19 May 2014

Breastfeeding a Preemie: Part Three


When we finally got to take J home on day 16, I was over the moon. Finally I could take care of my own baby and play by my own rules, without interference from others. But still, there was the fact that he was still only 35 weeks gestational age to contend with. Much as I wanted to immediately switch to on-demand feeding, it just wasn't possible as J would probably sleep for hours on end if I didn't wake him up. 


I did change one thing immediately though - I ditched the pump. I had more than enough expressed milk still in the freezer to use as top-up after each feed, it wasn't necessary for me to continue pumping. Plus, my rigorous pumping routine had resulted in an oversupply - my poor breasts looked like melons and were uncomfortably full most of the time. I knew I had to just breastfeed my kids to allow my supply to regulate. 

Each breastfeeding session was quite a mission, especially those middle of the night sessions. It would usually take a good 10 - 15 minutes just to wake J up, then he would latch - sometimes straight away, but most times it took another 5 - 10 minutes of coaxing for him to cooperate. Once he was latched, he drunk quite well - I could see and hear him swallowing, but there were many times where he fell asleep again almost as soon as he had begun. And then I would have to struggle to keep a half-asleep baby upright in order to feed him some expressed milk via cup. 



It was frustrating and on some level I felt embarrassed (ashamed?) that I had to give top-ups, that he couldn't just get everything he needed from my breasts. This was new territory for me and I didn't like it one bit. I started to notice a pattern though - the less milk J got via cup during the previous feed, the more awake he would be during the next feed. More awake means more efficient latching, sucking and swallowing and less need for top-up during that feed. 

I decided to trust my body, trust my boy and stop the top-ups after the third day home. I continued to monitor his diaper output - all good, which assured me he was getting enough to drink. He was more awake during each feed and best of all, he even started waking up on his own for some feeds. A week after J's release from hospital we had a follow-up appointment with his pediatrician. He checked his weight gain and declared it to be just slightly short of ideal and wrote out a prescription for human milk fortifier - which I was supposed to add to two of his feeds every day. This would mean that I'd have to feed him expressed milk again - either via cup or bottle. 

Given the doctors scale wasn't super precise and that the calculated weight gain was just 2g a day short of the 'ideal', we decided to not go the milk fortification route, but instead I fell back on the basics of breastfeeding. More frequent feeding equals more milk - both in terms of supply and in terms of the amount baby is getting. And if baby is getting more milk, it must lead to weight gain.


 I changed my alarms to wake J every 2 - 2.5 hours during the day (I stuck to the 3 hourly regime at night though) and again monitored his diaper output. From everything I could see, things were going well, but when you are the parent of a preemie you've been trained to focus on numbers, so I was anxious to take him to the closest pharmacy to get weighed and get confirmation that I was doing the right thing. I didn't need to worry - J picked up 400g over the course of the next two weeks. 

By that point he was considered full-term (37 weeks) and I noticed that I didn't really need to wake him up anymore - he was waking on his own when he was hungry and finally we were feeding on demand. He was also latching perfectly every time. Huge sigh of relief! Funny how something so small that most people take for granted (myself included with A), felt like such an accomplishment this time around. From there, J's weight gain really took off, ranging between 300g and 600g a week. Average weight gain for a breastfed newborn is 200g a week, but when your baby is born premature, your milk automatically adapts to be more calorie dense. Isn't that amazing? 

And it's because of this amazing design detail of the human body, that I am now proud to announce that, just a few days short of 3 months old, J is exactly average weight for his actual age, and off the charts in terms of weight for his adjusted age (1 month old). 

We've made it. We really and truly have. 

Happy J at almost three months old
In case you missed the previous two instalments of my breastfeeding journey with J: 

Breastfeeding a Preemie - Part One
Breastfeeding a Preemie - Part Two

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