Expert: ruth kraft - 5/21/2009

Question
Hi Ruth,
I am currently exclusively breastfeeding a 4.5 month old preemie ( 3 month
adjusted). She was 6 weeks early but only 2 and a half pounds. At the hospital
they encouraged me to use a nipple shield to feed her though she had no
latch issues. She mostly ate pumped breastmilk from a bottle. Things were ok
(except she still will only feed with the shield) until about a week ago. She
seems to be getting fussier when I feed her, but she will take a bottle. Also, I
am pumping still once a day ( i had to pump the whole time she was in the
hospital (one month). I used to get about 4-6 ounces when I pumped until
this week and now I am pumping almost half that and almost nothing from
the left breast. However, when she feeds she seems to be getting milk, she
has lots of wet diapers and seems content after eating (once I get her
started). I am breastfeeding her 5-7 times a day and she gets 1 bottle of
pumped milk in the evening. Her weight gain in the first 3 months was higher
than this last month where she averaged 15 grams a day.

I have a few questions. First of all, can I still be producing enough milk if I
am pumping less or is that a sign of low supply?  
Could this be related to the prolonged use of a nipple shield? If so any
suggestions on how to get her off?
Should I stop the one bottle and pumping and try just feeding her myself? I
always thought pumping kept your supply up so I am a bit confused as to
what is going on.
I want to continue exclusively breastfeeding but I also want to make sure she
is getting enough.

Your thoughts, suggestions etc. would be greatly appreciated.

Cheers,
Marla

Answer
hello! I commend you for working so hard :)

It is very possible to be producing enough milk if you are pumping less , because the baby is far more effiecint usually than the breast pump. However, if her weight gain has slowed down, then I might suggest starting pumping again to get that supply back up and more easily retrieved by her. because she was preemie, she will likely tire more easily and not nurse as effectivly as a full term baby for a while. she should be having 6-8 wet diapers a day and gaining appropriatly. if not, you want to get her more milk.

her refusing the breast might be because of the nipple shield if you are trying to teach her to nurse without it. I am not sure why they told you to use it if she was nursing ok without it. but either way, you have to just keep trying and trying to get her to latch without it. feed her half a feeding with it and then half without it that way she isnt so super hungry when you are trying and can avoid some frustration on her part. its try and try again as she is having to learn to eat another way and its not always easy.

If she is developmentally where she needs to be, and the doctor is ok with her weight gain and wet and dirty diapers etc, then you should be able to not pump that last feeding and feed her by the breast. this is best for all involved if you are sure she is doing well. You do not , long term, need to pump to keep milk up. the only reason to start it at the beginning is for a baby who you need to express milk for who doesnt nurse well, or at all. as any missed feeding is one that should be pumped. however, if you are there, and she isnt missing the feeding, there is no reason to pump it. If you go out and leave her with someone, you want to pump that feeding so your supply stays up. but if she is eating each feeding herself , there is not need for this.

the best way to tell if she is getting enough, is weight gain. secondly, on a daily basis, you watch for quiet alert times, being social,and  wet and dirty diapers. if she has all those, feeding her from the breast is the best for both of you !

good luck! I had a preemie so I remember it well!