A bunch of questions re: breast feeding

I'm pretty tired, so this may be all over the place. Tomorrow we are seeing a lactation consultant at our house but I thought if I could get some info in advance, it may help me prepare for her visit.

Our son was born 4 weeks early, weighing 2706 grams via emergency c-section. He is a sleepy little fellow and initially not a great sucker. The pediatrician did not want him losing up to the standard 10% of his birth weight so with the help of the hospital lactation team, I expressed colostrum and supplemented with formula. He did lose weight but within acceptable parameters. DS also had jaundice - initially treated day 4-5 (the day we left). He was readmitted 2 days later for an additional 48 hours of phototherapy for jaundice - we took him in for a re-weigh as per the hospital's request and they did not like his color so they ran a blood test and asked us to wait around (his weight had gone up a tiny bit).

My milk came in while still in the hospital (I stayed with him the whole time, so basically, he only had formula his first 4 days of life), so I was able to drop the formula supplement and supplement breast feeding with EBM - he drinks up the bottle like a fiend and he is now back above his birth weight at 2725 grams as of a few days ago - being weighed again tomorrow by MCHN.

He does attach to the boob but he still gets tired out (he's 16 days old today) - 20 minutes at each boob is an excellent feed for him - and that's with a number of breaks to re-wake him (and the 20 min/boob is a twice a day thing - for all other feeds it is more like 20 at one boob and 10 at the other) - I also can't tell if he is actually sucking/swallowing or just hanging out quite firmly - his jaw moves but I just don't see a swallow but I'm not sure what I'm looking for. Also, we have to wake him for most feeds (3.5 hourly during the day (3 hourly was just too close together for him - he didn't have enough energy for that schedule), 4 hourly during the night). I have rented a hospital grade pump and we are still topping him up with 20 mils of EBM each feed which he continues to drink up (my husband is excellent at waking him from his post-breast feed stupor and getting him to take the bottle which I can't do because I find it all too upsetting when I have breasts full of milk)...lately he has been spitting up more and we are wondering if we could now be overfeeding him breast milk between the breast and EBM. At the same time, we continue to be concerned about his weight gain so we don't want to drop it (he is being weighed tomorrow). Oh - plenty of wet heavy nappies and mustard poo - although last night he missed a bottle feed and his next nappy had only a little pee in it.

My milk supply seems to be good - when I express 5 minutes x 5 min x 5 min x 5 min (meaning 10 min each breast, total 20 min), I get 150 mils on average (twice a day - I could get more but I don't have enough bottles to store any more - we are going to address this in a couple of days).

I so want to stop the bottle top up - it's just such a PITA dealing with the pump, the bottles, the storage and the switch from boob to bottle at the end of each feed...and not what I want to do, but I'm afraid we will "starve" him. He finally has a tiny bit more energy (meaning, he has 10-20 minutes of quiet alert post feeds - previously, he would be just zonked post-feed) and he has actually started to cry close to feeding time - it's a funny thing to be happy about, but when you have a sleepy little fellow, it's a great sound as he never cries - only when changing his nappy and clothes - and it's more like a little wimper!

I'm hoping the lactation consultant can give us a program - what should I be asking from her? What ideas should I run by her? I'm most afraid that she will say he will never be a fully breast fed baby, and I will be forced to pump "forever more".

A completely unrelated question - I have not been sterilizing the bottles/nipples - only washing with really, really hot tap water - it burns my hands through rubber gloves it's so hot. Is this OK?

Thanks...

bullej - i don't have a lot of advice but i got told to know that bub is attached properly and sucking is that their ear should move up and down when they are swallowing, I know you said that you see his jaw moving but i know that was one of the things that the midwife told me when i had ds

not sure about the sterilizing as i use to have an electric sterilizer so just popped them in there and turn on when we used a bottle or the pump

hope it helps a lil bit and i hope all goes well with the lactation consultant tomorrow
xoxox

Hi buliej,

Congrats on your little December present! You're doing a fantastic job so far!

I don't know too much about breastfeeding (I express full time), but I wanted to say I wash and sterilise my pump parts once per day and store them in a container in the fridge - stops me having to wash them all the time. I have heard of some hospitals telling people not to sterilise and some telling them to do it.

How come you're doing 5x5x5x5? Are you pumping both at once? Could you hire an electric to make life a bit easier?

Hopefully one of the experts will be here soon to give their advice about the feeding side of things. Don't be afraid to call the ABA, even in the middle of the night. I'm old friends with those ladies - they are very helpful.

oxox

Regarding attachemnt and feeding, you can tell if they are actually feeding if they go 'suck suck swallow' or variations eg 'suck suck suck swallow suck swallow' but you have to see a swallow, so peer closely and look at the throat, you should see the movement when there is a swallow.
I've only skimmed your post coz I'm in a rush, but it sounds like you can drop the top up feed, seems bub is getting enough from your boobs directly. Save the EBM for emergencies.
I personally don't see the importance in 'sterilising' things, it's personal choice I think? Hot water should be fine. I never used bottles, but if I had, I wouldn't have sterilised either.
Sounds like you are doing really well with breastfeeding, good on you and I hope the LC tomorrow answers all your questions!

Bullej you're doing an awesome job and I absolutely hear you on the expressing and top-ups being a PITA. So that would be my first question to the LC - is it worth doing them if they're only 20mls per feed. If he didn't have that extra 20mls, wouldn't it just mean he'd wake a bit sooner for his next feed?

I know it seems like a lifetime but 16 days is early days and from what you've said, there's absolutely no reason he can't be a fully BF baby BUT I think the key is to be honest with your LC and any 'program' they come up with. It has to be do-able. I should have told my LC from the get-go that what she was proposing for me was not do-able for a whole bunch of reasons instead of feeling slack that I couldn't do it. But I won't hijack your thread!

Good luck!

Oh, and as for sterilising. I didn't bother for DD2 - I either washed the same way that the hospital advised for their expressers or I put bottles in the dishwasher.

You are doing a fantastic job hun, I remember the early days when i was so worried that DS was not getting enough and that my supply was dropping, I learnt so much for asking for advise on BB.

Firstly i would say that you are expressing heaps and that your supply sounds great :) with regards to storage i would highly recomend you going on the ABA web site and ordering some storage ice cube trays that way you can freeze amounts of 30mls at a time.

With regards to seterilising i was told it was not needed for a BF baby, just warm/hot soapy water

If he is getting enough wet/poo nappies then i would also drop the EBM as i remember Barb once telling me that topping up can sometimes effect your supply (Barb please correct if i am wrong)

I would just keep doing what you are doing by waking him and putting him on, what a fantastic job you are doing hun

Look forward to hearing of the weight gain tomorrow xx

He is doing really well, being 4 weeks early and jaundiced means he will tire very easily and he could have trouble with attachment, so see the lc is a good idea. Hang in there it gets easier. Dd1 was always topped up after being born 4 weeks early, but dd2 was three weeks early and was fully bf from about 4 weeks and after that she refused top ups.

Hey there Buliej :)

You are doing such a great job! Well done on expressing 150ml at a time :clap: You're a regular old moo cow! hehe! Sounds to me like your supply is ample, and I would be dropping the top up feed. I wouldn't stress about your little man getting "too much", or "overfeeding", as babies are very clever, and will only eat if they are hungry. Perhaps he is having little perks due to a bit of wind? Is he giving you a nice burp after feeds? If not, the airpocket gets caught under the milk, and when it comes up, the milk is forced up also (hence the little spew). I have read before that "patting" a babies back, often breaks up the airpocket, and rather than being one big airpocket (burp) it is broken up into smaller ones. So - What I have done with my babies, is rub their backs in a circular motion. They often gave me a burp, but if they didn't I resorted to the patting (figuring that some burp, is better than no burp, iywkim). Maybe you could give this a try?

I have also only sterilised in boiling water. Everyone has their own method :)

When you're feeding, turn the tv off and watch and listen carefully. Often you'll be able to feel your milk come in, then all of a sudden their sucks speed up and you can even hear them swallow. If you can't hear them, try and watch their necks, you can see the very subtle movement of their neck as they swallow.

Jaundice babies are very sleepy, as I'm sure you now know! You're doing a fabo job waking him up every 3.5 hours for a feed. The more feeds they have, the quicker their recovery. Wet cloths on the face, tickling the feet, basically just annoying them (haha!) will keep them on the job, and he should get what he needs/wants.

Congratulations on your new bundle, enjoy those cuddles, they don't last long enough :)
And good luck with the LC tomorrow! Be open and honest - its the only way!

Love Telly xox

sounds like bub is getting enough

DS used to feed for 20 minutes a breast and he ALWAYS fell asleep whilst eating, you just tickle their cheek and they will start eating again ;)

also post feed he always slept...babies always sleep don't they besides eating... It's been two years but that's right isn't it? For at least two months i think, then they stay awake for longer ....

Sounds like you are doing an awesome job, I'd stop all top up feeds..... DS was 2755g at birth and lost weight too, it's normal because they are using so much energy :)

You're doing a great job with the expressing hun!

In some ways, your story reflected the arrival of my DS1 - though he wasn't premmie (born three days before EDD). He was 2.9kg and suffered some mild jaundice for the first couple of weeks. He lost weight - more than they wanted - before we left hospital. BFing was very slow going for us to start with, and at the time of discharge I was told to get milk into him "however I could". So I ended up expressing and giving him EBM after an initial BF, where he would suck for a couple of minutes and then get crotchety and not attach properly or he'd just get drowsy.

For just over three weeks, EVERY feed was an initial BF, then EBM. It sure was a PITA to express all the time - particularly in the wee hours of the morning - but I kept at it and kept trying to BF. Sometime it would take me 10-15mins to get 150ml or more, other times it would take me 30 mins ... that's when it was hard to do.

And in those first few days it was so hard to know if I was giving him enough EBM. I finally realised he needed more when he would cry a bit within an hour or so of a feed. I recieved some advice (won't say where from - not BB though) that 20ml of EBM after a five-minute BF (not the best BF) was plenty as his "tummy is the size of his closed first". But ya know what ... it wasn't enough. He cried for more the first couple of days we got home from hospital. I upped the EBM to about 50-60ml and DS1 was finally happy and full.

Somewhere between 3-4 weeks we hit paydirt and our BFing journey took off. I continued to express for at least one bottle a day - that way DH could give him a feed - but we then BFd for over 13 months. Exclusively for the first six months.

So if you can, keep it up and keep offering your bub BFs. Hopefully, like me, it'll all gel for you both very soon. Good luck with your lc, I'm sure you'll get some great advice and encouragement. :D

YoU are doing such a great job. You and your baby seem to be following a pretty normal true Tory for a prem baby. I feel today's weigh in will reveal he has gained weght and you can stop the top ups . After 20 mins at the breast they have pretty much all the milk they are going to get, and will want the other. It's better for babies to have more, shorter feeds than fewer long feeds. In regards to cleaning pumps and bottles, no need to sterilize just rinse, hot soapy wash, rinse and you are done

Congratulations Buliej!
It sounds like you're doing a fabulous job feeding your baby, well done. It doesn't sound to me like you really need to be expressing now either.

Thanks everyone - this is the first chance I've had to log on.

The LC (lactation consultant) was great - she spent 3 hours with us - watched a full feed and then "taught". She suggested a weaning schedule (very brief) for getting off the bottle as she agreed with all of you that it wasn't really necessary. And it worked - no more bottle top up.

I'm also happy to report that not only has DS gained weight (the MCHN is thrilled with his weight gain and his color - the jaundice is gone) but he is also a much stronger sucker - it's like he turned a corner just after the LC visit.

Now I'm expressing to relieve my breasts once a day for 10 minutes each side because despite his feeds, they can remain full and hurt.

I do have to get on to the gear for freezing milk as I'm dumping old milk down the sink every day...it's just hard to get on top of things with a newborn who showed up so early that I hadn't even finished work!

:) buliej thats fabulous news that everything is going so well :)
Yes, dumping bmilk down the sink would be pretty hard to watch. You can buy disposable pouches from the chemist, I always used them and found them really good.
Hope your boobies settle down soon, nothing worse!
xox

so glad that ur lil man is doing sooo much better and the breastfeeding is going so well
well done sweety

wonderful news go the booby juice!

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Now I'm expressing to relieve my breasts once a day for 10 minutes each side because despite his feeds, they can remain full and hurt.

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Every time you express, you tell your breasts that they need to make that milk. If you need to express, don't time it and don't 'empty' the breast, just take enough so you are comfortable. They will settle down eventually but by expressing you don't let them regulate to what bub actually needs.

Great work on the weight gain and your LC appointment!