Breastfeeding a Preemie

Monday, April 15, 2013

Breastfeeding & natural childbirth are two things that I have been hell-bent on since before I even became pregnant. Well since natural childbirth didn't work out for me this time, due to pregnancy complications, I was more than determined to succeed at breastfeeding. You can read Kirby's birth story here. Let me tell you, it takes some serious dedication to breastfeed a preemie. Now it definitely wasn't anything that I couldn't handle, but lets just say I can see how people give up, so basically just know that you are a certified bad ass for even attempting it.  

First things first; I am not sure if it was the lack of sleep & overwhelming emotions of childbirth however; I never attempted to breastfeed Kirby until about an hour or more (timing is still a little hazy) after birth. They say baby is most alert during the first hour after delivery; I really wish I would have taken advantage & is one thing I do regret not doing. She was placed on my chest immediately after delivery & I am just not sure why I didn't think to attempt to feed her nor did anyone suggest it. When we finally got around to it Kirby didn't even attempt to latch. Not like we just had trouble getting a good latch this girl just wouldn't even try it! The lactation consultant came in & showed me how to manually express the colostrum & put it to her lips which she would then swallow, but still would not latch! This totally stressed me out because she did not nurse at all during the first 24 hours. We still tried every 2 hours & I was pumping & producing colostrum. I would get about 30ml (one ounce) & we would attempt to nurse & then we would manually "finger feed" her. They called it triple feeding, which was completely exhausting since we literally hadn't slept in 24 hours.
Our feeding schedule looked like this:
Attempt for Kirby to latch for about 10 minutes
Pump for 20 minutes (both breasts at once)
Finger or spoon feed her the colostrum
Clean the pump parts
& try to get some sleep before we had to get up again (we were waking her every 2 hours)
Also keep in mind that they count the every two hours from when you start the feeding process, not after she finished eating, so I literally got maybe an hour of sleep between feedings. 

That evening when the nurses had shift change we got Yolanda (my favorite). Everyone had been advising me not to use the nipple shield & Yolanda simply said that I should try it. I mean wouldn't we rather have her attempting to eat than to not at all? I totally agreed & even though I had brought some just in case I ended up preferring the hospital's (Medela brand). She was such an extremely sleepy baby from being born a month early that in order to get her to suckle, I had to physically put something in her mouth & I'll be damned if it was going to be a bottle. So let me tell you the nipple shield is what saved our nursing relationship. You just have to do what works for you. My biggest problem was taking every single bit of advice from everyone who walked in our room. I mean once I finally got her eating a different nurse, or pediatrician, or lactation consultant would stress me out all over again trying to get her to nurse with out the shield. Finally we just decided that this is what she & I both needed in order for her to nurse until she became a little more alert & was able to recognize the task at hand. Listen to your gut, which is so hard when your mind is so clouded & you just want to cling to everything everyone is saying in hopes that one of them will have the right answer. You have to do what is right for you & your baby. Don't loose sight on what is important here & creating that intimate bond with your baby, I feel like in the midst of things I sort of lost sight of that.

The entire time that you use a nipple shield you have to pump after every feeding in order to fully stimulate milk production so that your supply does not suffer. Which is tough when you are BEYOND exhausted. Meaning you have to;
Nurse with the shield 20 sometimes 30 minutes
Pump 20 minutes
Go store the milk that you pumped
Wash the parts & the nipple shield for the next feeding
Repeat in about an hour.
Talk about wanting to run your head through a brick wall. Now yes that is all completely doable; tiring but doable. However to top it all off with Kirby being a preemie that means she was a VERY & I mean VERY sleepy nurser. So it would worry me if she was even eating enough because it was so hard to keep her awake. I would say that was the most stressful part of the entire experience. I would literally undress her down to her diaper, change her diaper, wipe her forehead with a washcloth & that may only get me one minute of actual suckling. Then you add to that, my breasts are completely engorged with milk which fills up the shield with milk faster than she can drink it. Half the time the shield slides around and ends up spilling all over us! I can't tell you how many hours I spent contemplating throwing my pump out the window, taking some scissors to my nippe shield & feeding her a bottle with the millions of ounces of pumped milk I had accrued, but I was too afraid that if she found out it could be that easy that I may never get her onto the boob, let alone with out a shield!

I kept pushing and as the first two weeks went by I was able to get her to nurse more & more. She was born at 6lbs 8oz and left the hospital at 5lbs 14oz & by her 2 week appointment she was just slightly over her birth weight which was what we had to meet in order for me to continue breastfeeding without supplementation (being a bottle of pumped breast milk). She was fully weaned from the nipple shield two days after her 2 week appointment. I read online for some advice on weaning from nipple shields & a lot of the women I saw did it gradually as to not stress mom or baby & used the shield for months. It was recommended to start by doing one feeding per day without the shield & then to only use the shield over night (when mom is more prone to frustration) until baby has mastered the boob. I just couldn't do it; I grew to loathe pumping, as in I wanted to manually destroy my pump & never hear the daunting "nipple, nipple, nipple" or to my mom "breast pump, breast pump, breast pump" sound that it made for what felt like 24 hours a day. I was just not getting enough sleep by the time I pumped & cleaned everything & got her situated my alarm was nearly going off already (I had to set alarms for her to eat every 2-3 hours during the day & 3-4 at night). If I would have let her that girl would have slept for days I am sure of it. On top of that Brian was living in California & doing it alone made it even harder to not just give in & make it easier on myself.
So the day after our two week appointment, with conformation that I was doing alright & she was gaining weight I got the boost of confidence that I needed to attempt not using the shield. The two week mark was the first time when I finally saw some light at the end of the tunnel. I knew that we would be able to do it. It was really tough the first few times & so frustrating that I would have to step back & put the shield back on so I wouldn't completely break down. Then I started pumping (with my little hand pump) about an ounce or so out of each breast so that she was able to latch a little easier (my breast would be super hard & engorged before a feeding so it was hard for her to grip my skin/nipple). That would also help to extend my nipple & she was able to latch easier. The trouble would come about 5 minutes into the feeding where she would get so tired that she would revert back to just wanting something stuck in her mouth rather than doing the work herself. So I wound up undressing her for a majority of her feedings & wiping her forehead with a baby wipe when she would fall asleep, it was the only thing that worked, I hated it, it made me feel so sad to have to do that to her. Switching positions into the football hold vs the craddle hold helped sometimes too. The first night without the shield was very frustrating, I attempted going without it for every feeding, but on the verge of tears of frustration I would put the shield back on I was just too exhausted to fumble with it when I knew I still had to pump & clean & go down stairs to store the expressed milk before I could close my eyes. By the second day of nipple shield weaning she was taking every feeding without the shield throughout the day. So I told myself that I would not give in that night & to reward myself I was not going to pump overnight either. I succeeded & it felt amazing, so I never looked back.
There were times when I wanted to use the shield, but it would have just become a crutch for the both of us & with my burning desire to quit pumping & get some more rest I didn't allow myself to use it ever again. I called the lactation consultant & asked if I would be able to completely stop pumping. I had so much milk stored up & I was so tired of pumping that I just didn't want to for a while. I feared it would throw my supply into shock since I wasn't going to be demanding as much milk, but they said I should be fine & if I felt like it was getting low to just begin pumping again. I stopped pumping completely & I never had any issues with supply at all. I didn't pump again until 3 months later & I had no issues pumping nearly 5oz after our first morning feeding so that I could stock up just in case since frozen milk only lasts three months (so I have read/heard) I wanted to be sure & have some for her if I needed it.

Now that we were able to nurse without a shield, I felt like there was only one obstacle to over come. Which was the general commitment it was going to take to breastfeed. I mean for the first month at least we had marathon nursing sessions. Kirby would nurse up to an hour at a time, every time. As soon as she really got the nursing thing down & started gaining more weight her energy began to increase & she began to wake herself to eat. That was another obstacle I was so relieved to overcome. Waking up to my baby instead of an alarm every two hours is so much more peaceful! Especially since Kirby doesn't cry to wake me up she just makes little grunting noises & I am right up. I would say after we got through the six week growth spurt (which was nursing every 45 minutes for about 45 minutes) our nursing relationship became easy. I made myself a nursing cover (which I will post the tutorial for) & I was able to nurse anytime any place, no making/warming bottles & no cleaning pump parts or bottles. This is when I began to realize that not only am I benefiting Kirby, but I am making my life ten times easier, which is always great, right?

I highly recommend taking it day by day & really fighting through the struggles because it is truly worth it in the end. The biggest thing that I see mommas struggle with is they worry that their milk supply is low. Because their boobs don't feel full or baby is grunting & pulling at the nipple & doesn't seem satisfied, or you aren't able to pump enough if any. Trust me your supply is not low, it is extremely rare that a women does not produce enough milk for her child, it is the blind feeding that makes us second guess ourselves since everything is all about ounces. I experienced all of that & my supply was never truly low. Also people feel like their milk never comes in, however that is the most difficult part about breast feeding, you don't know how much your baby is getting & some people don't produce for a pump, but can successfully breast feed. You have to believe that your body can do it & you have to really commit to doing it. They go through growth spurts where it feels like they are sucking you dry & when in reality that is what they have to do in order for you body to produce more (it is all about supply & demand). The biggest mistake is when you begin supplementing because you fear that you're not feeding your baby enough, which is one of the greatest fears of a nursing mother since you never truly know how much you are feeding your baby, it completely blind faith. If you do have to supplement you have to pump for 20 minutes in its place. If you skip a pumping session to supplement then your body doesn't know to create that milk & thinks baby is not in need of that feeding & in return doesn't produce that milk. Another thing my lactation consultant said was that as long as her blood sugar wasn't low she was fine, all babies lose weight in the first day or two.  

For those of you wondering if my nipples were ever cracked & sore, they never were. Maybe it was all the pumping and the nipple shield that toughened them, but that was one thing that I never had issues with, thank goodness!
That's my story from the beginning, sorry for the long winded post, but I hope it was helpful to some & maybe some good preparation for those of you who want to breastfeed. Please let me know if you have any questions & I would love to hear some of your experiences with breastfeeding. You can take a look at our breastfeeding journey update here.

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