A Long Post About Food

It turns out that eating is way more complicated when you are a preemie! I mentioned in my last post that we've been working on breastfeeding for over a month now. I want to remember what a journey this was to get them to start eating, so this might not be the most interesting post to anyone else.

Shawn feeding Abby

When the girls were first born they both got their nutrition through an IV. When Abby was about a week old they let her have just a little breastmilk several times a day, like 1 or 2 mls. (To get perspective on that, there are 30 mls in 1 oz.) Both of the girls were off and on the breastmilk at the first, sometimes their bellies couldn't tolerate it, so they would take them off of the breastmilk, wait a few days, and try again. It was a day of celebration that Katie finally got breastmilk, it took her longer to have any because of her chest tubes. When they were tolerating the breastmilk they started adding calories to it. Of course all of these feedings were through tubes down their throats at first, and then through their noses once they were off of ventilators. The amount of breastmilk they received was based upon their weight, just the littlest bit at a time. 

I've been pumping since they were born. 12 weeks (on Friday) of pumping! I think I could do another blog post just about pumping, but I think I really would be the only one interested in that. I pump 6-7 times a day (though they recommend 10 for twins, but I haven't figured out how to get 10 pumpings in) for about 20 minutes each time. My last pump is a power pump for an hour.  I worked up to 20 ounces per day. (However there was a period when I took some allergy medication and my daily totals dropped to around 12 ounces before I figured it out.) I take most of the milk up to the hospital and occasionally put some in our freezer for the future. 

Abby

About six weeks ago when Abby reached 32 weeks they told me I could start "non-nutritive breastfeeding." That's the point at which a preemie starts to figure out the "suck, swallow, breathe" that is needed for breastfeeding. We started just doing once a day, and I would pump before I starting to breastfeed, so if the girls did get any milk it wouldn't overwhelm them. We started Katie about a week after Abby, she just didn't "cue" as soon. (A "cue would be sucking on her pacifier, putting her hands to her mouth, waking up at her feedings every 3 hours.) After about 2-3 weeks of the non-nutritive breastfeeding, we got to do nutritive breastfeeding! Which just meant no pumping first and we weighed the girls before and after to see how much they would gain and therefore how much they drank during that time. After what felt like weeks and weeks they just weren't getting anything, so we tried breastfeeding with a nipple shield, which makes it easier for them to latch and easier to suck, and they started to get milk! Katie got 19mls the first time we tried it and Abby got 7mls! I did a happy dance that night! It felt like a giant leap forward towards coming home. 

Annie feeding Katie

After what felt again like weeks and weeks, but was only about 10 days the girls STILL weren't getting full feedings from breastfeeding. I would try and try and try twice a day, but the girls didn't seem to be doing any better.  The Occupational Therapists, Lactation Consultants, Nurses and Doctors all talked about this "switch" in their brains, and once it went on the girls would figure out the nursing and do so well.  The switch never seemed to go on. 

Then last Monday I showed up at the hospital and they told me we were going to try bottle feeding the girls. I was so upset! I didn't want to try bottle feeding, I wanted to give them more time to figure out breastfeeding! I wanted the switch to go on first! The OT came and we talked about it. She said the bottle was the best way to get the girls home. And I agreed. And it was amazing, both the girls did amazing at their first bottles, eating at least half of the bottle! Soon the girls were on "cue based" feedings. Meaning, if they woke up for their feedings every three hours and cued, the girls would be fed with a bottle. If they didn't wake up and cue, they would be fed through the NG tube in their nose. And if they didn't eat all of their bottle or get enough breastfeeding, they got the remainder in the NG tube. I still tried breastfeeding every day. It worked! At least they were doing a bottle, but again, not enough to move on to the next step. So, last night they took them a half a step, they took their feedings down from 47mls (a full feeding based on their weight) to 36mls, about 75% of a full feeding. This way they would get hungry between feedings. If they didn't wake up they would get the NG tube, if they took a bottle they could take as much as they wanted, up to the full feeding. 

Katie

And this morning Abigail got moved up to the next step! On request feeding! She has to take all of her feedings orally and won't be given an NG tube unless she misses two feedings in a row. If she does well for 12 hours, they'll try for 24.  If she does well for 24 then they take the tube out, and she is at the final step, on demand feedings! That's the last step before home! 

As much as I wish breastfeeding was going better, I have to say the bottle feeding is pretty nice. The nurses feed the girls if Shawn and I aren't there, and it's great that Shawn can also feed the girls. It will be wonderful to come home and not feel like I'm the only way they're going to eat, like it was with Eliza. We were pretty determined that these girls would take bottles at some point. We're still working on breastfeeding, and I'm definitely planning on doing it at home too.  

So, there's a LONG post about feeding a preemie. It's been such a long road, and it feels so good to be at the end of this long road. Katie is right behind Abby. She had an eye exam today which can make it harder to take a bottle, so she'll start on request tomorrow, or if she does anyway, she'll skip on request and go straight to on demand! Yay! We're close! Just a few more steps and then HOME!