Hand to Hold's Official Blog: Written by Parents for Parents

When Nursing Your Preemie Doesn’t Work Out

Evelyn, with a feeding tube

Evelyn, with a feeding tube

Sometimes, despite your best intentions, breastfeeding a preemie just doesn’t work out. And that’s OK.

During my pregnancy I had vowed that I would try breastfeeding when the time arose. The problem was, when I delivered at 28 weeks I was utterly unprepared. I had planned to do plenty of research, including taking a class about breastfeeding at my local hospital. Those intentions – like my plans to take a newborn care class and have a baby shower – went out the window after I went into the hospital due to placental abruption at 26 weeks pregnant.

Looking back, it’s just as well that I didn’t have any prior knowledge. When it comes to feeding a preemie, it’s not an experience that any generic class or “What to Expect” volume prepares you for.

Shortly after my daughter was born via emergency C-section, a nurse came into my room with what I learned was a breast pump. I was told I would be using that to express milk that would be brought to my 2 pound, 7 ounce baby in the NICU. I was instructed on how the pump worked, how to rent one, how to clean it, where to get bottles, how to label those bottles, how to deliver the milk. In a state of grief and exhaustion, I couldn’t remember any of it. I was barely able to comprehend that my child had been born three months early, let alone learn a new skill.

I was told I would have to use the pump every three hours, waking up throughout the night as though I were nursing a newborn. I had been so consumed with holding onto my pregnancy for the past two weeks in the hospital that the reality of around-the-clock nursing hadn’t even occurred to me.

In the months that followed, I remember setting an alarm to wake up twice during the night to express milk. Sitting on the edge of my bed in a dark house in the wee hours of the morning, I would think about that tiny baby who should have still been inside me, but who was instead miles away in an incubator being tended by strangers. When I was done, I would take the bottles downstairs, label them with date and time, and put them in the freezer. Each morning I would load my insulated lunch bag with frozen bottles of milk and I would bring it to the NICU when I visited my daughter. In the early days, she was so small and eating just a few ounces at a time through her feeding tube, and half of that was a high-calorie fortifier. While my milk supply was meager, so was the demand. I built up quite a stock of 2-ounce bottles in my freezer, and I looked on them with pride.

My daughter was about 3-and-a-half pounds when I got to try breastfeeding her directly for the first time. I was so proud when she nailed it on the first try. From then on, I scheduled my visits around her feeding times, breastfeeding twice a day (this limit was set by her doctor in order to conserve calories). Six other times a day I pumped and it was fed by tube or, increasingly as she grew, by bottle.

Soon I realized there was a problem with my supply. I was pumping the same amount as usual, but as my daughter grew to 4 pounds, 5 pounds, the amount she ate at one time quickly caught up to – and exceeded – the volume I was producing.

I kept trying, but my anxiety grew. A nurse told me to put a picture of my daughter on the breast pump, but that just underscored the fact that she wasn’t home with me. I took fenugreek, I used warm compresses, I pumped both sides at once, I drank a ton of water. Nothing seemed to help. Nurses told me I needed to be calm for the milk to flow, that stress would only aggravate the problem. I’d love to know the trick for staying calm when your baby is in the NICU. I never discovered it.

Once, I remember standing next to my daughter’s incubator and telling a nurse about the volume I was pumping. Four ounces, I told her.

“That’s per breast, right?” the nurse asked.

“No,” I responded. “That’s total.”

I felt like a failure. I failed my daughter by not carrying her to term, I thought, and now I couldn’t even produce an adequate milk supply to help her grow strong. Why were these things so easy for other women, but so difficult for me?

My daughter came home in August of 2012 after 68 days in the NICU. She was on six medications, an apnea monitor and an oxygen concentrator. In addition to taking care of her unique needs as a preemie, I was trying to breastfeed twice a day, bottle feed her six times a day, and also fit in six pumping sessions.

About three weeks after she came home, I made the decision to stop nursing. My supply was meager compared with the amount of milk she was consuming, and managing a pumping schedule on top of all the care she required was pushing me to the breaking point. It was the right decision for my mental health.

But when I finally made that decision, I cried and cried. Yes, I felt liberated, no longer tethered to the machine, and I relished the new flexibility of my schedule. And yet, I remembered the first moment I breastfed my daughter, her tiny body surrounded by tubes and wires, and how she knew just what to do even though she wasn’t supposed to be born yet. I had taken that away from her, and it broke my heart.

Over a year later, I realize that I should have been proud. I made enough milk to last Evelyn through the first three months of her life. And while I didn’t carry her to term, I made her strong enough, and tenacious enough, that she made it through the ordeal with no complications.

It’s easier said than done, but as preemie mothers we need to stop blaming ourselves and let go of the guilt. It’s time to stop dwelling on what we didn’t do, and instead focus on what we DID do.

Kristin Beuscher About Kristin Beuscher

Kristin Beuscher (NJ) is the mother of Evelyn, born prematurely at 28 weeks due to chronic placental abruption. Evelyn weighed 2 pounds, 7 ounces at birth and spent 68 days in the NICU before coming home on oxygen. Today she is a perfectly healthy child. Kristin spent 10 years in journalism, most recently as editor of two weekly northern New Jersey newspapers, before becoming a stay-at-home mom in 2012. She seeks to provide hope for parents still in the NICU, as well as for those struggling with PTSD, anxiety or depression following the experience. Connect with her on Facebook.

Comments

  1. Jessica Sandler says:

    Thank you so much!!! I too stopped pumping very soon after my (former 27 weeker) daughter came home after 130 days in the NICU. I had been so proud to pump while she was in the NICU, but the reality of having her home (with colic) and trying to pump all day long was just too much for me also. “Luckily” she ate so little we had a frozen supply to last her to “adjusted” almost 6 months. I always wish she had breastfeed, but, like you, took great pride in helping feed her for all those months she was not home with us and taking it from the freezer for the next few months. Thank you so much for acknowledging anything that we can do is enough – and even without being able to produce enough we are able to love them enough – and that’s what matters.

  2. Kristin,

    THANK YOU THANK YOU for writing this. This is similar to my story. Sometimes, for the sake of your family and your sanity, you have to let go. I too was able to produce enough milk for my little ones 51-day NICU stay. I spent three more months continuing to try and pump as she never got the hang of breast feeding and had trouble with reflux. Such a relief to myself and my family when I finally said enough was enough. Society makes as feel bad about it, every can of formula says “if you choose not to breastfeed……”, well sometimes it is not so much a choice, sometimes nature has another plan, and a spunky two-year old to show for it.

  3. Thank you!! I pumped about 2 ozs every 3 hours when my 26 weeker was in the NICU for 103 days. (I’m certain I would have produced more; I refused to wake up throughout the night for my ‘electronic baby.’) That was more than enough for him, until he came home and like you mentioned, starting eating more than I produced. In no time my freezer stash was obliterated and I began exclusively nursing him, which he caught onto just fine. The lactation consultants suggested I still pump 3 times a day, but that I could continue exclusively breastfeeding.

    He never lost weight, but his weight gained slowed a ton after we started exclusively nursing and I had to start supplementing with formula a couple weeks ago. This was so difficult for me to do – barring fortifiers in the NICU, he had only had my breastmilk which was something I was SO proud of – for 7 months! And that’s a great accomplishment with a preemie!! My supply is now starting to dwindle since I’m supplementing but I need to focus, like you said, on the fact that I fed him only my breastmilk for 7 months. 🙂

    P.S. Your nurse was wrong. Pumping 2-4ozs total at a time is normal and anything more than that is considered an over supply.

  4. Beth PuskasBeth Puskas says:

    I just love this post, Kristin! I just wish you had wrote it last year when I was struggling with pumping, haha! Seriously, I still struggle with guilt over not being able to continue giving my baby breast milk for more than 2 months. Although he could not breastfeed, I really wanted to be able to give him breast milk and not just formula. But pumping just didn’t go well for me and I felt awful about quitting. And I still feel bad every time I read how much better breast milk is for your baby. At least my baby is one now, and I don’t have to explain once again to some nurse or doctor about why he is on formula and not breast milk. I just wish we, moms, could make the personal choice to not breastfeed, or not pump, and not be judged for it.

  5. Thank you for writing this! I struggled and stressed for the first 10 months of my son’s life with nursing/pumping/supply issues. By sheer stubbornness I was able to nurse about 40% of his intake once he was 3 months old and learned to latch.. but it was an uphill battle to that point, and my supply was just never enough for him. I shed an insane amount of tears those first 10 months, and every bottle of formula I gave him I felt incredible guilt. Once my supply ran out, I comfort nursed (dry nursed) him for another year, until he lost interest. Looking back, I’m glad I fought so hard, but my mental health was so affected by it, I sometimes wonder if I should have been easier on myself and quit earlier on. It’s kinda like darned if you do, darned if you don’t.

  6. Great post! I pumped with both my preemies, and it was brutal. All of it. Everything about it. And I never got to nurse my babies at home, so I have such a sense of sadness surrounding the whole topic of breastfeeding. But, I try to remind myself that I gave my children breast milk when it mattered most. Thanks for sharing, Kristin.

  7. This was a great post about the trials of pumping, NICU Mama Guilt, breastfeeding, and letting go. My son was born at 26 weeks and I was fortunate enough to exclusively pump for 6 months as he grew stronger to finally breastfeed. After a 151 days in the NICU he has a trach, is vent dependent, and a GT but exclusively nurses all day. His team thinks it’s phenomenal. It is pretty exceptional given his history. We had a longer and more complicated course than some due to his CLD but I am so grateful that nursing did work out for us. NICU/preemie Moms are the most resilient, patient, and determined people in the world!

  8. having had a 24 weeker at guys and st thomas’ hospital. london, i too know what its like to just produce a few drops for your baby.

    The consultants and nurses did nothing but praise us for every drop we produced, they told us we were doing more for our babies than parents who gave birth to healthy full term babies.

    Dr Kaiser of St THomas’ london said to us, we revere you mothers so highly for what youre doing, producing milk under such stressfull circumstances.

    Any guilt we felt was replaced with pride and it seems its the staff in Neonatal depts that have the power to make us feel guilty or proud.

    Guys and St Thomas’ hospital were amazing for encouraging us and an example to the rest of the world of Neonatal care.

  9. Nadine Budbill says:

    Thank you for writing this! You put into words so much of what I have felt attempting to breastfeed my baby who was born weighing 1 lb, 11 oz, at 27-weeks. After months of trying to nurse and even more months of pumping, I am finally letting it all go. The stress and anxiety of trying to make breastfeeding work was not good for either myself or my daughter, and I have decided that I’d rather spend my time with my baby than with the breast pump. It is heartbreaking to let go once and for all, but ultimately I know that it is the love and joy with which I surround my daughter that matters most. I feel great that all she got was breastmilk for 4 months and now will get a mixture of breastmilk from the freezer and formula. You are so right, we need to focus on what we did manage to do, despite our challenging circumstances…rather than spending time dwelling on the things that didn’t go as we had hoped. It’s not easy, being the Mama of a preemie, but it has certainly taught me beautiful lessons in surrender, gratitude, and love deeper than I have ever felt before.

  10. There is joy in solidarity. I made the same decision and it fills me with a sense of dread, but it also made it possible to sleep and take care of my older child who isn’t tube fed. Anyways, thank you.

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