When Nursing Your Preemie Doesn’t Work Out

February 10, 2014
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.