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How can I get back to exclusively breastfeeding?

My baby was 12 weeks premature and had a feeding tube and bottles in the NICU. I breastfed some in the NICU but focused mainly on bottles because I thought she "had" to have bottles to go home.

Once we got home I got her breast feeding 100% with the help of a great lactation consultant at her pediatrician's office. I had to return to work a month after her NICU discharge and she got bottles of pumped milk during the day. I noticed she started to seem to "forget" how to nurse and it just got worse. I rented a scale and she was usually taking only an ounce at a time.

Long story short, I couldn't keep up nurse/pump/bottle with working full time so now I exclusively pump and supplement with formula because I don't make enough milk for her to get 100% breast milk. She likes to nurse and I think she gets a little milk but she's just not efficient anymore and most of the time she falls asleep nursing.

Any ideas for a full time working mom to get a former 28-weeker preemie back to exclusive breast feeding? She's 7 1/2 months actual (4 1/2 months adjusted).

Christine Tracy | Other-provider

Christine Tracy

Absolutely she can get back to breastfeeding. It sounds like she may be associating the bottle with food and the breast with comfort.

We know you have milk and that when she nurses effectively, she will get more milk that the pump will. So how can we re-teach her to nurse well?

Flow is the key. When the flow is fast, she will swallow and continue to suckle. One way to increase the flow while she is breastfeeding is by using a supplemental nursing system (SNS) when you are home with her. This is a tube attached to a reservoir of breast milk on one end and the other end is taped close to the end of your nipple. When she breastfeeds, she gets your milk and the milk from the SNS at the same time. If you need to increase the flow, raise the reservoir. 

If the flow is too fast, lower the reservoir. Perhaps the lactation consultant at the pediatrician's office can help get you set up with the SNS. It will save you time because you will not have to supplement with a bottle. It will also increase your production because her breastfeeding will become more efficient and she will empty your breast better. 

It is a good idea to collaborate with your pediatrician, monitor her weight gain and for you to continue to pump right after feedings to make sure she continues to progress. Then re-evaluate your plan to see if any changes can be made with the goal of pumping only when you are at work or separated from your baby.

Read more answers by Dr. Tracy