Category: breastfeeding

Baby Emmett, breastfeeding, NICU

NICU day 83

Keeping up with the Hoffmans

We had an okay day on the feeding front. After E’s 22 ml feed last night, he was pretty sleepy overnight so they just pushed the full volume through his feeding tube at his midnight and 3 a.m. feeds. At 6 a.m. he looked like he might be ready to go, but then pretty much instantly fell asleep and only got 2 ml from me. At 9 a.m. he was raring to go and took an impressive 44 ml, though, to make up for it! So I know he’s got it in him; it truly does seem to be a stamina issue. His noon and 3 p.m. feeds were 10 and 12 ml, respectively, and much sleepier. I left to pick up T before the 6 p.m. feed, and will stay home tonight. Anxious to find out how he does with bottles tonight.

Interestingly, there appear to be two schools of thought on how to address the sleepy/stamina issue. Our nurse yesterday and the day before had us attempting breast or bottle every other feed, and just gavaging the others to let him rest. Today’s nurse (a different one), said even if he only gets a few ml and falls asleep, the practice is good for developing those muscles, so we nursed every feed. I can see the merits to both approaches, and don’t know what the best way is. I just wish there were some magic bullet so we could figure this out and go home!

Baby Emmett, breastfeeding, NICU

NICU day 82

Keeping up with the Hoffmans

Feeding is going better. Yesterday we were averaging 17 percent via mouth and today we’re up to 34 percent. They started alternating feeds via bottle and feeding tube, and that seemed to strike a good balance between letting him practice and letting him rest. I went into the office today and got to the hospital this evening just in time to feed him at his 8:30 cares, and he took 22 ml via breast, which is about 37 percent of his feed volume. We still have a long way to 80 percent, but it’s good to see things trending upward.

He gained another two ounces tonight and is up to 7 lbs 1.5 ounces. He’s really come a long way.

Baby Emmett, breastfeeding, NICU

NICU day 80

Keeping up with the Hoffmans

I spent the night at the hospital last night and got up with E at every cares, attempting to nurse. He did absolutely nothing at 11:30 p.m. and 5:30 a.m., which was disheartening. At 2:30 a.m. I thought he actually did pretty well but when they weighed him afterward he had only taken in a measly 4 ml (his normal feed volume is 60 ml). I almost cried. I’m really starting to get discouraged with this whole feeding thing. He did so well last weekend that they were talking about springing us soon, and now he’s totally regressed.

I left the hospital late morning to meet up with some girlfriends for brunch. I brought T with me so he could play with my friend’s kids at her house. It was a good afternoon with good friends and a needed break from the hospital and feeding issues. After T’s nap, he and I went back to the hospital in time for 5:30 p.m. cares. D met us there with dinner and then took T home so I could stay the night again tonight. At one point during our 5:30 feed I had two lactation consultants hovering over me giving me pointers, occasionally grabbing a boob and helping me reposition. It’s safe to say I’ve lost all sense of modesty (or what I had left after birthing two babies, anyway). The good news is, I think we just may be starting to get our groove back on feeding (knock on all the wood). He ended up taking in 12 ml at 5:30 and 22 ml at 8:30. After the single-digit feedings he’s been having, I’ll take it. Please, please let this be the beginning of figuring it out again.

At one point last night Emmett pulled out his feeding tube. I got a picture of him before the nurse put it back in. Seeing him without the feeding tube made me even more eager to get these feeding isssues resolved. He’s so cute with a naked face! He’s up 54 grams tonight, bringing him to 6 lbs 14 oz.

Baby Emmett, breastfeeding, NICU

NICU day 79

Keeping up with the Hoffmans

Today I had to go into the office, and D wasn’t able to be at the hospital either, so E spent most of the day alone. I got here around 7 this evening and checked in with the nurse to get a report on his day. One big brady/desat (reset that clock by 5 days again), and about 50 percent of his feeds by bottle (not too shabby). Unfortunately when I nursed him tonight he only took in 6 ml, which is just 10 percent. It’s frustrating, to say the least. On the plus side, he’s up to 6 lbs 12 oz.

He was pretty grunty this evening. He’s kind of a grunty baby in general, thanks to the reflux, but tonight he seemed especially uncomfortable. When I picked him up, he would calm down, but as soon as I’d set him down, he’d start up again. He really likes to be held. I can’t wait until he’s wireless and I can walk around or go find a comfortable spot to sit and cuddle him. Because he’s tethered to all the monitors, I can’t take him very far, which means I usually just stand next to his bassinet to hold him.

That’s about it for today. Onto day 80…

Baby Emmett, breastfeeding, NICU

NICU day 77

Keeping up with the Hoffmans

Today Emmett took a step backward from the great progress he’s been having. He had one brady overnight, which automatically reset our jailbreak clock back to five days. He also had a lot more desats today. They were all quick and not terribly low, and it’s not enough to put him back on oxygen just yet, but they also wouldn’t send us home if he were still doing that. He was also just really sleepy today and not very interested in eating. The nurse said he was probably just really tired from all the progress we’ve made in a short amount of time, and that this rebound effect is very typical of a preemie after making such big strides forward.

So it looks like we’re not as close to going home as we originally thought. He’s still doing really well, considering all he’s been through. But it was a bummer to realize he’s not going home in the next few days like we thought he may be. That said, this rebound could be short-lived and we could see him start trending upwards again very soon. It’s kind of a wait and see game at this point. He’s up to 6 lbs 10 oz now and doesn’t fit in most of his preemie clothes anymore.

Baby Emmett, breastfeeding, NICU

NICU day 76

Keeping up with the Hoffmans

Today was a good day. As I’ve mentioned before, we’ve done two trials off oxygen before, and both times he made it about 12 hours before he got tired and needed it back. I’m happy to report we passed the 12-hour mark. And then the 24-hour mark. And then they removed his tank altogether from his room because it was clear he was rocking it on his own. Yeah!

Feeds were kind of hit and miss today. I nursed him at every feed except the 2:30 a.m. feed, during which I slept and the nurse gave him a bottle. He’s averaging about 60 percent of his feeds by mouth currently. One was as high as 84 percent and one was as low as 24 percent. So we’ve still got some work to do to get to the required 80 percent over 48 hours. He seems to prefer breast over bottle, which as the nurse pointed out, is a nice problem to have. He will take both, though, which has been the goal all along.

We’ve been talking to Theo a lot about E coming home, now that we’re getting closer. I know there will be an adjustment period while he learns how to share us (or maybe we’ve already begun that since D and I have been splitting our time?), but so far he is really excited. His daycare teachers say he’s been talking a lot about “his” baby too. He’s been asking for a few days to go see baby Emmett so I picked him up after school today and brought him back to the hospital. I nursed E while T sat and played a game on the iPad. Aside from the fact we were in a hospital room, it felt really normal, and I got a glimpse of what it might be like on a random afternoon at home with my boys.

This evening they moved us to the pediatric wing, which we have been told is a springboard for going home. The room is nicer and bigger, and is meant for rooming in (we get an actual bed instead of a daybed/cot), as they like parents doing more and nurses less as we get closer to discharge.

He lost half an ounce at his weigh-in tonight, which is a bummer, but not surprising. Over the past two days he’s gone from having most of his food delivered straight to his belly to having to work for every meal. Hoping he keeps getting stronger and more efficient at eating, so we can finally go HOME. Tomorrow we’ll have been here 11 weeks.

Theo helping the nurse move little brother down the hall
Baby Emmett, breastfeeding, NICU

NICU day 75

Keeping up with the Hoffmans

Today Emmett is 37 weeks adjusted, which means he’s officially a full-term baby now. He did pretty well with his bottles last night and today, and this evening he nursed a full feed. He’s averaging about 60 percent of his daily volume orally, and we need to get to 80 percent before the feeding tube comes out and we start the clock for his release. I was able to clarify the other criteria – five days without a major event – and confirmed it started at last event … which was five days ago (!!!), so we are good to go on that front, as long as he continues to behave.

Today was jam packed at work trying to wrap up as much as I can and organizing all of my projects so I can hand them off. It’s hard because I feel like I’m still catching up after being gone those six weeks after E was born, so I’m feeling a little bit panicked about getting everything squared away for a second leave!

I also gave notice at daycare that we will be pulling T while I’m home on leave. We had debated whether to keep him in or not, and I was initially leaning toward keeping him in at least part time. But daycares are germ factories and we will be playing things a little cautious for a while, so we’ll just keep him home. I’m anticipating extreme exhaustion in my future, staying home with a toddler and an infant. Going back to work may very well feel like a vacation!

They removed E’s nasal cannula today around 11:30 a.m. We’ve done this twice before and both times he’s made it about 12 hours before he gets tired of breathing and needs support again. It’s almost 11:30 p.m. now and he’s still doing well. His weight was good too (he’s up to 6 lbs 8.5 oz), which is a good indicator he isn’t having to work too hard. I like seeing more of his face, and with any luck the feeding tube will be next to go!

Baby Emmett, breastfeeding, NICU

NICU day 74

Keeping up with the Hoffmans

Today we had a major breakthrough on feeding, and they are suddenly talking about sending us HOME soon. I can’t believe I’m typing those words.

This morning, I woke up to one of my favorite nurses bringing us some intersting news. He said he and the rest of the team huddled and we have a new plan: instead of giving a bottle 1-2 times per day and breastfeeding 1-2 times like we discussed yesterday, we’re going to either nurse or bottle feed at every feeding. They think E can handle it and don’t want to lose momentum. So when I’m there, I’ll breastfeed. When D is there, he’ll give a bottle. And if neither of us is there (which is rare), one of the nurses will give a bottle. They subtract whatever he gets from breast or bottle and push the remainder via his NG tube.

So this morning, we started up the weighted feeds again (weighing E before and after nursing to figure out how much he got). At our first feed he took in 14 ml (his normal feed is 57 ml). Second feed was 22 ml. Third feed was 54 ml, and fourth was 56! He took 22 ml via his bottle tonight. Everyone is shocked at how quickly we’ve turned the corner. To think we were talking g-tube surgery just two days ago. If he goes 24 hours taking 80 percent of his feeds by breast or bottle, they’ll remove his NG tube. If he keeps this up for 48 hours, we can start feeding on demand. If he goes 5 days without a major event, we can go home. We hadn’t had anything since Thursday, as far as I know, so I need to clarify when the clock starts, exactly — now or since last event?! He’s still on oxygen, but they are going to trial him off of it again tomorrow. I have everything crossed he handles it this time (third time’s a charm?), but even if he doesn’t, he’s on a low enough level that he can come home with an oygen tank, if needed.

I think we’ve been here longer than any other baby in the NICU currently, and news spread quickly that E may be going home soon. This afternoon, several nurses who have taken care of Emmett over the past 10+ weeks stopped by our room to see us and a couple of them teared up. Of course, so did I. It’s really bittersweet to be thinking about leaving these amazing people who are responsible for my baby’s life. I don’t know how I can ever thank them.

Baby Emmett, breastfeeding, NICU

NICU day 73

Keeping up with the Hoffmans

After a highly emotional day yesterday and facing the possibility that E could need g-tube surgery, I arrived this morning to find out the nurse had tried a bottle on him and that he ate half his feeding! I was very surprised, considering the physical therapist yesterday thought a bottle would just overwhelm him and cause him to shut down. I was initially a little apprehensive about what introducing a bottle might mean for breastfeeding, but to go from thinking he might need surgery to realizing he probably won’t really put things in perspective and I’m kind of at peace with whatever happens as long as he doesn’t need surgery.

That said, we tried breastfeeding later today and he actually did better than before. I talked to the lactation nurse and she said while the conventional wisdom is that introducing a bottle before breastfeeding is established can sabotage breastfeeding, sometimes it’s just the opposite in preemies, and that giving a bottle can sort of kick start their understanding that sucking can result in food. E did so well with nursing today that we’ve decided to start up the weighted feeds again so they can measure just how much he’s getting via breast. Our plan going forward is to give a bottle 1-2 times per day, breastfeed 1-2 times per day, and the rest will be via feeding tube. As he gets stronger we’ll start doing more breast and bottle and less via tube. What a 180 from yesterday.

Overall it’s been a very good day. Hardly any events, starting to figure out how to eat, and a healthy 54 gram weight gain tonight, bringing him to 6 lbs 7 oz. I really needed that today.

Baby Emmett, breastfeeding, NICU

NICU day 72

Keeping up with the Hoffmans

Today I went into the office for half the day and then worked from the hospital in the afternoon. I had a sobering conversation with the doctor this afternoon about E’s feeding progress. I guess maybe I was naive or in denial but I kept thinking any day the light bulb will go on and he’ll figure out how to nurse. But the doctor today gave me some preliminary information about the possibility that E could end up having g-tube surgery. Basically they insert a port in his belly directly into his stomach, so instead of feeding him through a tube that goes down his throat, it goes straight to the source. It’s a semi-permanent solution to chronic feeding issues. In some ways it makes life easier becaue there’s no tube for him to pull out, and while dressed he’ll look just like a normal baby. But… surgery. And the dashed hopes that he’ll just grow out of this. Granted, we’re not quite there yet. The doctor said we still have a few weeks before we start seriously talking about surgery. But the fact that he’s not made any progress after that initial latch a couple weeks ago isn’t good news, either.

The physical therapist stopped by after I talked to the doctor, and I could barely get a few words out to her before I broke down. I’m just so heartbroken. But she’s going to work with us and help us hopefully move toward feeding by either bottle or breast. I had held off on introducing a bottle because I’d really like him to breastfeed — but it’s not even like a bottle would help at this point. In fact, the physcial therapist said she wouldn’t be comfortable giving him a bottle because it would probably overwhelm him and he’d shut down. She gave us a few pacifier exercises to do whenever he’s alert, and then maybe we’ll see if he’s ready to try a bottle in a week or so. Meanwhile, I can keep trying to nurse him a couple times per day. Once we introduce a bottle — IF he even takes it — there’s probably no going back to breastfeeding. But as much as I hate the idea of giving up on breastfeeding, today’s conversation with the doctor certainly put things in perspective. I’ll happily bottle feed over having him go through surgery and feeding him through a hole in his belly.

Of course, we got all this news right before D and I had plans to go to a concert tonight (yes, another one. We had a busy summer planned, thinking I would still be pregnant!). We had a good night out tonight together, though I kept spilling my soul to anyone who would listen. I guess I was a real buzz kill tonight.