I’m writing this post for the mom I met at the end of our stay in special care. She doesn’t know about this blog, and will probably never find it, but I want to tell her that there is a reward for the dedicated. And she was dedicated. I met her briefly as our hospital stay with August was nearing its end. She was about six weeks behind me in her breastfeeding journey with her preterm son and she was frustrated. Oh so frustrated.
When I was pregnant my goal was to breastfeed. I had the support of my family and I had my sister to look up to. She breastfed her daughter until nine months when her goal was six. I know how difficult it was for her and was in awe of how she persevered. I never thought much about the health benefits. My biggest motivation was the convenience and closeness it would bring. I also never thought about how I’d feel or what I’d do if for any reason I was not able to breastfeed.
And then I had a micro preemie. My baby was whisked away to another floor of the hospital no less than ten minutes after I delivered him. It would be four more hours until I could see him again, four long days until I could hold him, and seven weeks until I could attempt putting him to breast.
My intimate breastfeeding experience started with a pump, the Medela Symphony. My breastfeeding needs quickly changed. Instead of a pillow I desperately needed a hands-free pumping bra. The lanolin was still a must, and I wanted a cover up since I soon found out critical meetings with the doctors would occur bedside while I was pumping. And of course, it was my amazing sister that showed up the next day with all of these things in tow.
Pump every three hours, they said. It’s common for mom’s under the stress of the NICU and without the closeness of their baby to have supply problems. We were given a pamphlet and asked to sign a consent that if I could not produce enough we approved the use of breast milk from the Milk Bank. August was born so early that donated milk would be covered by insurance. This is how critical breast milk is to babies this early, it protects their unfinished digestive systems. So I pumped every three hours consistently for weeks. At first it was for 15 minutes, then as directed, it was until the milk stopped. My breasts were so engorged between pumps. I was uncomfortable but knew how important is was. I desperately searched for a bra that fit to ease some of my discomfort.
And then Mastitis. I have to say that my favorite lactation consultants were the ones at the NICU, however they didn’t help spot my oversupply. I knew something was up when the nurses would nearly gasp when I handed them what I had just pumped. Turns out at my peak, which resulted in mastitis, I was pumping about twice what I would need, for a two-week old TERM baby. “A good problem to have” they all said. But my goal was to breastfeed my son when he was ready, and with a supply like that he’d be too overwhelmed. I slowly decreased pumping time, then frequency, it became a bit more reasonable, but I still struggled with engorgement discomfort and oversupply off and on until August was about 16 weeks old.
The pacifier is a very important therapy aid for premature babies. The suck reflex and act of swallowing is finessed by a baby in the last four weeks of pregnancy. It’s common for even babies born four weeks early to have some issues feeding by mouth. We worked with an occupational therapist weekly teaching August to suck on the pacifier. He wasn’t awake often, and couldn’t hold it in his mouth himself for quite some time, so during a care time we’d dip it in breast milk and hold it for him. He still uses pacifiers occasionally, but they aren’t something that stops him from crying. I’d still consider them a therapy aid, because when he’s disorganized, especially when he’s fighting sleep they give him something to focus on and seem to center him. Also, when we had reflux issues offering a pacifier after he ate helps keep the milk down.
Non-nutritive is something that hopefully most hospitals offer to mom’s who plan on breastfeeding their premature babies. Once August showed signed of rooting during meal times, and he was stronger with the pacifier, I was allowed to put him to breast after I pumped to “empty.” This is good for bonding…though looking back all this really did for me was increase my supply again. He was about six weeks old, 32 gestational weeks when I could start this. Imagine breastfeeding a three-pound baby! The NICU nurses actually let me try without pumping first when August was seven weeks old, it was pretty amazing to see, he was able to keep a latch for about three sucks.
The transition to the special care nursery ended up being harder than I thought, in ways I have never thought about. I hope to write more about that another time. I can’t say the NICU nurses didn’t warn me. The goal in special care is to get your baby feeding by mouth so they can go home. If they struggle with breastfeeding and bottles turn out to be easier, then that’s what they will do. I expressed my desire to leave the hospital breastfeeding August and I had the support of the nurse manager. But when you can’t be at the hospital 24/7 your baby ends up getting their first bottle from a nurse, not even his mom. It took us a while to get over this – but he was taking several feedings a day by mouth, and that means he was closer to coming home. I would attempt breastfeeding him when I was there, but we struggled so much. My supply was back up again,he was still learning and choking all the time.
An LC brought me a nipple shield, and told me to try that next time. At this point she had man handled me AND my baby’s head trying to get him to stay latched and I didn’t want anything to do with the LCs anymore. After two more bad days I tried it. I hated it. August loved it. It was such a pain to get on and keep on. I suddenly needed five more hands to feed him. But he was eating at breast, finally! And he was doing well enough with the nipple shield that I could finally enforce that I did not want him to be offered a bottle after nursing. This was another thing special care did. I clearly had plenty if August had the stamina to get what he needed. He wasn’t going to learn if we kept offering bottles after nursing, and at this point his average weight gain was fine. This was around 37 weeks gestational age.
It was time to choose a bottle that we’d use once he was home. He was doing ok on the hospital ones, but I wanted something to help keep the air out because of his reflux. The hospital recommended Dr. Browns bottles. We tried them a few times and it wasn’t anything special, they also have lots of parts to clean. I did my research and ended up choosing the Munckin Latch. It was designed to aid the breast to bottle and bottle to breast transition. It took about a week of the nurses using it with him at night until he was a pro.
Then I took off the nipple shield. I’d put it back on when he got frustrated. But I attribute this success to the Munchkin Latch bottle. He needed to work to get milk out of it, and the more they used that, the longer he’d breastfeed without the nipple shield, and soon we ditched it!
The frozen milk at the hospital was adding up. And since they had us freeze in bottles, I asked them to use it so I could bag what I was pumping to store at home. So they began preparing his night bottles with the frozen and he began refusing bottles! Apparently there is this enzyme in breast milk that some people have more of than others and it changes the taste of frozen milk. Just my luck. We had 45 liters of frozen milk in our deep freezer.
Donation was how I dealt with the frozen milk that August refused to drink. I was unable to donate to the milk bank because of my blood pressure medication, but I found Human Milk 4 Human Babies and I’ve been able to donate to three other moms.
40 Weeks is important. That’s when August was finally breastfeeding as if he was born to do it. When he came home just after 42 weeks gestation age we still had some issues with my over-supply and him choking. But we’ve turned to block feeding most of the time and are doing really well. I have happy tears almost every time, just thinking of how far we have come and how amazing he’s feeding. And he’ll take the frozen breast milk now! His pediatrician is also on board with our breastfeeding and dropped his added calories after he was home for jsut two weeks. His weight gain continues to be great.
Yes, this was a long post, but I wrote it in the hopes it will help other mom’s breastfeeding their preemies. We missed so much in regards to our pregnancies and deliveries that if you want to still breastfeed you should be able to. It will be harder than the average breastfeeding journey, but it’s possible. It just takes determination.