Advice on switching from exclusively pumping to exclusively bf'ing?

Hi all,
my back story: my guys were born at 35weeks at 5lb5oz and 4lb13oz. I had an emergency c-section because of distress to Baby A. Except for a quick glance/kiss, I didn't get to see/hold Baby B until he was five hours old, and Baby A until he was 12 hours old (was in NICU for 18 hours). By that point, both babies had been given several formula bottles to build their strength . After they were back in my room, we continued to give formula for the first couple of days - the doctors and nurses said that, due to the boys' prematurity, they needed the nutrients and the full bellies. I had alot of pain from my c-section, and my milk didn't come in until the 3rd day, so I didn't argue with the medical team. I did continuously try to put the boys to breast, and I did use the pump periodically, but, I admit that my c-section pain and exhaustion made me rather unenthusiastic about regular pumping.

Since we've been home, we've been pumping and feeding bottled breastmilk exclusively. At first, I tried to focus on nursing foremost, and pumping simply as a supplement. But, neither boy has a good latch, and they lose energy before even getting to letdown. I met with a great lactation consultant, who advised me to focus on pumping more than nursing right now (because the boys' on-breast 'demand' isn't enough to stimulate the 'supply' that they need). So, since then, I have been pumping every three hours, and have been increasing my output. I put the boys to breast before each pumping, but they still don't have good latches, and they fall asleep after a few sucks.

I really want to have them full-time on the breast before my DH is back to work full-time (about 3 weeks). I may still pump, but just as a supplement, to improve supply, and/or to stock the freezer with milk. I will continue to work with my lactation consultant, but I could really use some experienced advice to get my plan going... what do I need to do to get my twins to take the breast after becoming used to the bottle?

ANY input welcome!
Jessica

 

:Clap: Good for you for getting the breastmilk into those boys!! I wonder if maybe you shouldn't give yourself a deadline, it might create stress for you. Sorry I don't have any other advice, Good luck.

 

The thing that made the difference for my Sabrina (Sydney did just fine) was gaining enough weight to have the energy for it. You said that your boys get worn out by it. It takes more work than a bottle. Sabrina was 5#3 at birth (at almost 38 weeks... her sister was 7#9) and dropped to 4#9. Took her a month to get back to birthweight. The thing that finally got her over that hump was high calorie formula. I also nursed her some, just so she wouldn't hate it/reject it later. And gave her EBM. But she got a fair amt of formula for a few weeks. Then when she put on some good weight and didn't look like she was starving anymore, she also got more energy and could nurse better and not fall asleep within a couple minutes. I just kept nursing first, then giving her a bottle if she didn't seem to drain me very well. I don't remember when I finally dropped to just 1 bottle (which she got til she was a year old), but I'm thinking it was about 3-4 months, and gradually done. I agree that a deadline might not be the best idea. Having a goal is great! But sometimes these little guys just don't fit our time tables. Oh, she's 25 months and still nursing (Sydney is too, but not as much). She's tiny (about the size of a thin 16 month old), but healthy.

 

Joel had a tough time with breastfeeding the first few days--and took a colostrum/formula mix until my milk came in. The essential thing with getting him to come back to the breast was getting him fed until he had a ton of energy, then waiting until he was truly HUNGRY and asking for food before feeding him. This meant keeping him dopey milk-drunk all day and then finally waiting for about 4 hours to feed him. Then he latched on and never looked back.

But we learned the hard frustrating way that he had to have the energy level first or it just didn't work.

 

Exclusive BF is very doable and absolutely worth it.

IMO.....you need to start putting them to breast every chance you get. When they wake, when they cry - you get the idea. The only way they will become competent nursers is by practice practice practice. Pump after you have nursed them. If possible have them both at breast together as often as possible. They both do not need to be actively nursing. Having your DH will help. If you have trouble with let down not being quick enough, pump for a minute to get things going & then pop him/them on. You could even pump on one side with a baby on the other just to stimulate the let down.

Your babies are very young and many premature babies do not really "get it" until the have reached what would have been their 40 wk due date - they will get it though. Always offer the breast first. A bottle nipple is much easier for milk to flow out of and you do not want your little ones turning up their noses at the breast because it is more work(with good reason of course - jaw developement, etc).

Best advice I can give you is to contact your local La Leche League. You can find a group near you by clicking here or by calling 1-877-4-LALECHE.

Going to LLL meetings is a great way of getting them on breast full time. You do not have to join or pay to attend meetings.

Keep coming back here for support & advice.

 

I would second the person who said don't set a deadline. The best thing to do is to keep putting them to breast as much as you can but keep up your pumping too so your supply stays up. Also, give yourself a break once in awhile. I remember in those early days sometimes I would be so tired and frustrated at trying to nurse that I needed to have a break and just pump and feed them a bottle. That's ok! You and the babies will get it all figured out eventually. I used a nipple shield with mine and then went to a LC to help get them latched without it. That did the trick.

And don't put too much pressure on yourself to exclusive BF. The real goal is to keep them gaining weight. I exclusive BF for a month and was so proud of myself and then we went in to the doctor for their weigh in and they had lost weight! So we did start supplementing again and it wasn't the end of the world. If you do make it to exclusive BF I would get them weighed after a week to make sure they really are getting enough. good luck!

 

my twins were born just shy of 35 weeks and DS stayed in the nicu for 6 weeks. Like yours they would fall asleep while eating and the nurses would "rough them up" to get them to wake up and eat. Cold wash cloths, strip them down to their diaper, stimulating/scratching their scalps (and not the hesitant gentle petting that I did as a new parent!). We tried for at least 30 minutes per twin before giving them their bottles, sometimes longer.

I agree with the LC that you need to pump in order to safeguard your supply, since their weak sucks are probably not enough to establish your supply. But if you are serious about getting them to BF directly, I disagree with the advice to just focus on pumping for now. IMHO you should work on getting them to latch and eat also. Get an LC who can help you with that, & good luck! I am living proof it can be done. My babies are 9 months and are still BF'd exclusively (except for solids) -- no bottles!

 

Jessica ~ Congrats on your boys!!!!

For us, we started removing one bottle and replacing it with a breast feed. As long as that seemed to go well (they were gaining, pooping and peeing appropriately), then we'd take away another bottle and replace with a breast feed. Wait a couple of days and do it again. In a couple of weeks, they were 100% breastfed and we haven't looked back.

 

I'm sorry if I'm repeating anyone but we were in a similar situation. I didn't decide to nurse exclusively until a couple of weeks after they were born. My advice to you...if you want to exclusively nurse, then do just that. You will literally be naked all day, but it is so worth it in the end. I have a freezer full of spoiled milk that I'm too coocoo to just throw out already! It's incredibly scary to just take the plunge and rely on nursing without the security of a night time bottle or "I think he/she is still hungry" bottle. But those seemingly harmless here and there bottles make a big difference in the beginning. I glanced at someone's response that said continue to pump AFTER each nursing session and I agree totally. It took me a long time to let the pump go although I wasn't even using the milk. You can definitely do this, but it's okay if you don't. Always remember that. Good luck!

 

Daniel didn't 'get it' right away. He would get so exhausted just trying. We put him to the breast every other feed for a while, because he got so frustrated and we didn't want to wear him out. And for a few days, when put to the breast we did the syringe thing - where you take a small plastic syringe and put it in the corner of his mouth while he is latchted on. Every time he attempted to suck, you squeeze a little into his mouth - so his efforts were rewarded and he didn't get frustrated, and eventually he started to learn that by sucking on the breast, he would get milk. Once my milk supply was enough that I could hand express, then I didn't need the syringe, I could just squeeze a little milk out for him, and that would help him get started. After a couple weeks he figured it out.

Also we had a big problem with them falling asleep on the breast - and we had to resort to everything we could think of to keep them awake to feed. Callie was the worst. We would start peeling her clothes - she often ended up in just a diaper. We would take a cold wash cloth and wipe her face, and sometimes the rest of her body. Anything to wake her up.

 

QUOTE(3greysandamutt @ Jan 23 2008, 01:12 AM) [snapback]585219[/snapback]
I really want to have them full-time on the breast before my DH is back to work full-time (about 3 weeks). I will continue to work with my lactation consultant, but I could really use some experienced advice to get my plan going... what do I need to do to get my twins to take the breast after becoming used to the bottle?


Definaltely keep talking to your LC. My guys were born @35.3 and 5.1 and 5.15, both jaundice and sleepy. We had to bottle feed a BM/ formula mix (for extra calories) for 5 weeks until they had steady weight gain. Slowly we started BF again, I had to nurse until they tuckered out then pump and bottle feed. This transition lasted about 4 weeks until they were taking in enough and we could cut out the suppliment bottles.

My husband stayed home from work for 3 weeks and my mom came to help for another week so I also wanted to get them on the breast before I was left alone, but, just like everyone else said, DON'T SET A DATE, I know it's hard and when the babies were 5 days old and they told me I couldn't nurse them because we had to monitor their intake, I burst into tears! Now 4 mos later they are nursing pros and ironically Thomas won't take a bottle anymore. Be patient and good luck.

 

First I have to say it is AWESOME that you are pumping and feeding!!! It is such hard work and it gets discouraging because it seems like all you re doing is pumping, feeding & washing then of course changing diapers :winking0009:

Anyway, I went through this with my twins. For the first 3 weeks they were pump-n-feeders! At qabout 3 weeks I began to break down mentally because I just could not see how I could do it with an older child to care for as well. So, I scoured the internet and called a lactation consultant. She wsa not from the hospital I delivered at, but that is a great place to start. The trouble I had was that I had breastfed before so even though I was asking for help in the hospital I wasn't getting any... Just a bunch of well, you have done it before they will catch on too... :icon_eek: So, the lactation consultant I called offered to come to the house and do a consulation there. It was what saved our sanity!

Basically, she came when we knew they were going to be hungry. She had me try latching one on and watched what I was doing. She also made a couple of very subtle but huge changes in my hand position and my babies were feeding!!! I was so happy and relieved. She also did a pre and post feed weight so that we could see how much they were getting which was so increadibly encouraging! This pre/post weight also told me that the one I though was the better feeder was actually not feeding as well as the one I though was not getting anything!!!

I found her by checking out International Board Certified Lactation Consultants (IBCLC) in my area. Try googling thqat and see if you can get someone to come to your house. Having someone help you where you will be helps a lot!!! Also, they were exclusively at the breast within a week and she came to the house 2-3 times!!! Insurance paid for the visits also since for us $$$ was an issue.

Good luck and good for you keeping it up!!!

 

I may be repeating someone b/c I didn't have time to read all these. One of my girls was in the NICU for 10 days and they wouldn't let her BF until day #8. She would never take a bottle there (had an NG tube) and they finally just let me room in with her and BF and they weighed her before and after feeds until they were satisfied that she was getting enough (nursed every 2 hours for about 24 hours) and they let me take her home. They nursed every 2 for the first 8 weeks ... around the clock ... and they would nurse 24/7 if I would have let them but I "cut them off" at 45 minutes. So, literally, almost HALF my life was spent nursing. I think that is what helped us the most ... it helped my supply, it helped them (and me) learn ... frequent nursing and a lot of patience. Oh I remember those days ... my letdown showed itsself by itchy armpits and I remember precariously holding my teeny babies and not being able to scratch my armpits =) It WILL get so much easier ... so my best advice is to stick with it through the hard times and don't think that it will always be hard!!!

SO, that being said ... one of my LC told me to use nipple shieds (though I read that they are bad for supply??) b/c my girls were so small and their mouths were so small that it was hard for them to latch. Especially if they are used to the bottle, a nipple shield may be a good transition tool to use. Also my girls are BOTH tongue tied and I never had either one clipped and they are BOTH great nursers now (and my Meredith STILL won't take a bottle ... actually neither will!) I agree with someone else that said to pump after they nurse too ... even if you don't get any milk, it will stimulate supply.

 

Thanks everyone for all the great input! This whole process of nursing-pumping-bottlefeeding my boys has been emotionally and physically exhausting, so I'm thankful for the support and encouragement that I've found here!

I nursed my singleton DD for 19 months, and it was one of the easiest things I've ever done! She latched on within her first hour, and never had ANY serious nursing complications! Nursing a full-term singleton is TOTALLY different than nursing preemie twins!!!!

I wanted to update after my follow-up visit with my lactation consultant yesterday! AJ has gained a full pound, and Benny has gained 15oz., in the 10 days since my previous Lactation Cons. appt!!!!! I am SO excited! My Lactation Cons was stunned at how much they have gained, and how good they've gotten at the breast! She said that, with preemies (or other babies who are weak at the breast), you see them double their breast intake each week. At our first appt, AJ only took 2oz at the breast, and Benny took zero. Ten days later, AJ took 34 oz at the breast, and Benny took 26oz!!!! My Lact Cons. says that they are definately exceeding her expectations (she was expecting that I would have to pump for a couple of months), and that she fully expects AJ to be full-time on the breast by next week, and Benny soon to follow!!!! YIPPEE!!!

... now that they are mastering their latches and suckles, I have to start getting the hang of tandem nursing! Can't wait!!

 

That is soooooooooo awesome!!!!!!!!!!!!!!!!!!

 

That is so encouraging, I'm in much the same boat right now trying to transition from EBM to exclusive BF. You gave me so much hope! I also nursed before without any issues at all, so this is much different this time around. I'm going for my 2wk post-op appt tomorrow and I think I might hunt down my LC at the hospital and see if we can do a feed there with weights before and after to see what the babies are transferring.