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Old 10-03-2010, 08:16 PM   #1
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Breastfeeders! I need some info!

My cousin had her baby early and the baby is only about 4 pounds and 16 inches long. I think her due date was November 5th. They told her that the baby would be burning too many calories to nurse, which I get but her milk isn't in yet and she had her on the 24th!

How often should she be pumping and how often can she go sit with her baby at the hospital? They let her stay for a very short time and then make her leave. This is her first baby... HELP!

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Old 10-03-2010, 09:02 PM   #2
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Re: Breastfeeders! I need some info!

My BBF had an early baby on Sept. 28th and she is allowed to stay as long as she wants. They have her pumping ever 2 hours. The baby is getting preemie formula along with her BM beacaus she's not making that much yet. Her baby was born at 32 wks gestation. Her last baby was born at 28 wks gestation and she did the same thing.

When I was having nursing problems after DD was born the LC told me to pump every 2 hours also and to not go more than 5 hours at night.

I've heard that it takes awhile for your milk to come in after the birth of a preemie. I hope that what I said help. I don't really have personal experience wtb this.

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Old 10-03-2010, 09:05 PM   #3
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Re: Breastfeeders! I need some info!

First, the idea that the baby uses too much energy to nurse as opposed to bottle-feed is disputed by a recent study. You may wish to share this with her.

http://www.ncbi.nlm.nih.gov/pubmed/19933725
Berger I, Weintraub V, Dollberg S, Kopolovitz R, Mandel D. Energy expenditure for breastfeeding and bottle-feeding preterm infants. Pediatrics. 2009 Dec;124(6):e1149-52.

OBJECTIVE: We hypothesized that resting energy expenditure (REE) would be higher after breastfeeding than after bottle-feeding.

METHODS: Nineteen preterm infants (gestational age: 32 weeks) in stable condition who were nourished entirely with their mothers' breast milk were assigned randomly to feeding either by bottle or at the breast. Each infant served as his or her own control subject. REE was measured for 20 minutes after feeding. Breast milk quantity was evaluated with prefeeding and postfeeding weighing. REE values for bottle-feeding and breastfeeding were compared with paired t tests.

RESULTS: Contrary to our null hypothesis, the group's mean REE values after bottle-feeding and breastfeeding were very similar (284.7 +/- 26.8 kJ/kg per day [68.3 +/- 6.4 kcal/kg per day] vs 282.6 +/- 28.5 kJ/kg per day [67.5 +/- 6.8 kcal/kg per day]; not significant). The duration of feeding was significantly longer for breastfeeding than for bottle-feeding (20.1 +/- 7.9 vs 7.8 +/- 2.9 minutes; P < .0001).

CONCLUSION: There was no significant difference in REE when infants were breastfed versus bottle-fed. Longer feeding times at the breast did not increase REE. We speculate that it is safe to recommend feeding at the breast for infants born at >32 weeks when they can tolerate oral feeding.


Another useful document might be the Academy of Breastfeeding Medicine's protocol for Breastfeeding the Near-Term Infant: http://www.bfmed.org/Resources/Downl...rotocol_10.pdf
which encourages immediate and extended skin-to-skin contact.

I know that many people, especially with their first, are just inclined to do what the docs and nurses say, but it doesn't sound like they are being supportive of breastfeeding for her. I would encourage her to seek out other resources for opinions. Perhaps the hospital has a lactation consultant (I don't mean a nurse who took a 2 hour class and calls herself an LC either, I mean a real IBCLC) who can help.
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Old 10-03-2010, 11:07 PM   #4
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Re: Breastfeeders! I need some info!

DS was 32 weeks and I pumped every 3 hours round the clock after he was born. I started getting a little colostrum the next day (which is great stuff for baby and can be mixed with the formula). My milk came in after 2 days. After it came in I pumped every 3 hours during the day and didn't go longer than 5 hours or so at night until DS came home from the NICU.
Nine days seems like a a long time for milk to come in...Is she getting any colostrum at all? Does she have a hospital grade pump? I second the suggestion that she get the help of a good LC.
When DS was in the NICU I could go there anytime except 30 min before/after shift change twice a day. I could stay as long as I wanted to although I believe that they did say if there was an emergency situation with one of the preemies they might have to ask us to leave. However, at the beginning I usually only help DS for 10 minutes or so because they didn't want him to get tuckered out and when he was under the bili light he couldn't be out of his isolette for too long. So perhaps there are medical reasons that your cousin can't hold the baby for too long, but she should be able to sit in the NICU more or less as long as she wants. I never saw any of the NICU staff telling a parent to leave
Also, my DS got his formula/EBM through a gavage (tube in his nose that went into his stomach) because he was to weak to suck for long at the breast or bottle. So with a gavage the baby doesn't have to exert any energy to get fed, so in this case it would be easier than breastfeeding. The doctors and nurses at my NICU said that breastfeeding is actually easier for preemies and uses less energy that bottlefeeding (because it is hard for them to slow the flow of milk from a bottle nipple where as they can get the milk as slowly as they need to at the breast).
Another thought...kangaroo care is highly recommended for preemies and facilitates BFing for preemie mamas.
I have a couple of good books on preemies. The Sears one and another one too. If your cousin is interested I could send them out FFS. PM me and LMK!
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Old 10-04-2010, 03:01 AM   #5
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Re: Breastfeeders! I need some info!

My friend had her twins at 28 weeks and started pumping ASAP every 3 hours. All day every day for the 10 weeks until they came home. She was only able to see and hold the girls during their feedings, but her and her DH were able to do Kangaroo care (her after 3-4 days, him after they were a week old) during them. After about 6 weeks they were able to try BF one feeding a day, until they were able to go home when all feedings were from the bottle/breast. They did mix the breast milk with formula so the girls would get more calories.
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Old 10-04-2010, 07:43 AM   #6
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Re: Breastfeeders! I need some info!

Quote:
Originally Posted by Selene View Post
DS was 32 weeks and I pumped every 3 hours round the clock after he was born. I started getting a little colostrum the next day (which is great stuff for baby and can be mixed with the formula). My milk came in after 2 days. After it came in I pumped every 3 hours during the day and didn't go longer than 5 hours or so at night until DS came home from the NICU.
Nine days seems like a a long time for milk to come in...Is she getting any colostrum at all? Does she have a hospital grade pump? I second the suggestion that she get the help of a good LC.
When DS was in the NICU I could go there anytime except 30 min before/after shift change twice a day. I could stay as long as I wanted to although I believe that they did say if there was an emergency situation with one of the preemies they might have to ask us to leave. However, at the beginning I usually only help DS for 10 minutes or so because they didn't want him to get tuckered out and when he was under the bili light he couldn't be out of his isolette for too long. So perhaps there are medical reasons that your cousin can't hold the baby for too long, but she should be able to sit in the NICU more or less as long as she wants. I never saw any of the NICU staff telling a parent to leave
Also, my DS got his formula/EBM through a gavage (tube in his nose that went into his stomach) because he was to weak to suck for long at the breast or bottle. So with a gavage the baby doesn't have to exert any energy to get fed, so in this case it would be easier than breastfeeding. The doctors and nurses at my NICU said that breastfeeding is actually easier for preemies and uses less energy that bottlefeeding (because it is hard for them to slow the flow of milk from a bottle nipple where as they can get the milk as slowly as they need to at the breast).
Another thought...kangaroo care is highly recommended for preemies and facilitates BFing for preemie mamas.
I have a couple of good books on preemies. The Sears one and another one too. If your cousin is interested I could send them out FFS. PM me and LMK!


DD was a 4 lb. 34 weeker. I pumped every 3 hours while she was in the NICU. They allowed me to nurse her whenever I was there, for as long as I was there.
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Last edited by natmarie6; 10-04-2010 at 07:45 AM. Reason: typo
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Old 10-04-2010, 07:52 AM   #7
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Re: Breastfeeders! I need some info!

Yeah, I don't see how breastfeeding or bottle feeding would expend more energy than the other. If she's so small and has a poor suck reflex, they may be just giving the baby tube feedings, or a combination of tube feedings and bottle feedings.
DD1 was 4 weeks early and had a poor suck reflex. I couldn't get her to nurse very easily, and I pumped and gave her syringe feedings of colostrum for the first few days. Then I ended up giving her pumped breast milk for about 6 weeks until I finally got her latched on correctly.

Quote:
Originally Posted by CEVmommy View Post
First, the idea that the baby uses too much energy to nurse as opposed to bottle-feed is disputed by a recent study. You may wish to share this with her.

http://www.ncbi.nlm.nih.gov/pubmed/19933725
Berger I, Weintraub V, Dollberg S, Kopolovitz R, Mandel D. Energy expenditure for breastfeeding and bottle-feeding preterm infants. Pediatrics. 2009 Dec;124(6):e1149-52.

OBJECTIVE: We hypothesized that resting energy expenditure (REE) would be higher after breastfeeding than after bottle-feeding.

METHODS: Nineteen preterm infants (gestational age: 32 weeks) in stable condition who were nourished entirely with their mothers' breast milk were assigned randomly to feeding either by bottle or at the breast. Each infant served as his or her own control subject. REE was measured for 20 minutes after feeding. Breast milk quantity was evaluated with prefeeding and postfeeding weighing. REE values for bottle-feeding and breastfeeding were compared with paired t tests.

RESULTS: Contrary to our null hypothesis, the group's mean REE values after bottle-feeding and breastfeeding were very similar (284.7 +/- 26.8 kJ/kg per day [68.3 +/- 6.4 kcal/kg per day] vs 282.6 +/- 28.5 kJ/kg per day [67.5 +/- 6.8 kcal/kg per day]; not significant). The duration of feeding was significantly longer for breastfeeding than for bottle-feeding (20.1 +/- 7.9 vs 7.8 +/- 2.9 minutes; P < .0001).

CONCLUSION: There was no significant difference in REE when infants were breastfed versus bottle-fed. Longer feeding times at the breast did not increase REE. We speculate that it is safe to recommend feeding at the breast for infants born at >32 weeks when they can tolerate oral feeding.


Another useful document might be the Academy of Breastfeeding Medicine's protocol for Breastfeeding the Near-Term Infant: http://www.bfmed.org/Resources/Downl...rotocol_10.pdf
which encourages immediate and extended skin-to-skin contact.

I know that many people, especially with their first, are just inclined to do what the docs and nurses say, but it doesn't sound like they are being supportive of breastfeeding for her. I would encourage her to seek out other resources for opinions. Perhaps the hospital has a lactation consultant (I don't mean a nurse who took a 2 hour class and calls herself an LC either, I mean a real IBCLC) who can help.
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Old 10-04-2010, 07:54 AM   #8
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Re: Breastfeeders! I need some info!

My nephew was born 32 weeks and they let my sister stay as long as she wanted to. I think that is awful that they won't let her stay. Unfortunately the breastfeeding thing did not work out for her.
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Old 10-04-2010, 08:00 AM   #9
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Re: Breastfeeders! I need some info!

If her milk hasn't come in, she should be seeking out an IBCLC and definitely pumping every 2 hours. If mine hadn't come in, I wouldn't be going more than 3 to 4 hrs at night either. Use some herbals to help bring it in, fengreek, More Milk Plus, brewers yeast.

As for being in the NICU, I second what everyone said. If the baby is under billi lights then the time she can hold baby will be short, but only for a few days. Other than that, she should be able to be there as much as she wants with the exception of shift changes and a possible emergency within the unit.

As for breastfeeding v. bottle, if baby can bottle feed, baby can breastfeed. However, having a baby in the NICU is like having your baby in prison. It's horrible. Some are definitely better than others. But, generally, they are very, very picky about feeding (and everything). Some are more pro-breastfeeding than others. You definitely can and should argue your case and present facts to the drs. Unfortunately, you are basically at their mercy. It shouldn't be that way, but me and almost every I know has had that experience. You do what you can and just be thankful the NICU is there at all. One thing she definitely can do is work to get her milk in and make sure baby is getting as much BM through the feeding tube or bottle as possible. Most NICU's will "fortify" the BM, meaning add formula too it in order to bump up the calories, but they will give the baby BM if you provide it. Keep asking the nurses/drs when she can nurse the baby. I found that I was allowed to do things but if I hadn't asked, they wouldn't have offered and I would have never known. Nurse baby when you can, but the key is to make sure you get your milk in. Not all, but most babies can be transitioned to the beast when they are finally released.

Congratulations on the new baby in the family! Good luck to her!
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Last edited by HeatherlovesCDs; 10-04-2010 at 08:04 AM.
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Old 10-04-2010, 04:37 PM   #10
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Re: Breastfeeders! I need some info!

And not 100% BF related but if she should also look into doing kangaroo care

http://www.prematurity.org/baby/kangaroo.html

http://www.kangaroomothercare.com/

HTH
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