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@BabyPenguinXO: I also had a 34 week preemie and also struggled to BF. His mouth was too small to nurse efficiently and he had to have bottles from the beginning. I wasn't even given the option of just nursing while he was in the NICU. They told me that breastfeeding actually burns more calories when they are so tiny than they take in, so they really need the high calorie formula to compensate and the early nursing is more to stimulate supply and train them what to do. They only let me nurse for 10-15 minutes at a time so that he would still have time for a bottle before he needed to go back to sleep. We had to supplement with formula and pumped breast milk until he got back to his birth weight...then they told me it was fine for me to try to move to just nursing. Aside from giving bottles the SNS was the only other option and I literally hated that thing (and we were still using bottles anyway, so I didn't stick with that at all).

Honestly, after the struggles we had, if I have another preemie before 36 weeks, I think I am going to just EP from the beginning. It was so so stressful for me to try to do both nursing and bottle feeding combined for every feeding. EPing isn't ideal by any means, but it was so much easier than the nurse, bottle feed, pump cycle. With a toddler at home, I think I will just skip that process completely.

I know that doesn't really answer your question, but I thought I would share my thought process. I hope everything goes well for you!

@BabyPenguinXO: I am sure it depends on the baby! He was born at 5lbs 9oz, so he wasn't super tiny, but when they took out the IV the day after he was born that is when I had to start formula too. He went down close to 5lbs, and he had a day or two where he didn't gain much...but then he caught up pretty quick. We were only in the NICU for 8 days, thankfully.

The SNS is a tube that attaches to your breast underneath a nipple shield. You fill the bottle with the amount of formula/breast milk that baby needs, and then hang it somehow (I don't remember how we did this). The idea is that baby nurses like "normal" with the shield, and gets the food from the bottle without using a bottle.

The LC at the hospital gave us one and showed us how to use it, but I felt like it was the biggest pain in the butt ever. I only used it a couple times. Cleaning was ridiculous, and I wasn't opposed to using bottles so we just went back to that. But I know other mommas have had more patience with it and a lot more success, so it is definitely something to look into! http://www.amazon.com/Medela-009-0003-Supplemental-Nursing-System/dp/B000W73YKY

@BabyPenguinXO: The tube is pretty tiny...I think it is similar to the amount of milk that they would get once your milk comes in, but I could be wrong. Maybe you could talk to an LC during your pregnancy and come up with a game plan. They are so knowledgeable! Your OB or MW may be able to help you get in touch with someone.

@BabyPenguinXO: I'd say feeding on demand (every hour if need be) would be a great thing to do.

Also- see a LC very soon after leaving the hospital to make sure you are on the right track. Don't use pacifiers until bf'ing is going well for at least 4 weeks.

Its possible to rent a baby scale to use at home so you could consider doing that for a week or two if you want to know for sure how much your LO is eating. Good luck!

Re: SNS. We had to do a tiny bit of this when my son was born (similar size to yours, but born at 42 weeks, so the concern was "small for gestational age". It is a teenie tiny tube that they will tape along your breast/chest, and it attaches to a small bottle. I didn't even have to do it with a nipple shield. Was a pain, but a good compromise with the overly aggressive medical team who were so concerned about his sugar levels. Good luck to you

@BabyPenguinXO: nurse I def think it would be great for you to see an LC after you get home. One more expense to worry about isn't ideal, but having a scale (buy or rent) might give you piece of mind!

@BabyPenguinXO: sounds like you son had a really easy going temperament, which is great, except when everyone is freaking out about weight gain!
If this kind of thing happens again I would make sure everyone knows about your breastfeeding goals and request an LC follow you closely. Another option is to have a OT/pediatric feeding therapist do a feeding evaluation to see if there is anything else going on that would contributing to irregular volume intake.

Talk to w LC but it's normal for the amount of milk they drink during the day to vary. So even full term babies might take 1 ounce in the morning and the 3-4 ounces in the mid day. (Ounces for an infant not newborn obviously).

@BabyPenguinXO: OT is occupational therapist. With children they do feeding therapy among other things. I hope things go more smoothly for you this time!

@BabyPenguinXO: No advice on breastfeeding after leaving the NICU, but I did want to comment on buying a scale to measure feeds. Two LCs told me not to bother buying a baby scale on the internet because they aren't very accurate and they are known for driving new moms nuts.

I was told if I was REALLY wanted to weigh my baby before and after feeds, I should rent a medical grade baby scale, or go to the pediatrician's office of LC's office (where they will weigh the baby for free).

@BabyPenguinXO: I would highly recommend you make a plan with the hospital lactation consults before you get discharged. Have them teach you how to do "finger feedings" to avoid bottles. Make sure the doctors and nurses all know about your breastfeeding goals. Remind them every day. Plan to have a lactation consultant come to your home very soon after you are discharged. And also if feedings are inconsistent and you're not sure why, then ask for an OT evaluation. You probably already know this but pediatric OTs do feeding assesments and plans for babies.

Oh and renting a medical grade scale is a good idea. Also many drop-in breastfeeding support groups have scales you can use to weight baby pre and post breastfeeding.

EDIT: hehee opps just realized this is an older post and I already gave you these same suggestions!

@BabyPenguinXO: I am a planner too, the unknown in this case must be really hard!

Does't hurt to ask about the LCs but I know many hospitals do inpatient and outpatient lactations services but don't do home visits. If they have a Lactation outpatient clinic you could go there, but with a newborn its hard to get out of the house! Thats why I suggested having someone come to your home. Also see if there is Le Leche League in your area, you can call the leaders for free advice over the phone (they are usually very experienced with breastfeding although are not certified lactation consultants).