Breastfeeding and the Preemie

Breastfeeding has been an incredible journey for me. I knew it was something I wanted to do, but hadn't really put a ton of thought into it before CJ was born. I had purchased a breast pump (it was actually my ONLY purchase before his birth) because it was on-sale on Groupon, and that was it. 

When I was rushed into emergency surgery, breastfeeding was the last thing on my mind. But shortly after I finally met my little man (7 hours after he was born), the nurses brought me back to my room and taught how to use a pump. It was 1am and I could barely keep my eyes open but knew this was incredibly important for my preemie. I pumped that colostrum and woke every 3 hours to continue deliriously doing so throughout the night. In the morning, I met the lactation consultants who told me that it looked like I had a great supply already so for that I was grateful.

Since he was born at only 29 weeks, CJ wasn't able to eat yet. Babies don't have the sucking reflex until 34 weeks and he was receiving his nutrients through his IV. Over the next few days, the nurses started by just putting some colostrum in his mouth and then later inserted a feeding tube to give him tiny amounts of my milk. Initially he was getting about 5 ccs per feeding and that increased each day. Pumping was a hassle (I had to carry my pump parts with me to and from the hospital and my hospital grade pump came with me pretty much everywhere else I went), but it felt like the only thing I could do for him and so I kept to the schedule of pumping for 15 minutes every 3 hours no matter what was happening or where I was. 

After a couple of weeks, he tried a bottle and I started putting him to breast every day or every other day. I was lucky to have the help of the NICU lactation consultants who were very supportive. We had to use a nipple shield and we stuck to short sessions of 10 minutes max. There was little privacy in the NICU-- we had to find and set up screens which offered only minimal coverage to be honest. Each time felt like a bit of an ordeal, but we worked through it. 

When he came home, I kept up the pumping. We were feeding him bottles of breastmilk and then I was pumping after each feeding. My entire maternity leave felt like that's all I did (change, bottle feed, pump). I tried to breastfeed about once a day but that added a step-- triple feeding required me to attempt a short nursing session, then offer CJ a bottle, and lastly pump.

Right around his due date, he seemed to be open to the idea of nursing more. I finally called the lactation team and asked them what they'd recommend. I was thrilled to hear that they thought I could move to exclusively breastfeeding (no more feeding by bottle and pumping after). I was nervous but they told me to just schedule a few weight checks with my pediatrician to make sure he was getting enough. He still required the shield, even though his suck was strong by then, but I think that was mostly just what he was used to. All of this was timed to my return to work so he received 3 bottles a day from whoever was taking care of him.

His weight gain is about 0.5 ounce a day, which is acceptable (recommended weight gain for breastfed babies is 0.5-1.0 ounces a day). One of the doctors at our pediatrician felt that was a little slow but he's been pretty stable at that number so they others are all comfortable with that, since all other signs are good (wet diapers, etc).
 
CJ's turned out to be a pretty flexible baby when it comes to eating-- he has little preference between bottle and breast. After about a month of "exclusive" (in quotes since I was only able to breastfeed when not at work), we were able to get rid of the shield. It was funny because he would generally fuss when I would try to get him to eat without it and one day I wanted to show my mom how he did that, and that time he just latched and never turned back!

I'm lucky in that I have a pretty sizable stash from all that pumping I did when CJ was eating very little. Even though he wasn't eating it, I needed to do it so I'd have the supply when he was ready to eat. Now, I pump twice a day at work and that typically covers the next day's bottles. When I get home from work, he's pretty much always ready to eat no matter what time he ate last. I like to think it's because he misses me when I'm gone! We've also experienced our share of cluster feeding nights, but those are generally (thankfully) short-lived.

I'm so grateful that it all worked out. I think I'm even more grateful that we were able to make it work despite the circumstances of his early birth. My goal now is to make it to a year!