The Hunger Games

Do not be alarmed. For those of you who are into the latest fad, The Hunger Games (a movie and a series of books), I will not be writing about children eating children. The NICU continues to supply Elise with enough milk that she doesn't have to start looking at her next door preemie neighbor, David, as her main food supply.

The Olsen's hunger games are much less gruesome, but still filled with worry and excitement. Before Elise can get the 'pass' to go home, she must take all her feedings by breast or by bottle. I mentioned in a few posts back that breastfeeding seemed optimistic with Elise. I know many factors play into a successful breastfeeding bond, but ever since the day when the lactation consultant was with us, breastfeeding has not gone well at all. Unfortunately, many times preemies are started on bottles first, instead of the breast. For one, mothers are not around for every single feeding, so if a baby is ready for a feeding by the mouth, many times nurses bottle feed the baby. Second, it can be quite challenging to breast feed a tiny 4 lb. baby with wires all over the place and no true private/quiet area to relax and bond.

When a baby is given a bottle before the breast, many times the baby gets very used to the instant milk supply. One suck, and the milk comes out of the bottle. The breast is quite different. So far, Elise has not shown patience when we try to breastfeed. She begins to cry and squirm when she doesn't get instant milk. This makes me feel bad, and my stress level rises (at the same time trying to keep the latex gloves on [MRSA regulations] and making sure I don't pinch any wires). I'm sure Elise can feel me becoming stressed. I end up calming her down and giving her a bottle.

I am not going to give up, but it is certainly disheartening after every failed attempt. Like nurse Karrie said, many times breastfeeding goes smoother once a mother and baby are in the privacy of their own home with no wires, no gowns, and no gloves. I plan on scheduling more lactation meetings to make sure I'm doing everything I possibly can to make breastfeeding easy for Elise. Sometimes weight gain and maturity of the baby will help the process. It is easy to forget at times that Elise still has 3 more weeks until she should be here with us. Worst case scenario, breast feeding doesn't work for Elise, but she will still get my milk through a bottle.

This brings me to the next Olsen Hunger Game: Pumping. I've been pumping every 2-3 hours for almost 3 months straight. Sadly, I've started to see a decrease in my supply in the last 2-3 weeks. Before my decrease, I was getting 10-11 ounces of milk per day. I am lucky to get 7 ounces a day now. Elise currently takes a little over 8 ounces a day. Of course I have two freezers full of milk at home that I've pumped while at home and even as far back as when Elise was on the TPN (IV nutrition) and couldn't take my milk. However, the freezer supply will be used up quickly as she continues to grow and requires more and more ounces.

I've talked to the neonatologists and read a lot of research on Fenugreek. It is an herbal supplement that helps many mothers increase their milk supply within 24-72 hours. I started taking the pills last Wednesday and haven't seen any increase so far. It is my hope my body just needs a little more time with the pills than the 24-72 hour window. I'm still drinking lots of water and safely dieting with Weight Watchers for Breastfeeding Mothers. I certainly hope I am not one of those preemie mothers that pump for so long (with no success of breastfeeding) and my milk supply diminishes. This, unfortunately, does happen to some preemie moms who pump many, many times without the closeness of their baby. The body basically says, "I'm over this," and shuts down. However, if this happens,  I will cross that bridge when it comes.

Elise continues to do well with bottles (this is the exciting part of the hunger games!) She doesn't take them entirely, due to being a tiny tot and tiring out quickly, but she is slowly increasing the amount she can take by mouth. The remaining milk is placed on the feeding pump and is pumped directly into her stomach. Once she shows that she can take several bottles entirely by mouth, they will remove her NG tube (feeding tube).

The Game is not over yet....

On Thursday Elise was placed on regular nasal cannula from Vapotherm and did well for 24 hours. By Friday afternoon, she was tuckering out and her breathing was more labored. By Friday evening, the doctors placed Elise back on Vapotherm after a big ol' 5 minute brady when Elise decided she was going to become a blueberry muffin again. I was there to witness this brady. It wasn't pretty to say the least.

This step back to Vapotherm is not huge. Vapotherm will give her a higher flow than regular nasal cannula. Today, after being back on the Vapotherm for 12+ hours, she has already started taking more by the bottle than she has in the past couple of days.

Again, it's a game. The main 3 issues for Elise are to (1) gain weight, (2) take more feedings by mouth, and (3) get off respiratory support. The game becomes that these three issues don't always increase/improve together. If she doesn't have enough respiratory support, she will burn too many calories trying to breathe. Moreover, she won't gain weight and she won't have the energy to eat by mouth.

Grant and I so badly want her to soar quickly through these last few steps of her NICU stay. However, as much as we want her home right now, we want her ready to be home. All we can do is give her our little pep talks and snuggle her close. Aunt Suzi and I were able to do just that today!

"I'm a big girl!" 

Two beautiful ladies

Back on Vapotherm and sleeping peacefully! 

Game on,

G & J & E