Bottle to Breast after the NICU
Sammi was in the NICU for 10 days after birth, so she started on the bottle. I'll be doing a post on how I got my milk supply to come in while Sammi was in the NICU soon. I attempted breastfeeding a few times in the NICU, but it was clear that we needed a more relaxed environment. So I waited until I got her home to attempt the transition to the breast.
I found that by offering her some expressed breast milk from the bottle at the start of a feed took the edge off, so she was less "hangry" and able to tolerate me offering her the breast. She was very used to the fast flow of the bottles in the NICU, so we also switched her to the Dr. Brown's bottle. Eventually, she figured out how to feed off my breast with the use of a nipple shield.
One day about halfway through that two week transition period from bottle to breast, we "boot camped" her by only offering the breast for about six hours, per my pediatrician's recommendation. ALWAYS FOLLOW THE ADVICE OF YOUR PEDIATRICIAN WHEN IT COMES TO FEEDING. It took about two weeks of patience and diligence to get her to feed consistently off my breast, without needing to be coaxed into a feeding by the bottle.
Baby is Slow to Gain Weight
Early in our breastfeeding experience, Sammi was very slow to gain weight. My doctor told me never to let her go more than three hours without eating after that first boot camp, because of the slow weight gain. Sammi has never woken up to eat at night. She prefers to sleep for 6-7 hour stretches, only having woken up at night a handful of times.
My doctor was recommending that I wake her for at least one nightly feed, but after attempting this a few times I found I wasn't successful at getting her to eat at night. Even when I would change her diaper and other things to rouse her, she just fussed and went back to sleep. This is just how she's wired. Despite my attempts to apply our pediatrician's advice, Sammi's never been a night eater.
I shared this with my pediatrician and lactation consultant, and they both advised the same alternate course of action. Instead of trying to force a night feeding, we focused on making sure she was getting at least 7 solid feedings in during the day time. After a lot of experimentation, we found a combination of breast and bottle feeding (all breastmilk) was the best solution to help her put weight on. It took a month for Sammi to get back to her birth weight. It wasn’t until around 2 months that she began to gain weight at a consistently healthy rate, once we'd figured out the right combination of feeding modalities.
Using a Nipple Shield
Sammi fed off a nipple shield until about 10 weeks old, never able to latch on a bare breast. I worked with a lactation consultant several times to successfully get her to feed without the shield.
We identified that she had an upper lip and both anterior and posterior tongue ties, which were the main obstacles to her being able to latch without a shield. More on how we addressed those below.
Both my lactation consultant and pediatrician encouraged me to not worry about the use of the shield during this first 10 weeks. Because Sammi was a slow gainer, it was much more important that she eat, period, than that she eat in the way I wanted her to. Feeding without a shield moved way down the list of issues I wanted to address until later in our journey.
Supplementing with Bottle Feedings
While her weight gain was slow and we were working on feeding issues related to her ties, I was going back-and-forth to the pediatrician for lots of weight checks. At one weight check, a different doctor at our pediatric practice came down on me for not switching to formula or bottle feeding. I was enraged.
We had been deprived of so many experiences because of her NICU stay, such as me being able to hold my baby right after birth, or have skin-to-skin in the first 24 hours. I was resolved that we wouldn't be formula fed or feed exclusively from the bottle. This may make sense for some families, but it didn't feel right for us.
I did ultimately decide to give her expressed breastmilk via bottle for a few feedings a day. I fought this, because it was so challenging to get her from bottle to breast initially. I finally relented at six weeks, when she still wasn't gaining weight quickly enough. I was pleasantly surprised to find she went very easily between the two, sometimes even during the same feeding. No nipple confusion at all!
Tongue Tie and Upper Lip Te Revisions
At about two weeks, we had a frenectomy done on Sammi's anterior tongue tie. This didn't really make a big difference in her ability to latch or feed. She continued to gain weight very slowly for the next month, when we decided to do a second revision, this time more drastic.
We had her lip ties (all three on the upper lip) and further, posterior tongue tie revised at around 8 weeks old. We diligently performed exercises to help proper healing. The same doctor who had told me to switch to formula (jerk) told me that tongue and lip ties are a "fad." Well, I can definitely say from our experience that they were a very real obstacle to her latching, and it was necessary to revise those ties before we were able to latch on a bare breast.
My regular pediatrician verified that the ties existed (as did my lactation consultant). They both encouraged me to get the procedure done, not only for feeding but because ties can also contribute to speech impediments later in childhood. ALWAYS FOLLOW THE ADVICE OF YOUR PEDIATRICIAN WHEN IT COMES TO REVISING TONGUE AND LIP TIES. But find a doctor who is supportive of you trying to breastfeed, even when difficulties arise.
Successfully Weaning Off of Nipple Shield
Truthfully, I wouldn't really say we "weaned" Sammi off the shield. She weaned herself when she was ready and we'd performed the procedures to free up her ties. After the ties were revised, I kept offering the bare breast not quite every feeding, but at least a few times a day. By 10 weeks and a few days, she just popped on my bare boob one day, as if she were saying, "I know how to do this now." She decided she was ready, not me.
At 11 weeks, we're now successfully gaining weight and feeding off the bare breast for several feeds a day. She takes only breast milk, but by giving her at least 3 x 4-oz of expressed breast milk from a bottle, we ensure she takes a sufficient volume of milk each day. This has helped her to gain weight consistently.
My lactation consultant has suggested that she may develop a stronger suck as a result of getting more milk, and having her ties revised, so one day we might be able to scale back on bottle feeding.
Weaning Off of Bottle Feedings
Once she's been gaining really strong for at least a month or so, I would like to see if we can decrease her reliance on the bottle feedings. But I'm not going to force it or do anything that slows her weight gain. Until then, I'll continue to do her "suck training" and give several bottles until we feel that she's strong enough to feed off the breast for a majority of her feedings.
In some ways it's more convenient to feed Sammi from the bottle, when we're out and about or traveling, or when I need a break and want to hand her to someone else to perform the feeding, like Daddy or Grandma or other care giver. So in reality we probably won't ever fully wean, but it would be a better quality of life for us both to do less pumping, cleaning, and mishigas around those bottle feedings. But I'll do it as long as it remains necessary for her well-being.
Should I Breastfeed?
It is such a deeply personal choice to breastfeed or not. For some families, it's just not the right thing. For me, I've never felt there's an alternative. In my bones, it just seemed like Sammi needed to be able to breastfeed, and so we've committed tremendous time and resources to make this happen. But every family must do what is right for them. And you MUST follow your doctor's advice navigating this journey. That said, find a doctor who is willing to support you in trying to breastfeed, if that's what you want to do.
Here are the resources we used to succeed with breastfeeding, in the way that makes sense for us!
Northern Virginia Lactation Consultants
Smile Wonders Pediatric Dentistry
Do you have questions about breastfeeding? Or an experience to share? Leave it in the comments and let me know!