So, Thankyou and know that your job is so important not only for the babies you see but for all the mums and inturn the families that you have been in touch with.

My baby is now 11 months old and I am still breastfeeding him. I think of you all the time...

Have a wonderful day. Xxxxx

Nikki

28th September 2017

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Breastfeeding Ashwin (Melanie's Story) sent to me October 25 2013

"Hi Cathy, I don't know if you remember me - I lived in Revesby when you came to help me early 2012. My son Ashwin was still tiny, a little prem baby and I had had to feed him expressed milk in a bottle as he tired easily which then led to breast refusal. You gave me some shields that worked miracles and I was able to get him back to the breast. Ashwin just turned 2 a couple of weeks ago and is still feeding. He never had a drop of formula. In celebration of making it to 2yrs feeding I typed up our story and thought you might be interested so have attached it. Thankyou so much for your help,

 

Feeling like my body had failed my two youngest by not nourishing them properly, leading to the loss of Anil and the premature birth of Ashwin,  it was incredibly important to me to be able to somehow make up for that by successfully breastfeeding Ashwin. I felt it would in some way make up for my failure. Also as a premature baby breastmilk was vitally important for Ashwin – for growth, for immunity, and to greatly reduce his risk of what can be a fatal infection for far too many prems – NEC. It took 5 months until I could say breastfeeding was successfully established.

 

As Ashwin was born at 33 weeks by emergency C-section severely growth restricted (the size of your average 28 weeker, 1.2kgs) and taken straight to NICU I had none of the usual cues to help promote milk supply – nowhere near term, no labour, no baby to hold, no suckling. To begin with he was on a drip with TPN (total parental nutrients) and lipids. Lactation consultants supported me as I began pumping round the clock, every 2 to 3hrs. It was painful with no milk, not even a drop. On day 3 as I stood by his humidicrib his doctors came around and said to me “Your job today mum is to get us some milk for him, he needs to start soon.” I just about fell apart crying….I was trying!!! I was taking fenugreek tablets, had been eating lactation boosting cookies since before his birth knowing this was coming, and still nothing. Finally…finally….later that day a few drops. I had to carefully catch them by drawing them into a syringe. The beautiful thing about NICU is instead of scoffing at the few drops I sent, they treat every drop of breastmilk as liquid gold. That night I was with Ashwin when we noticed his arm swelling, they had to take out his drip as it was going into his tissue and put another one in till they could do a long line. Doctors were there and several nurses, they asked me if I could produce any colostrum, even a few drops for them to give him. There I sat by his crib with doctors and nurses all around, topless, a nurse helping me syringe off a few drops of colostrum. They put them on his tongue and he instantly calmed and was quiet and relaxed through the whole procedure. I was awed at the power of my milk for him, and like many a mother of prems before me, realised that although I felt helpless this, breastfeeding, was the one thing I COULD do for my baby.

 

By the end of the next day I got my first full 1ml, my husband and NICU staff celebrated with me! By the time I had to leave hospital  5 days after his birth I was getting 20mls. Day 8 I got to put him to the breast for the first time. He was so tiny it didn’t seem possible but he latched on and managed some really good sucks! It would be a good couple of days before he would manage that again though. He slowly built up his breastfeeding time till he was finally on full suck feeds (bottles overnight when I wasn’t at hospital). He had slower gains when feeding at the breast and very frothy frequent poos. This was so frustrating as it delayed taking him home. A nurse finally identified that due to his small size and tiring easily he was just taking the foremilk from each breast and not  working for the hindmilk. We switched to only one breast a feed and had some improvement. He finally reached a weight that satisfied the doctors and at 5 weeks old we brought our beautiful boy home!! I had worked hard to build up my supply for him and was averaging 700mls in a day. With him home on full breastfeeds and being only 2kgs he didn’t need nearly that much so the first week as my supply adjusted was very painful with engorgement.

 

Once home he was extremely unsettled and would only sleep on our chests with us propped upright and rubbing his back most of the time so my husband and I took turns sitting up with him sleeping on our chest  while the other slept. We found he had silent reflux and improved a little with medication but was still not making good gains, and sometimes none at all. With him being IUGR (growth restricted) he was extra small with almost no subcutaneous fat – you could run your finger down his thigh and the loose skin would bunch up in front of your finger. It was vital that he begin putting on weight as he had no reserves should he get sick. I was told that due to being so small breastfeeding was too tiring for him and burning too many calories. I had to let him feed for 10 minutes, then pump off the rest of the milk and give it to him in a bottle. All up breastfeeding, pumping, bottle feeding, settling him then sterilising everything ready for the next feed took 2hrs each time. Slowly the amount he was taking from the breast lessened and he was taking more and more from the bottle till he started refusing the breast altogether (right over the Christmas period, this was very stressful being out, trying to put him to the breast, him screaming in frustration but also hunger, me dashing off to a private area to pump while my husband tried to keep a very hungry baby happy, then rushing the expressed milk back for my husband to feed him while I cleaned and sorted equipment). Everyone would make comments about how much he loved the bottle and it would break my heart. I tried breastfeeding in different positions, a supply line with expressed milk in it and all sorts of different ideas to get him back to the breast, but it would end in him screaming and me pumping. Throughout all of this we also had thrush (him oral, me nipple) 3 times.

 

Finally I called a lactation consultant who came to my home. She gave me nipple shields that were very thin, made of silicon and moulded to the breast. The silicon felt like a bottle teat to him and I hand expressed milk into the tip before putting them on so that he got the immediate reward of similar to a bottle. It worked first time!! I was over the moon….we were using shields but we were breastfeeding!! He gained steadily but his gains were low. It took him a full hour to feed with the shields – and we were still only doing one side each feed. I felt that my supply was starting to drop. One day I went with my children to a shopping centre about 40 minutes from home. I sat down to feed him and realised I’d forgotten the shields. He wouldn’t attach at all and we rushed for the car and went straight home with him crying all the way so that I could field him with the shields. I hated that we were so dependent on them and with the low gains knew that we couldn’t keep this up long term. I gradually started to wean him off them, putting him to the breast first without them. In the beginning he’d only suck once or twice before realising there was no shield, but gradually that time increased till we were getting several minutes. At one point after another very low weigh in I had a very emotional day where I cried a lot as I realised that the day had come to make a very hard decision. It was incredibly important that he start gaining weight, and I felt it had gotten to the point where it was selfish of me to keep pushing if it was detrimental to him. I didn’t feel I could express feed full time due to the time that took up – my older boys were already suffering from my being so preoccupied throughout Ashwin’s high risk pregnancy, hospital stay, and feeding issues. My husband had had nothing but support for me throughout this journey but was relieved when I told him that if he hadn’t gained 100gms at the next weigh in I would go and purchase a tin of formula. I worked hard at increasing Ashwin’s time off the shield over the next couple of days but went to the weigh in heartbroken, looking at the chemist I was certain I would be going to afterwards to buy his first ever formula from. Nothing can explain my elation when I saw he had gained 105gms!!!!

We didn’t look back from there, the shields were gone completely within a few days and I delightedly packed up all the expressing and sterilising equipment. Not long after that he began to have regular hospital admissions – 5 times for bronchiolitis, another stay for pneumonia, oxygen studies, swollen fontanel and lumbar punctures, sleep study, establishing CPAP for all sleeps as we found he had severe sleep apnoea, tonsils and adenoids out, infected dermatitis. Breastfeeding was our magical cure all – he fed to sleep so I had no trouble getting him to sleep in busy hospital wards, could always comfort him, was reassured even when he would refuse to eat that he was getting my milk. We fed through it all. Feeding was a comfort to both of us after I watched doctors resuscitate him. After I spent hours with him in recovery as they couldn’t stabilise his oxygen levels. I had to be vigilant about my supply till he reached about 15months. I think this is because of our rocky road to establishing a supply, so never let him skip a feed he’d usually have more than twice in a row, always did breastfeed before solids.

 

He has just turned 2 years. We made it. This was my goal way back when he was a tiny little thing. He is 11.8kgs, strong and healthy. No hospital admissions in 9 months. He is so full of life, so vibrant. He only feeds once a day now, but we both cherish that feed. Every morning he wakes up in his cot which is pushed up against my bed, snuggles in next to me, and feeds. He comes off grinning at me and we both know this is the perfect way to start the day. Through all the ups and downs, since those first few drops on his tongue, breastfeeding has been a comfort. We did it!!

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