overzealous, and cut in on my alone time with my baby, I kept asking the lactation nurses to watch me and give me tips, even during that initial lick and cuddle phase. Even though I have exclusively breastfeed two full-term babies, these nurses have specific tips and tricks for dealing with preemies. Utilize them as much as possible while your baby is in the NICU because it is much harder to get that kind of help once you are home.
Most of the NICU nurses are also very helpful and know a lot of tips and tricks, too, so don’t be shy about asking.
The lactation consultants will remind you ad nauseam about the importance of drinking a lot of water. And it is true. Get a cute water bottle if it helps, add some lemon/lime/fruit, or Crystal Light (I know it’s chemicals, but whatever it takes to get the water down in big volumes!).
Lactation cookies weren’t a big thing when I had my first preemie eight years ago, but now there are so many great recipes online and cookies you can order. I think this is the very best lactation cookie recipe. Freeze the cookie dough or baked cookies and take out as needed.
After four babies I’ve realized the emotional act of breastfeeding rarely ends the way you want it to. I planned to breastfeed until she was one year adjusted (15 months) but Louise stopped breastfeeding the week of her first birthday. She was sick with a sore throat and refused to nurse. I tried so hard to make her latch on but she just cried and leaned away from me.
Everyday that week I kept telling myself to go pump and maybe she’d start nursing again when she was well. But I just could not will myself to be tethered to that thing one more time.
I was quite emotional that our breastfeeding journey ended abruptly and felt guilty for not pushing through one more time. But my husband – always quick to squash my mom guilt – reminded me: “Lee, you breastfeed a preemie baby for an entire year. You gave her the best gift. You should be proud of yourself.”
I may have given her a small gift but, truly, being able to breastfeeding and care for her has been one of the most precious gifts from the Lord. So I will try not to be sad about but instead relish in those precious moments of motherhood while they are still near to my heart and mind.
Also, maybe a little off topic, but I wanted to remind y’all about the giveaway I’m hosting with some awesome fashion bloggers to get you ready for the biggest sale of the year. Early Access to the Nordstrom Anniversary Sale begins Thursday (read all about why I LOVE this sale here). Enter below!
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