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Breastfeeding Moms Breastfeeding Moms

prematurity/bf'ing

Posted by on Sep. 16, 2012 at 10:33 AM
  • 10 Replies
I had my son at 24 weeks and he never developed the ability to suck and swallow and still has a feeding tube (mickey button) at 11 years old. I only got to pump for him. My daughter came 36 weeks and I breastfed her for 14 months. I really want to breastfeed this time too. I have an incompetent cervix and am 28 weeks 2 days now. At what point in gestation can I still breastfeed? Can babies go from an ng tube for feedings to breastfeeding even if they are in nicu and need feeding help in the begining? Sorry for all the questions. Now that survival isn't my main concern for a premature birth I'm starting to worry ill miss out on bf'ing.
by on Sep. 16, 2012 at 10:33 AM
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maggiemom2000
by Ruby Member on Sep. 16, 2012 at 11:15 AM


Quoting thedathree:

I had my son at 24 weeks and he never developed the ability to suck and swallow and still has a feeding tube (mickey button) at 11 years old. I only got to pump for him. My daughter came 36 weeks and I breastfed her for 14 months. I really want to breastfeed this time too. I have an incompetent cervix and am 28 weeks 2 days now. At what point in gestation can I still breastfeed?
Potenially at any age. There are babies born at 24 weeks who go on to nurse, but as you know, every case is different. The older their gestiational age the better their odds.
Can babies go from an ng tube for feedings to breastfeeding even if they are in nicu and need feeding help in the begining?
Yes. It is very common for premies to start on an ng tube and move on to breastfeed. My 34 weeker was gavage fed for the first few days, then went to the breast.
Know that they can often go to the breast before the docs in the NICU say they can. If they are ready to try a bottle then they are ready to try the breast. Breastfeeding is actually much less stressfull for a premie than bottle feeding.
Sorry for all the questions. Now that survival isn't my main concern for a premature birth I'm starting to worry ill miss out on bf'ing.

Really good info here:

Breastfeeding the Premature BabyPrintE-mail
Introduction
Mothers too often have preventable problems with breastfeeding. Many hospital routines make it difficult for mothers and babies to breastfeed successfully. When the baby is born prematurely, mothers have even more difficulty with breastfeeding, and this is unfortunate because premature babies need breastmilk and breastfeeding even more than healthy full term babies. The reason for mothers not getting the help they need is that many of the “techniques” used to save the lives of premature babies were developed during the 1960’s and 1970’s when breastmilk, never mind breastfeeding, really wasn’t a priority in neonatal intensive care units (NICU’s). Unfortunately, despite much about what we have learned since that time about how to help mothers and babies to breastfeed, NICU’s seem to be, in general, with some exceptions of course, resistant to change the way babies should be fed. Even worse, some techniques have been adopted that make the situation even more difficult.

Some Myths About Premature Babies and Breastfeeding

1. Premature babies need to be in incubators
Actually premature babies, even very small ones, often do better skin to skin with the mother (or father) than they do in incubators. Evidence shows that premature babies (and term babies too for that matter) are more stable metabolically when they are skin to skin with the mother. Their breathing may be more stable and less distressed, their blood pressures are more normal, they maintain their blood sugars better and their skin temperatures better in Kangaroo Mother Care (skin to skin care for most of the day) than they do in incubators. Furthermore, mothers and babies in Kangaroo Mother Care will more likely produce more milk, she will get the baby to the breast earlier and the baby will breastfeed better. A document from the WHO discusses this at length with many references. Please show this document to your baby’s doctor(s). You can get it at the website http://www.who.int/reproductive-health/publications/kmc/text.pdf free of charge.

2. Premature babies all need fortifiers
Actually, most don’t. If the mother is expressing enough milk, babies over about 1500 grams (usually about 32 weeks gestation babies weigh this much, though there are exceptions) can grow just fine with breastmilk only, perhaps with the addition of vitamin D or phosphorus, maybe.

The real problem behind this “need” for fortifiers is that it has become a gospel, carved in stone, for many NICU policies that babies must grow at the same rate outside the mother as they would have had they not been born so early. But there is no good evidence to prove that, whereas there is evidence that babies who grow faster than the premature baby on breastmilk has problems later in life with higher levels of “bad” cholesterol, higher blood pressure, insulin resistance (which may be an early finding of type 2 diabetes) and overweight. These studies were done in premature babies given a) just breastmilk b) breastmilk plus banked breastmilk or c) breastmilk plus preterm formula. The babies who got the preterm formula did grow faster and bigger but there was a price.

How can the baby be fed without using fortifiers? Well, first of all, some babies will need fortifiers, true: really tiny babies and babies whose mothers are not able to express enough milk. However, fortifiers are now being made from human milk (breastmilk) but admittedly they are not easily available yet and are very expensive as well. There is no reason fortifiers need be made from cow’s milk. However, most premature babies don’t need fortifiers because most premature babies are “big” premature babies.

  • Many NICU’s have a rule that babies can receive only a certain amount of liquid a day. This is usually kept at about 150 to 180 ml/kg/day, sometimes less. If the baby also has an intravenous, the fluid given orally is cut down even more. This restriction of fluid makes sense, for example, if the baby is on a ventilator to help him breathe because too much fluid may cause him to go into heart failure and prevent his coming off the ventilator. So, restriction of fluid, plus the “baby must grow as if he were still in the uterus” results in the “need” for fortifier.

    One way avoiding the need for fortifiers in some premature babies, I learned when I worked with premature babies in Africa, was to give them more breastmilk than what is ‘allowed’ in NICU’s. True, these babies were not like babies in NICU’s in affluent countries; they were bigger, not as sick and needed not more than a little oxygen to survive. But, as a believer at that time in “the baby must grow as if he were still inside the mother”, I increased the amounts of milk the baby received well above the 150 to 180 ml/kg/day, sometimes up to 300 ml/kg/day and the babies did fine and grew well. So as not to give the baby too much milk at one time, the milk was dripped into the baby’s stomach continuously, a few drops at a time.
  • There may be a need for additions to the breastmilk, depending on the baby’s levels in the blood. It is possible to add vitamin D, phosphorus, calcium, even human protein (albumin) and human milk fat (from a breastmilk bank) to the baby’s milk without using fortifiers. If the baby doesn’t need fortifiers, then fortifiers actually should be considered diluters since they decrease the concentration of all those elements that make breastmilk special and unique.

3. Premature babies cannot go to the breast until they are at 34 weeks gestation
This is simply not true. Work in NICU’s friendly to breastfeeding, especially in Sweden, have shown that babies can start taking the breast even by 28 weeks gestation and many are able to latch on and drink milk from the breast by 30 weeks gestation. Indeed, some babies have gotten to full breastfeeding by 32 weeks gestation. This means breastfeeding, not receiving breastmilk in a bottle or tube in the stomach. With Kangaroo Mother Care and early access to the breast, it can be done elsewhere as well. 

Of course, every baby is different and some babies may take longer depending on whether they were sick with respiratory problems or other issues, but waiting until the baby is 34 weeks gestation before trying the baby on the breast is using the bottle-fed baby as the model for infant feeding.

See the following articles or refer your doctor to them: 
Nyqvist K. The development of preterm infants’ breastfeeding behavior. Early Human Development; 1999;55:247–264
Nyqvist K. Early attainment of breastfeeding competence in very preterm infants, Acta Pædiatrica 2008;97:776–781
4. Mothers of premature babies need to use nipple shields to get their babies latched on well and getting milk well
This is certainly not true most of the time from my experience in Africa (actually, we never used nipple shields in Africa) and the experience of the NICU’s in other countries such as Sweden. The second article by Nyqvist had babies born as small as 26 weeks gestation and up to 31 weeks gestation and only a small minority ever used a nipple shield. Yet, unlike what happens generally in North American NICU’s from which very few babies leave the hospital breastfeeding (at best they are getting breastmilk in the bottle and frequently the mother is not putting the baby to the breast), almost all the babies actually left the hospital breastfeeding. 

The key is to take time to get the baby to take the breast well. This does take extra time compared to using a nipple shield with the mother, but in the long run the result is worth it. Nipple shields eventually lead to a decrease in the milk supply which makes getting off the nipple shield very difficult (see the information sheetThe Baby Who Does Not Yet Latch On).

The way to get the premature baby latched on is not essentially different from the baby who was born at term. See the information sheet When Latching and the video clips at the website nbci.ca. These video clips do not show premature babies but the principles of a good latch are the same.

5. Premature babies need to learn to take a bottle which teaches them how to suck
Well, I don’t know what to say about this. It’s just not true. Premature babies can learn to suck without getting bottles as shown, once again, from experience elsewhere in the world. Too often, mothers and babies are hurried out of hospital with the “advice” that the baby will be discharged earlier if he starts taking a bottle. This is not a way to help the mother and baby. In any case it would not be true that the baby needs a bottle to learn. Kangaroo Mother Care and getting the baby to the breast before the “magic” 34 weeks gestation would do a lot to avoid this situation. Furthermore, as different muscles are used when bottle-feeding vs. breastfeeding, bottle-feeding ‘teaches’ baby poor sucking skills and these can sometimes be extremely difficult to ‘unteach’.

6. Premature babies get tired at the breast
This is believed to be true because babies, not only premature babies, tend to fall asleep at the breast when the flow of milk is slow especially in the first few weeks. The baby is given a bottle and because the flow of milk is rapid, the baby wakes up and sucks forcefully. The false conclusion? The baby tired out at the breast because it’s hard work and the bottle is easier. 

Premature babies often do not latch on well, partly because we teach latching on so poorly. With a good latch, the use of breast compression and, if necessary, using a lactation aid at the breast to supplement if necessary, the baby will get good flow and not fall asleep at the breast. Get that flow increased and you will see that breastfeeding is neither difficult for the baby nor tiring for him.

7. Test weighing (weighing the baby before and after a feeding) is a good way of knowing how much milk the baby got at a feeding
Test weighing presupposes that we know what a breastfed baby is supposed to get. How can we know since the rules that say a baby of this weight and this age should get x amount of milk are based on babies fed formula by bottle? And how can we say how much the baby would have gotten if he had been well latched on, with the mother using compression, especially if the breastfeeding is limited to a particular time or schedule like 10 or 20 minutes (because of the concern that the baby will tire out)?

The best way to know if a baby is getting milk well from the breast is to watch the baby at the breast. See the video clips at the website nbci.ca.

8. Premature babies need to continue getting fortifiers once they leave hospital
This is a relative new wrinkle in the undermining of breastfeeding the premature baby. Perhaps someone presented a paper at a conference that showed the baby gained better if the fortifiers were continued even after his discharge from hospital. But, again, more is not necessarily better and breastfeeding is more important than more weight gain, which is not necessarily good. See the information on fortifiers above.

Premature babies and their mothers run into breastfeeding problems much more frequently than do babies born at term. But these can be fixed. Get good hands on help as soon as possible. See also the following information sheets:

When Latching
Protocol To Manage Breastmilk Intake
Sore Nipples
Candida Protocol
Lactation Aid
The Baby Who Does Not Yet Latch On


Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
maggiemom2000
by Ruby Member on Sep. 16, 2012 at 11:16 AM

Watch this video on bringing in a milk supply with the pump when baby is in the NICU. Lots of really good info!!

http://newborns.stanford.edu/Breastfeeding/MaxProduction.html

thedathree
by on Sep. 16, 2012 at 3:48 PM
thanks everyone!
thedathree
by on Sep. 16, 2012 at 3:50 PM
Quoting maggiemom2000:


thanks for all the info. I.know ita a possibility but the hospital probably wont assist much with actual feeding just pumping. so I want to be prepared and have a plan just incase.
Nicolle_09
by Silver Member on Sep. 16, 2012 at 4:49 PM

fight for your babies right to breatfed. you are the mother, you are their boss. if the doctors and nurses fight you on it go above their head. Tell them that when baby starts bottle you WILL be trying to nurse before each bottle. If they dont listen to you then report them to the higher ups

Two preemies here and two NICU stays I know the struggles and fighters 

Quoting thedathree:

Quoting maggiemom2000:


thanks for all the info. I.know ita a possibility but the hospital probably wont assist much with actual feeding just pumping. so I want to be prepared and have a plan just incase.


maggiemom2000
by Ruby Member on Sep. 16, 2012 at 6:33 PM


Quoting Nicolle_09:

fight for your babies right to breatfed. you are the mother, you are their boss. if the doctors and nurses fight you on it go above their head. Tell them that when baby starts bottle you WILL be trying to nurse before each bottle. If they dont listen to you then report them to the higher ups

Two preemies here and two NICU stays I know the struggles and fighters 

Quoting thedathree:

Quoting maggiemom2000:


thanks for all the info. I.know ita a possibility but the hospital probably wont assist much with actual feeding just pumping. so I want to be prepared and have a plan just incase.


You can also demand no bottles, or at least no bottles when mom is present. That is what I did with mu NICU baby. I said no artificial nipples (no pacifiers or bottles) and he was breastfed when I was there and gavage fed when I was not (I was able to be there for all but 2 night feedings). The last 2 nights I allowed them to give bottles when I was not there at night.

I really had to push for more skin to skin time and to be able to breastfeed on demand, not on their stupid 3 hr schedule, but it worked!

thedathree
by on Sep. 16, 2012 at 6:57 PM
Just wondering who is higher than the doctor? they have so many rules in nicu and I know you need to be realisstic but I have a lot of faith in my baby. I think she is stronger than most her age.
gdiamante
by Group Mod - Gina on Sep. 16, 2012 at 7:23 PM

Head of the department. Then chief of staff.

There should be a hospital ombudsman or person who handles patient relations.

Quoting thedathree:

Just wondering who is higher than the doctor? they have so many rules in nicu and I know you need to be realisstic but I have a lot of faith in my baby. I think she is stronger than most her age.


thedathree
by on Sep. 16, 2012 at 7:27 PM
Quoting gdiamante:


thanks..
Nicolle_09
by Silver Member on Sep. 16, 2012 at 9:34 PM

yes what she said, and Im a CNA so if any one at the hospital tells you that you have no choice tell them you want to speak to the ombudsman or you will get legal involved. The ombudsam is the person from the state that makes sure everyone follows the rules. 

Quoting thedathree:

Quoting gdiamante:


thanks..


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