03 May 2014

Breastfeeding a Preemie - Part Two

Going home without my baby would've been horrible whether I was breastfeeding or not. After the initial first few days, my supply was at least now well established. Expressing sessions became a race to see how much I could get out, how fast I could fill the bottles, counting how many feeds' worth each session yielded. It was also a depressing reminder of the reality of the situation - I was separated from my baby boy for the majority of every 24 hours. 

I was pretty glad at this point to still be breastfeeding A - it meant I could skip some sessions with the pump in favour of feeding her instead and still keep my supply up and ever increasing. J's tummy had started swelling up the afternoon before I went home (day 3) and by the time I went to visit him on the morning of the fourth day, he was on zero milk feeds as per the doctor's instructions. They wanted to give his stomach a chance to settle and the swelling to go down without placing any strain on his digestive system. During this time he continued to receive intravenous feeds (a mix of the most important minerals & vitamins for survival). Milk feeds only resumed again 48 hours later - by this time I had built up an impressive freezer stash as I continued to express every 3 hours. I was pumping 200ml at a time - enough for more than a week's worth of feeds if the amount stayed constant at 3ml per feed. He was also under UV lights during this time as his bilirubin levels were too high (ie he was jaundiced) - this meant I went without holding him again for those two days. 

When his milk feeds resumed on day 6, it was at the previous level of 3ml per feed, administered via a naso-gastral tube (basically a tube inserted in his nose and going straight into his stomach). He was 34 weeks gestation at this point - usually the point at which they will allow you to try breastfeeding. However, the doctor first wanted to see whether he would tolerate the milk feeds now. Things finally started looking up - he was kept on 3ml for the first 24 hours and tolerated it well, thereafter feeds were increased to 5ml, 10ml, 12ml. They were checking his stomach contents before each feed to see how much was digested of the previous feed - I will spare you the glamourous details of this procedure. I was able to hold the syringe with milk (that fed into the nasal tube) a few times at this time - indirectly feeding my little boy with the milk he was born to drink for the first time. 

Once it was clear that J was tolerating the milk feeds well, they started increasing the quantities given to him quite rapidly, until he was on so-called full feeds (40ml every three hours) by about day 9/10. 

The next morning I went to go visit J again and managed to catch the doctor on his rounds. He casually asked whether I'd put J to the breast yet - um, no, I was waiting for the go-ahead from him! When he uttered those next words: "you should probably start trying today then", I very nearly kissed him. J being able to get milk without any need for tubes was literally the only thing still keeping him in the NICU. Getting him to latch and practising breastfeeding directly from the source was a big step forward to getting him home. 

J's first latching attempt
He latched like a pro on that first attempt on day 11, but the next few attempts were hit and miss. I was encouraged to put him to the breast for every feed that I was present for. With the 3-hourly schedule the NICU ran on, this meant we could practice bfing only two, sometimes three times a day as I was there from 8 to 1 and again in the evening after A was asleep (if she played along!). It was quite frustrating coaxing J to latch on each time - sometimes he just didn't get what he was supposed to do. 

After bfing I had to give him a top-up of expressed milk via cup to avoid nipple confusion. I found cup feeding quite difficult to get right without spilling half the milk down J's clothes, but I pressed  on. I would do anything to get him home at this point and if it meant he could come home on the virtue of me being able to get milk into him via a cup, well so be it! For this same reason I didn't argue when the doctor recommended we add some human milk fortifier to my expressed milk. Secretly I hated it, but it meant picking up more weight and weight gain reduces NICU time. I also hated the 3-hourly feeds (I was used to demand feeding with A, so watching the clock was a pain), but I resigned myself to playing by their rules. 

Rooming in with J at the hospital, the day before he came home
I figured if everything went according to their schedules, he would get to come home sooner. And once home I could follow my instincts. I was right - four days later the doctor was confident enough in my ability to feed J (whether by breast or by cup) that J was due to be released from hospital the next day! I spent the last 24 hours of his hospital stay rooming in with J - breastfeeding with top-ups via cup after each feed. His weight gain was great, so there was no need to add any more fortifier to my milk at this point.

On day 16 we could finally bring J home. And boy was I keen to get rid of that damn cup!

{In case you missed it; Breastfeeding a Preemie - Part One}

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