Expert: ruth kraft - 12/1/2008

Question
My daughter had twins at 32 weeks. She was hospitalized from 23 weeks till 32weeks. babies were born C-Section. They spent 5 weeks in NICU where they were gavaged, and bottle fed. My daughter made it known she wanted to breastfeed but was only given the chance 2 times. She has plenty of milk and has been pumping to supplement as Dr's orders after offering breast first. Babies have been home for  alittle over 3 weeks. They weigh 8.1 and 7.12 as of today.

Ok here's what's happening: The boy (the bigger of thetwo now) can successfully latch on and breastfeed for 5 - 15 minutes. ALthough he will not always do do. Th egirl, is hit and miss with latch on and breastfeeding. Sometimes she just refuses and we usually have to offer a bottle of breastmilk or she won't eat and will fall asleep. Will they ever get it??? I breastfed all 6 of my children (a set of twins) one of which now has these twins.

My daughter is tied to the pump and sterilizing bottles after every attempt to breastfeed because they will not nurse long enough. Th egirl sometimes also comes off the latch very easily. She will nurse when milk lets down, but not always. We have tried everything we can think of. My daughter has been awesome throughout this whole thing.

Is this a common problem with premie NICU babies?? ANd how have others overcome the breastfeeding issues of not being able to breastfeed babies for whatever reason in NICU? This makes tryig to teach them how very hard.

Any encouraging words for my daughter?? We both dread thinking that she may always have to supplement with her own breastmilk in a bottle. Will the babies get stronger and nurse longer? Is it OK to stop offering bottles after, and just try to offer breast no matter how long or short the interval?

What if one baby nursed good and the other didn't and the one that didn't is fed again soon after, but the one that did goog, is not ready to eatagain? How do we keep them on feeding schedule close to one another??

Thanks for any help anyone can give us!

Answer
ok... I am going to do my best to help here.... and I think I will be answering all the questions but if not please post a followup or e-mail me directly at honoringwomen@gmail.com.

so... the first question... will they ever get it ? yes. they will. with alot of patience and loving guidance. I also had a preemie at 32 weeks. and it was quite something getting the nurses to let me nurse. I was just very hard headed and they were very un supportive... So... with what you have now to deal with... have faith. they will get it if given enough time to get it.

Preemies are a little different in nursing rules because they are just that... preemies. most often you have to start them out bottle feeding because their latch and suck reflex is so poor that they cannot effectively pull the milk out so supplementing is possible. the things you have going gist you are that there are 2, that they have had little exposure to the breast while in the nicu, and that mom is tired and worn down.

the good news, is that she has a supportive mother, 2 young babies that are term now, and although maybe a little delayed, are unbelievably resilient. There are mothers who adopt babies at 8 months old who have never nursed , and then go on to lactate the never before nursed baby. There is hope! I PROMISE!  the good news also is, that they are attempting! and any baby that attempts can become more successful over time...

another note... your daughter doesn't have to sterilize each bottle after every feed. that will save some time... its breastmilk which has antibodies in it to kill most germs anyway. general washing and rinsing is perfectly fine to do... hopefully that will save her a step.

preemies tend to get tired quicker when eating. this is SO normal. very frustrating and hard to get used to... but they do become stronger over time... it took my daughter about 3 months, and when she got it, she got it... and she went on to  nurse for 11 months.  it took alot of persistence but it worked.
because the girl was smaller, maybe shes also a little weaker... If she nurses when the milk lets down, you may try pumping to get the milk forward enough to let down , latching her on so she gets the instant gratification and then doing breast compressions ( squeezing the breasts while she is nursing to produce roe flow to make it easier for her while she nurses.  this is also only temporary. over time she will be strong enough to do it on her own...

I notice you said you have done everything you can think of. I don't know what all those things are so its hard for me to suggest what else to do... if you would like, you can e-mail me directly and I will give you my phone number so we can discuss it in person. The issues you have are multi faceted... and can be worked though but they are not as simple as writing a paragraph and fixing all issues... it often with preemies and twins , ongoing and alot of tweaking and reevaluating. I would love to help as much as I can. Please keep that in mind...

everything you mentioned is very normal nicu baby stuff...  If I could run every nicu, it would be done in a very different way.... but keep trusting you can get through this :)

NO, with perseverance, she will not have to always supplement with her own milk. She can go on to nurse both easily...if she sticks to it. and tell her, to pat herself on the back and know, that what she has done for her babies by pumping and giving that milk is far more than 90 percent of this country does. even with singletons.

the answer to the question of if its ok to just offer only the breast... I need more information before I can answer that effectively. and often, that done on a day to day basis and see what happens... I can also suggest getting a sns. ( supplemental nursing system ) it is a system that will help baby get more instant gratification when she nurses, by getting milk through a small tube while latched on. google it , get one and see how it works for her and the babies.  there should be a LC or LLL leader in the area who can help make sure it is working well. If I cannot help you enough through this , email or phone, I will refer you to a local resource to help you figure that part out too.

I would try hard to not worry about a schedule at this point. main focus should be getting them to nurse effectively. then setting the schedule in place will be alot easier...

I hope that helped! at least a little!