Breastfeeding a premature baby – the most UN-natural thing in the world
This blog will follow the long, tiring and emotional journey I took to finally be able to breastfeed my premature baby. This is an educational blog (a long-winded one at that!) and won’t suit everybody, but feel free to read on and learn something new! For those that are going through something similar and have found my blog by scouring the internet in a hot mess, don’t check yourself into crazy-town just yet. I hope this makes you feel less alone and that it even gives you some reassurance, or at the very least, gives you the strength to run a brush through your hair!
When I fell pregnant, my heart was set on breastfeeding. I knew the importance of immediate skin to skin contact with my baby at birth in promoting this connection, and it was something I had been looking forward to well before conception – a precious moment in time where I would meet my little bundle and establish a bond that would last a lifetime. My experience was quite the opposite. When James was born at 30 weeks, I was unconscious. He was whisked away for emergency medical treatment and I didn’t get this once in a lifetime experience until he was about 19 hours old. But I won’t let anyone tell me that it meant any less. That first moment when I held my tiny little miracle on my chest signified something different – courage, protection and hope. I was his armour and he was mine. Breastfeeding was the furthest thing from my mind.
Nevertheless, just 4 hours after James was born (while I was still groggy AF), a midwife taught me how to manually express my breastmilk so that James was given the best nutrition possible. I was told not to expect much due to the circumstances of his birth – it was rare for mothers in my position to produce much breastmilk. On first try I squeezed out (yes, literally) a mere 3mls of colostrum, but was told this was incredible! The feeling of accomplishment was overwhelming. In a time when I felt utterly helpless, this was the one thing only I could do to help nurture my baby. From day one, James was exclusively fed my breast milk through a feeding tube – there was no bigger motivation. I threw everything into this and began expressing every 3 hours around the clock. Against all odds, my supply was one of the best the nurses had seen.
Not surprisingly, my first piece of ‘been there, done that’ raw advice is this: spend as much time in the beginning (every waking hour if possible!) at the hospital with your miracle, and enjoy as many skin to skin cuddles as possible. This was really healing for me and I believe it dramatically triggered my milk supply and let down. Let bubs nuzzle near your breast while he is being fed through his tube. I once had a beautiful nurse I had never met come up to me as I was sitting reading to James beside his cot. She put her hand on my shoulder, acknowledged how often I was by his side and assured me it was the reason James was doing so well. It was a moment I will never forget.
My first attempt at breastfeeding James was at 32 weeks. Again I was told not to expect much as the suck-swallow reflex normally only develops at 35 weeks gestation. But James was organised and had apparently done his research! He latched on straight away and managed 10 sucks before tiring. Initially we tried once a day, and it was very brief. This did not replace his tube feeds, but was a learning experience for us both and a huge step in the right direction. At 33 weeks, James was attempting two breastfeeds a day and was sucking for 20-30 minutes, meaning he no longer required full tube feeds at these times. After a breastfeed, the nurses would come in and ask me how he went and if he needed a ‘top up’. I remember thinking ‘I love you girls, but how the hell do I know?!’ It was not only impossible to judge, but also such a huge responsibility (if anyone is clever enough to invent a gauge to measure how much breastmilk a baby gets per feed, let me know – I will steal it and make millions!) Above all, I – almost obsessively – had the importance of his growth in the back of my mind. Of course I wanted to trust that the breastfeed was enough and all he needed, but I couldn’t. James didn’t have the same strength as a newborn. I had no idea whether he was full, or just tired. I would constantly second guess myself and would opt to give him a top up no matter how well I thought he had fed – I didn’t want to be the reason he didn’t put on weight that day!
But at 34 weeks, our doctor told me to have faith in my breastfeeding (that easy, right?!) and we stopped giving James the extra milk. James kept putting on weight and I continued to breastfeed twice a day until we were discharged at 35 weeks on the Neonatal Early Discharge (NED) program. This allowed us to take James home on tube feeds with regular visits to the hospital until he had transitioned to complete breast/bottle feeds. When we went home, we had to wake James for feeds otherwise he would have slept right through them – he was not mature or strong enough to demand feed at this stage. This of course makes it difficult for your baby to learn when he is hungry! But during those first couple days at home, James impressed us beyond belief. There were times when he wouldn’t wake enough (if at all!) to suck and we would have to feed him through his tube, but after only week at home, we were able to wean James off tube feeds completely, and he was strong enough to breastfeed exclusively. For the first time I finally felt like an ‘actual’ Mum who could provide completely for her baby.
Unfortunately, my optimism was short lived. When we went back to hospital for his next check, James had lost 40g. I received mixed reviews from the midwives on his weight loss. One made me feel extremely guilty and suggested my breastfeeds weren’t enough and I was expecting too much of James at this early stage. She recommended I breastfeed James but always top him up with a bottle after, and even suggested giving him a break and purely bottle feeding him once or twice a day. Another was very reassuring and said it is completely normal for babies to lose weight during an adjustment period like this. She suggested I continue to trust my breastfeeding and see what James’ weight was doing at the next visit. Either way, James was no longer requiring the feeding tube and it was removed. This was such a memorable and heart-warming moment in James’ journey, and to this day I still feel upset that it was slightly tainted by the guilt I was made to feel for his weight loss.
My second piece of advice: Take the opinions of others with a grain of salt. I know premature babies don’t give signs and it’s therefore difficult (ok, impossible) to ‘read’ their cues, but don’t let anyone instil doubt in yourself as a Mum – I’m sure you’re already feeling inadequate enough. A premature baby is a-whole-nother ball game to a newborn. And even those who are professionals in their field can have power trips and not necessarily think of the consequences of their words. A mum of four -the biggest expert in my eyes! – once said to me ‘take little pieces of advice from everyone, put them together and find what works for you’. I cannot agree enough.
I left the hospital that day feeling completely deflated. I felt an enormous pressure (along with an underlying responsibility) for James to gain weight. I remember feeling whole-heartedly to blame and I consequently lost a huge amount of confidence in myself. We decided to take a little bit of advice from both midwives and I continued to breastfeed James, but would top him up with a bottle if I felt the feed wasn’t very successful. This process was extremely tiring. I would attempt a breastfeed, top him up with a bottle and then express the excess to prevent mastitis. And then I would do it all over again about an hour later!
Just as I began to feel more at ease, James became very fussy when feeding and would have trouble latching on and staying on. I soon realised that my huge supply (which was meant to be such a blessing) was causing him a huge amount of grief. I’ll never forget the time when James was choking and spluttering that I took my nipple out of his mouth and milk literally sprayed him in the face with the force of a fire hydrant! And it didn’t stop there – I was constantly dripping and would wake up in the middle of the night with a wet top and bed sheets! My supply was too large and too fast for the little guy to handle. People would say ‘oh you’re so lucky having such a good supply’, and I was! But an oversupply can sometimes be as much trouble as a low supply (honestly, before you hate on me, google it!)
James soon became frustrated at the breast – he was gulping air and clawing at my chest. He would arch his back and pull his legs up in pain. I was lucky to get him attached to the breast at all. If he did, it would be a painful experience for both of us. There were the odd times when James would breastfeed like a pro and it was such a rewarding experience. But mostly I would sit at home in James’ nursery (with everything I ever wanted) crying helplessly because he wouldn’t feed. Scott remembers driving home from football training one night feeling physically sick with unease wondering how James had fed and if he would walk into a blissful calm or a blubbering mess. No shit, I would either be a glowing smile with a face attached or a chaos of puffy redness. It was so hit and miss, there was no happy medium, and it was causing a huge amount of suffering for all of us.
After a few days of tears and anguish, James became so uncomfortable with wind and reflux that I had resorted to full bottle feeds. His relationship with the breast had become an unhappy one, and I couldn’t bear to see him in pain. It was the final straw; I just couldn’t do it. The stress was eating away at me (literally!) and I was convinced it just wasn’t meant to be. It immediately became obvious that James was a much happier baby on bottle feeds. He was able to feed upright, we could control the flow and he wasn’t gulping air in frustration. He was comfortable, he settled easily, and it wasn’t as hard or as stressful on either of us. We knew exactly how much milk he was getting, and we knew it was enough. Looking back, it was without a doubt the best thing for all of us at the time. The silver lining was he was still getting my breastmilk. I almost talked myself into thinking that this was what I wanted. But in all honestly, I felt like a failure.
My next piece of advice: do what is best for your baby (and you). Most of the time these go hand in hand. The ‘best’ might not always be breast and it might not be what you had hoped, but it could also send you bat-shit crazy. Who knows, the alternative might only be temporary. Keep expressing and try again down the track…or don’t. The bonus? It is your decision! You are not a failure. Stop beating yourself up over it. You are a Mum who has had a tough enough bloody time as it is!
Our next visit to hospital confirmed what we had suspected – James was thriving and had gained 100g in just 2 days. We were officially discharged from the care of the Women’s and Children’s Hospital and referred to Child & Youth Health for home visits. I had regrettably accepted that I wouldn’t be breastfeeding and continued to express my breastmilk for bottle feeds. However, a lovely midwife visited 9 days later and (shock horror!) suggested I try one more time to breastfeed now that James was stronger. I was either stubborn or stupid – or both – and began the process of breastfeeding, bottle top ups and expressing all over again. Things didn’t go well initially and I thought ‘why the eff am I doing this to myself?!’, which is probably what you’re all thinking right now! In addition to all of the previous issues (which hadn’t magically disappeared), James had become accustomed to the bottle and was lazy at the nipple – he wasn’t all that interested and just ‘gave up’ after 5 minutes, only to smash a bottle minutes later. Talk about disheartening.
Then came my last-ditch effort – I know right, give up already! But I wanted to know I had tried everything before finally admitting defeat. My oversupply was an issue, so I started reading articles on how to reduce it. I stopped expressing so frequently, and only long enough to relieve the ‘lumps and bumps’ and feel comfortable. I researched conservative ways to ease the discomfort of his reflux, and tried nursing in different positions. I used wind drops and massage at every nappy change, and we introduced daily baths. I asked for advice from my friends who are Mums and even called the breastfeeding helpline. Then, wait for it….my lovely sister-in-law had a stroke of genius and suggested I tried using a nipple shield. Man these things aren’t glamorous, but James latched on immediately, sucked strongly for 30 minutes and drained a boob. He didn’t fuss, he was comfortable and he didn’t even need a top up. What was the secret? James didn’t have to work so hard, it was similar to a bottle teat, it was easier for him to latch and it slowed the speed of my flow. We haven’t looked back; and from this day, our breastfeeding relationship has been a happy and successful one. While I feel as though that was a huge anticlimax, it’s the honest truth. In the end, after all the heartache, this annoying and inconvenient thin piece of flexible silicone was our saving grace!
My final piece of advice: as difficult and as tiring as it is during one of the toughest times of your life, if your heart is set on breastfeeding, try different things with the intention of fixing the root of the problem. I didn’t want to express, I don’t enjoy using the nipple shield and I really don’t like the idea of giving James reflux medication. But trial and error is fundamental, and at some point (hopefully before turning grey) you will find something that works.
This is my story, and I can only hope that you don’t have to try this hard to achieve ‘the most natural thing in the world’. But for me, breastfeeding was the hardest part of taking home our premature baby. If a prem baby doesn’t have a good breastfeed, it’s not as easy as saying ‘ok he’s not hungry’ and putting him back to sleep to wake when he is – because he won’t! You can’t assume he’s full, even after a 30-minute feed. You don’t have the luxury to experiment – his one goal right now is to grow. You have no clues to ‘read’, I mean, the little guy doesn’t even cry yet! You question everything, but you will never get an answer. Your confidence will be sky high, and then you will hit rock bottom. You will be given advice from every man and their dog and it will be conflicting, and you will want to punch some of them square in the fanny.
We still have our moments – James loves a good comfort suck and doesn’t always (actually, ever!) pull off when he’s full, he over-eats to the point of vomiting and he has his ‘witching hour’, or 3! I still have days (like today) where I think giving up would be easier. And it probably would be! But I wouldn’t change it for the world, and I am so relieved that I was stubborn, or stupid…or in my Mum’s eyes – determined.
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Hello,
Oh dear lord as I relate to this and I am so in the thick of this right now. My little lady was born at 30+3, she is now 37+5 and we are trying to establish breastfeeding. I thought we were going well this week using a shield, swapping two tube feeds and halving one whilst I was at the hosptial and then yesterday she was super lethargic and disinterested and it set us back ages because we were back to the ‘how much should be top up questions’ and like you I felt like ‘I HAVE NO IDEA’ – then there is the judgy looks when they are seeing if she is breastfeeding and it is like they are thinking you are making it up that they are sucking or that you think you are BF but actually just kidding yourself.
I feel I am going to be pushed into bottle feeding because of it and I don’t know how we would go to that and then back to breast. Also she is struggling to get her final stage of oxygen sorted and to stop desating particularly when she is feeding which makes the whole process even worse. I am currently so down and constantly crying or on the verge of about it all. I pray she will be ok and one day we can have her home and breastfeeding.