Andrea, I work for WIC and the majority of my NICU moms come home 
bottle-feeding. Maybe one out of ten will try to breastfeed at home. 
Some are told bottles are best. Most of these mothers have zero 
confidence in breastfeeding -- they are not necessarily keen to 
breastfeed in the first place but will pump a little bit because they 
are loaned an electric pump from WIC for free. It makes a huge 
difference when the mothers are told to breastfeed by hospital staff vs. 
the ones who are told to bottle feed.

My biggest irritation is when mothers are pumping some, say 3-4 times a 
day, making very little milk - and the hospital staff tells them just 
pump and bottle feed, don't worry about breastfeeding.  Nobody is 
telling them to pump more often (except me!).

 I do find that most preemies need several weeks to become good at 
breastfeeding. I would estimate that an early good feeder would be 38 
weeks, often they are 42 weeks adjusted before they are doing well on 
their own at the breast. I also find that the smaller babies, say 4-5-6 
pounds like to eat about 1 to 1.5 ounces per feeding. At the hospital, 
the nurses seem to get them to bottle-feed 2-3 ounces but at home, mom 
can not get more than 1.5 ounces. Therefore, I have come to the 
conclusion that smaller feedings for smaller babies is the biological 
norm, not the 2-3 ounces the nurses get down them.

My point is that if mom feels she can breastfeed, she will and if she 
feels the hospital/doctor/nurse feels her baby is too fragile to 
breastfeed, she will not. If the hospital staff is pushing too many 
ounces into the baby at each feeding, the baby often will not 
participate in feedings (rather stays passive and just swallows). Those 
babies do not usually suck at the breast. In my ideal world, staff needs 
to help mothers breastfeed for more than one time before discharge and 
encourage mom to keep pumping 8 times in 24 hours so that she makes 
enough to feed the baby once at home (16+ ounces in 24 hours). Most just 
discharged preemies will need some supplementation as they tire easily 
and self-limit their intake for a while.

The real issue maybe that many health care workers do not know how to 
teach a baby to breastfeed so they naturally are more comfortable with 
bottles. Also, working with newly discharged preemies takes follow up 
and weekly weight checks, plus a good care plan to ensure adequate 
caloric intake, and a pumping plan.

And I have many babies coming home at about 35 weeks who I feel are poor 
feeders. They do not participate, or wake fully, but will swallow on the 
bottle with eyes closed. So mom has them home, and naturally she does 
her best to feed them and this means bottles. If the hospital staff had 
no confidence in breastfeeding at the breast, a mother with a sleepy, 
non participatory feeder will often quickly give up. If she breastfed 
once before discharge, this is disaster. If she was breastfeeding from 
tube feedings like a few hospitals do here, then she comes home willing 
to continue.

Kathy Eng, BSW, IBCLC

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