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Micro preemie mom needs lactation help

An off lj friend of the family delivered a micro preemie (24 weeks, 1 lb and change) yesterday and is having trouble getting lactation started. She has a hospital grade pump that she is using every 90 minutes, and my MIL is heading over to the hospital to bring her some fenugreek tablets and I've suggested asking for reglan.

What else can she do? She hasn't produced so much as a drop yet.

ETA: My friend is working with lactation consultants at the hospital, and I will be cutting and pasting the replies to send to my MIL, who is visiting back and forth while the rest of Audra's family travels to her and the baby. Obvs, the relatives weren't quite ready to make the trip.


( 24 comments — Leave a comment )
Nov. 8th, 2012 02:14 pm (UTC)
Frequent pumping is key. It takes time to bring in one's supply.

I am guessing at 24 weeks, the baby likely can't be taken from its incubator, so skin-to-skin is out of the question, currently.

The NICU my child was in dealt with micro-preemies. Talk to their nurses and lactation consultants. Also, not milk supply establishment related, but request milk bank milk, if they aren't already doing it.

Edited at 2012-11-08 02:14 pm (UTC)
Nov. 8th, 2012 02:16 pm (UTC)
Drink lots of water. Hospitals are extremely dry to prevent the growth of bacteria, but milk is mostly water.
Nov. 8th, 2012 06:07 pm (UTC)
I advised water, water, water - I'll add milk bank.

Thank you.
Nov. 8th, 2012 08:51 pm (UTC)
Make sure she's also eating plenty of varied nutritious food. Some hospitals are better than others with that, so if others can bring in food for her, that could help.
Nov. 8th, 2012 02:14 pm (UTC)
I had a preemie (not nearly so early) It took 3 days for me to get so much as a drop. Try mother's milk and remember to remind her to relax.
Nov. 8th, 2012 03:39 pm (UTC)
Hell, first go-round I didn't have a preemie and it took 5 days for my milk to come in.

If she just gave birth yesterday, I would be surprised if she was getting much and am not at all surprised that she's not getting anything.

Water, water, water. Mother's milk tea is fantastic. I would recommend trying different breast shields--I had extreme pump resistance with my oldest and found that the SoftFit shields from Medela allowed me to get *something*. I know skin-to-skin isn't going to be an option, but see if she can get a blanket or a hat that her baby has been wearing so she can have the scent.

Good luck! I'd offer to donate if I had anything left.
Nov. 8th, 2012 06:08 pm (UTC)
I'll add shields to the list, and baby blanket.

I could only ever pump while looking at the baby, I'll see if they'll let her pump in the actual NICU.
Nov. 8th, 2012 02:33 pm (UTC)
Another option is to look into domperidone. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC80627/

And donor milk for the interim, if need be - I've heard that hospitals now offer it for preemies. If hers doesn't, she may want to investigate her options further.
Nov. 8th, 2012 02:36 pm (UTC)
Yes, definitely make sure that baby is getting human milk. The risks of formula for preemies are much greater than they are for healthy full-term babies.
Nov. 8th, 2012 06:09 pm (UTC)
That's the one I couldn't remember, thanks.
Nov. 8th, 2012 02:34 pm (UTC)
I don't think that herbs, etc. are necessary - at least not at this point, and side effects need to be considered (Reglan can cause depression). It generally takes at least a few days for a first-time mom's milk to switch from colostrum to mature milk. If she's trying to collect colostrum, she may have more luck hand expressing. Frequent pumping with a hospital-grade pump is her best bet, along with patience, as much rest as possible, and any skin-to-skin contact that is possible, whenever it becomes possible. She definitely needs to get in touch with an IBCLC; the hospital should have one.
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Nov. 8th, 2012 06:12 pm (UTC)
This was super helpful, thanks. She's in the NYC area. (Hartsdale, in case that means anything to you.)

I'm glad to hear from another micro preemie mom, I know that my personal experience is not relevant here.

Nov. 8th, 2012 03:49 pm (UTC)
24 hours after delivering a micro preemie, I'd be surprised if she was getting milk, they certainly won't start reglan at this point. It sounds like your friend is doing everything right, frequent pumping is key. If she's feeling up to it, pumping close to the baby can help with kick starting the milk supply, if she's not, or if her NICU doesn't offer that option she should ask the nurse for a blanket the baby's been laying on that she can hold by her face while she pumps. The baby's scent is going to trigger the chemo receptors in her brain and that can help with early milk production, if she can look at a picture of the baby while she pumps that might help too.

When a mom delivers so early it tends to take several days before she is able to get milk. It will also likely be at least a few days before the babe is ready to start getting feeds, and when they do start, it's going to be tiny amounts and only every 3-6 hours. At this stage the feedings the baby receives are to prime the gut with flora, not for nutrition so even if she only gets a couple of drops here and there at first that's ok.

The hospital is going to try and wait for mom's milk before initiating any donor feeds, like i said the aim of early feeds in a micro preemie is to prepare their gut so what your friend is producing is going to be far more beneficial than donor milk. Eventually if she is not able to produce, donor milk is a superior option to formula. Right now the babe is getting the bulk of his/her nutrition through their IV.

Best of luck to your friend and her baby.
Nov. 8th, 2012 04:03 pm (UTC)
What everyone else said. Also, she needs to be pumping round the clock, trying as close as possible to mimic how a newborn would be nursing. 3-6 hours is likely too long. I would say 2-3.
Nov. 8th, 2012 04:13 pm (UTC)
She needs to learn about early colostrum collection, rather than pumping. It's proven to increase milk production for prems. Also, she should NOT be pumping every 90 minutes. Her prolactin levels will increase while she is sleeping. She should be pumping every 3 hours, MAYBE every 2 hours, but she simply must be getting enough sleep.

The NICU is a marathon, and pumping every 90 minutes is sprinting. She has just given birth. She needs to recover. And they likely won't be giving a 24 weeker oral feeds immediately, anyways, and if she wants to give breastmilk, they will probably hold feeds and give just parenteral feeds until she's got some supply.

(I'm a NICU RN, FWIW).

Edit: Also, because I'm sure someone will mention it, do NOT tell her to take Fenugreek. It can cause hypoglycemia in babes under 34 weeks gestation, and she should confirm even that with her lactation consultant that works with her NICU.

Edited at 2012-11-08 04:24 pm (UTC)
Nov. 8th, 2012 04:44 pm (UTC)
I didn't know that preemie-specific fenugreek information, though I did know that it could cause hypoglycemia for moms, so thank you! Yet another reason why I am on the "galactagogues after trying everything else" train.
Nov. 8th, 2012 06:14 pm (UTC)
Thank you for that - I had serious hypoglycemic shock with fenugreek, I didn't even THINK about what it could do to the baby.

Sending a text RIGHT NOW!
Nov. 8th, 2012 04:45 pm (UTC)
i'm just going to park it right here on this comment.
Nov. 10th, 2012 06:08 pm (UTC)
I agree with this.
Nov. 8th, 2012 05:21 pm (UTC)
It sometimes takes a couple days for the milk to come in. Keep trying for at least a week!!
Nov. 8th, 2012 05:37 pm (UTC)
What everyone else said.

The only thing she should be taking is more water and more sleep.

With my first it took 3 days for my milk to come in, and she was term.
Nov. 10th, 2012 03:58 am (UTC)
I had a baby girl (stillborn) at 25 weeks and my milk came in about 3 days later. I had a 13 month old who was nursing a few times a day but nowhere near a newborn, but my milk still came in without pumping. She should try to collect the colostrum but I wouldn't start supplements or anything yet, with my first baby it took 5 days to come in. Anyway, her milk will come in like normal and I too would say pump every 2-3 hours to mimic a new baby. :)
Nov. 10th, 2012 05:37 am (UTC)
When I had my twins at 28 weeks, it took about four days for my milk to come in. When I had my most recent baby at 35 weeks, it took a little longer. I was completely freaked out about it, too, because he was in the NICU and his blood sugar was low so he had to be supplemented. I just kept pumping pumping pumping and it finally happened.

I was allowed skin-to-skin with my twins (one was also below two pounds). It's just going to depend on the hospital, whether or not they allow that and what their rules are. She should definitely ask for it as often as possible. In our case, they just put warm blankets over us but I was pretty well allowed to hold them whenever I wanted it and they encouraged it as often as possible.

She's in for a long road, bless her. Ask if the hospital has a support group, some do.
( 24 comments — Leave a comment )


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