Weekend Chats: My Thoughts on Breastfeeding After The NICU

Breastfeeding is a touchy subject these days. I have never hid the fact that I believe that  breast best for a baby and never will. That being said, a fed baby trumps everything in my book. Furthermore, I don't make decisions for other families just as they do not make decisions for me, but I like to come to my choices from an informed place. For me, saying breastfeeding just wasn't for me was not an option I felt comfortable with when it came to my children. However, I don't think less of a mom who uses formula because I assume they have their reasons just as I have mine..... it falls into the category of things that I like to label: none of my business. I never want to offend people with my views on breastfeeding because they do not come from a place of criticism and are mainly pulled from my expectations for my role as a parent. 

So how does my little disclaimer above come into my everyday life? I would call my breastfeeding journey with both of my children unconventional in my eyes.... Kellen (now 3 years old) is my first baby. Kellen was in the NICU for 5 days after he was born due to pneumonia. I wrote about this experience before and how I felt I had to fight to feed my baby. I felt really defeated by everything and eventually made the decision to exclusively pump for Kellen. Kellen had trouble with his latch and I was overwhelmed by the entire experience of my first baby being in the hospital. I visited the lactation consultant while inpatient and again after discharge. However, I ultimately felt pumping was a better choice for me and Kellen. If you are not familiar with what it means to exclusively pump it means you exclusively feed your baby breast milk from a bottle versus putting them to breast. Pumping is still breastfeeding. There are some people who do not feel that it can be classified as that, but those people can piss off for all I care, it's breastfeeding. There are various reasons to do this and mine, at the time, was to make sure my baby got breast milk no matter how it came to him. I will talk about exclusive pumping more in another post because it really deserves that to explain how it works because it is something, like any form of breastfeeding, that requires a lot of dedication. I started pumping the day I left the hospital and pumped 6-9 times per day and once over night to establish a supply. Some observations about Kellen's eating that I noticed as a result of being a NICU and bottle fed baby were that he ate a lot. He was a big baby to begin with, but ate quickly. Plus with a strict NICU feeding schedule he was always eager for his next meal (aren't we all, ha). I was always worried about maintaining a supply for him. Occasionally we needed to supplement with formula or, late in the year, we used donor milk. Ultimately, we made it to a year and switched to cow's milk. I was, and still am, very proud of the experience. It was really hard and affirmed my desire to include feeding my next child from my breast in addition to a bottle in the future.

Fast forward 3 years and Rowan is here. Rowan had a great latch from the start, but was admitted to the NICU the night after he was born. His breathing was quick and he had a central line and a gavage feeding tube. A gavage is a tube feed that goes directly into the babies stomach. He needed this because nipple feeds were a little too much for him with his breathing. The first 6 Rowan was in the NICU we could not hold him and certainly could not put him to breast as he was using the gavage. I was not very worried about feeding him once we got home because his latch was great at the hospital and some of the latch problems I had experienced with Kellen weren't there, or I was just able to deal with them better. I started my pumping routine of every three hours to build my supply for when he came home. In the back of my mind I knew that he may have a larger appetite than my supply because of the tube and eventual bottle feeding. Eventually, we were able to hold Rowan and able to feed him expressed milk and formula from a bottle. The NICU has lactation consultants and I worked with them prior to discharge and was given a few nipple shields to help with the transition from bottle to breast. I had previously tried them with Kellen and knew they could help with his latch after he was use to feeding from a rubber nipple. My view on the nipple shield was to use it for transitional purposes and hopefully move away from it after a few weeks.  I felt really good about going home and started feeding him once we were home. However, I hit a bit of the roadblock. My great latcher would latch and then sit there. He would not eat. He would just look at me with his sweet eyes and hang out till he got a bottle of expressed milk. We had to give a few formula bottles because, as it also happened with Kellen, he was eating 4 ounces every three hours when he left the NICU and I was not at the same pace as him. I found this a bit stressful, but kept pumping and putting him to breast. Gradually, his volume went down and my supply went up and we were able to keep up with each other. However, I was pumping a lot at that point and still having issues with him latching and not eating. I was getting really frustrated because I didn't know what to do. I actually almost threw in the towel and went back to pumping. However, I spoke with my Doula and also Rowan's doctor after a few weeks and they both mentioned SNS. SNS means Supplemental Nursing System is basically a feeding tube outside the body worn by the mother to help babies latch and, in Rowan's case, identify the mother as the food source. I met with the lactation consultant and learned to use the SNS. It is pretty tricky and I felt like I needed an extra set of hands to work it. When I finally got it working I looked down and my little baby had pulled the tubing off and was essentially drinking from the tube. Sneaky. I kept up with the SNS for a few days and hated it. I hated how hard it was to use and was getting very frustrated. I, again, contemplated just pumping but really wanted this to work and kept with it. After a few days Rowan stopped ripping off the tubing and started nursing. Actually nursing. I was so excited. I also was able to stop using the nipple shield and that was a big relief. Slowly, all these parts and assists we needed were going away. Rowan still preferred the bottle, but would actually nurse. I am still having to pump after most feeding because he does not always want to nurse long or will prefer a bottle in some cases. This was really challenging for both of us. Rowan needed to identify me as a food source and I needed to give him the time to learn without frustration of thinking how things "should" be. Currently, Rowan is 6 weeks and will nurse or take a bottle. He is a great little eater and I feel so lucky we can keep working on our nursing relationship and it is not a fight anymore.

What did I learn from both of these  post NICU experiences?
1) The NICU is hard and if you can breastfeed your baby after you discharge you are awesome because it is a bbbiiiiggggg learning curve. It was not till Rowan that I realized how much it is essentially starting over for mom and baby once you get home.
2) Prepare that you will have to work to establish whatever breastfeeding relationship you choose while in the NICU. It will be hard because you are not in an ideal situation. Accept that you can't control that and work on what you have the ability to influence or control.
3) Celebrate small victories often. My first was when Rowan latched for over 6 seconds. Relative to now that is very small, but at the time that was a big step for us.
4) Let people in who care about your goals when it comes to breastfeeding. Not everyone will care and that is ok- don't hold it against them. However, the ones that do care, will support you and remind you of why something is important to you- especially if you begin to feel frustrated. They will also praise the efforts of you and your child. Most importantly, they will let you complain to them and you will need this. I think I complained to my friends Emily and Kayla for 4 days straight when I was working with the SNS.
5) Do not beat yourself up if something does not go how you want. Try again next time, or know that you made the best decision you could at the time. That's being a parent- not every hand dealt is a great one and stand behind your choices. This is what I worked for when I was pumping for Kellen and now I am very proud of that choice.

That sums up my breastfeeding journey immediately after the NICU with both boys. My experience with Kellen taught me so much and gave me a  lot of insight on what I liked and what I wanted to do with our next baby.  Rowan and I are still very fresh out of the gate and still working together. I will keep you updated with another breastfeeding post as time goes on, but I am feeling really good so far.

Here is a quick preview of the next week: Hiring a Doula/ Placenta Encapsulation. 

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