I just got off the phone with my neighbor, whose baby was born five weeks premature and is now three weeks old (or negative-two weeks old, since she was a preemie). My neighbor is, understandably, obsessing about weight gain, and she doesn't trust that her breasts can produce enough, although her daughter is gaining weight. She is pumping so she can "see" how much her baby gets, she is bored with nursing (baby wants to nurse constantly now that she is more awake), and she has noticed that her baby seems more content when she feeds her baby formula twice a day. So she called me up to ask, "Should I just switch to formula?"

Now, she knows I have nursed both my kids, and that I am currently nursing a toddler. So I think--I hope--that she called me because she actually wants to keep nursing, but has reached the end of her rope. I told her to go in for weigh-ins every two days if she is worried about her baby's weight; to set the alarm at night for 1/2 hour later than she has been, to see if her daughter will wake her up for night feedings now; and to stop supplementing with formula and stop pumping. I told her that nursing is her ONLY job right now, it is all she has to accomplish in a day, and she should rent lots of good movies and just sit around and watch them while she nurses non-stop. *L* I also told her that I have never been in her shoes, so I can't tell her what to do, but that I would never, ever choose to formula feed one of my kids.

I was very careful to be calm and jocular, and to try to put her at ease. I would never judge her harshly if she does switch. But I'm not sure I have done enough to convince her to stick with the nursing. I did tell her about my problems with nursing (namely, constant and brutal nipple pain for six weeks) and how they went away and nursing suddenly became easy. I told her that will probably happen for her, if she just gives it another month.

Is there anything else I can do? Are there some resources on the web I can point her to that talk about nursing preemies? Do any of you have experiences you could share? She needs to talk to someone who has been where she is. She needs to know that she's not crazy, and it's not impossible, and she will be SO much happier later if she sticks with it.

Aauugh, any ideas would be appreciated! If she does switch to formula, I at least want to know I did everything I could to help her keep nursing.

IDEAS PRESENTED:

• This is not my area of expertise, but as far as persuading her... Do you think it would do any good at all to stress to her the importance for bonding and the immune system esp. for preemies and how this is important for growth and thriving, not just weight? Maybe she hasn't thought of it that way--most people don't, we are very hung up on NUMBERS and forget to just watch the baby for signs of health. And also that doing anything feeding-wise other than nursing for at least the first 6 weeks is only going to 1) lessen her supply and 2) undermine the baby's suckling skills, neither of which is conducive to weight gain and thriving!

• Other than giving her all the reading material you can and positive encouragement that you already have...I don't know what else you can do. I would feel confident if it were me and I had provided her with reading material, experienced voices (printing out stories from the 'Net or whatever), a number for LLL!!! and my undying support.

• I just had a similar conversation the other day with a new acquaintance at a support group for parents of children with Downs. Not the same as a preemie, but definitely one group of children that NEEDS all the extras of mothers' milk, KWIM? Anyway, there was this OBSESSIVE woman there who went on and on about how she just knows her daughter (not the one with Downs) is not getting enough milk because she can only pump an ounce at a time. She about fell out of her chair when I told her that a baby's suckling beats any pump out there (provided there is no sucking problem/other physical problem) She truly did not know. In my case, that was all it took to get her to reconsider - I know, it seems so damned simplistic but there were quite a few raised eyebrows so I take it that many people didn't know that... Just thought I would share. I agree with the other posts - and I think so far you have handled it beautifully - just keep offering gentle support and information - and I agree that she must already have some trust in you to have gone to you in the first place. Maybe in the back of her mind she really does want to encourage her to continue nursing so keep it up!

• Good advice so far...one thing to add... When she says baby seems more content after ff does she mean the baby sleeps more? If so this is often because formula is much harder to digest therefore the baby will need more rest to recharge from digesting the stuff. This in turn means that baby may will most likely not gain as much as she would if exclusively bf because she may be sleeping through potential feeding. This might help sway you friend because it will play on her weight obsession KWIM? Anyway it is worth a try.

• Update on the "contentment" thing… Turns out her baby does sleep after taking formula, but she also spits up the formula! I told her that formula is more difficult to digest, so it slows down digestion, which isn't a good thing for babies that need to process lots of calories in a short period of time to "catch up" with full-term infants. Basically, it's the difference between eating sawdust and eating vegetables--sure, the sawdust will fill you up, but you won't get any nutritional value from it.  I also reminded her of the obvious: if her daughter is spitting up the formula, then the formula can NOT account for her daughter's weight gain! This is the kind of "DUH" thing that a new mom who is nervous, especially about a preemie, can easily overlook. She looked like a huge lightbulb had gone off in her head when she realized that! *L* I think it made her happy to know that her milk is "good enough."

• Just to expand on the above. Babies that are exclusively breastfed do gain more weight in the first 4 months of life than a formula fed baby. It also takes less energy for her baby to feed from her breast than it does to feed from a bottle. It has been have shown that premature babies fed from the breast have more oxygen exchange than babies fed from a bottle. And of course the immunity benefits are second to none. Again, like everyone said; the best way to get milk from your breast is from a baby's suckling. There isn't a pump out there that can do what a baby can do! If her baby is gaining; maybe you can reassure her with how many wet diapers and bowel movements the baby is having? I tend to recommend staying away from the scale unless there is a problem. A weekly weigh in may reassure her if the baby is already gaining. Well, I'm going on and on! Good luck with your friend, and it sounds like she's very lucky to have someone as understanding and supportive as yourself!

• you got some great advice - I'd second (or third) the advice about ditching the scales and counting diapers and nursing all day long. Oh and the pump, unless she's a real producer will not get nearly as much as a baby.  The only thing I might consider is seeing if she wants to increase her supply with herbs. Sometimes the only way womyn will acknowldege their ability to produce is to see overproduction. Drink some mother's milk tea and when she can coat the walls with sprayed BM, she might have more faith in her body. Then she can cut the herbs/milk.

• My daughter  was born around 7.5 weeks early. Nursing her in the beginning was very frustrating. Her mouth was small and had a difficult time latching on, she was overwhelmed by my letdowns, and she nursed ALL-THE-TIME. I took her to her ped when she was a few days old to be weighed and so the nurses could criticize my nursing techniques (hussies ), and that was the first and last time I did that!  It was not until I ACCEPTED her needs and let go of everything else, that I was able to enjoy nursing her around the clock. The fact that your friend's baby is wanting to nurse often is a GOOD thing. It means she is absorbing the good stuff in her milk very quickly...she will gain well this way. I would really advise against ffing and pumping too...the air that would get into her tummy from a bottle feeding is NOT good for babe's that small (well it's not good for any babe). As long as her baby looks healthy and is wetting frequently, I would encourage your friend to stay far away from the ped's office....it can be very scary to have Drs telling you that you are going to kill your baby if you don't FF.

• She thought maternity leave would be a vacation; it simply did not occur to her how much having a baby would change her life. (How many of us could have predicted the monumental changes?) And then she has a preemie! She is not someone who sits still for long. In fact, I've never seen her sit for more than five minutes, even in her own house. I can relate to that--slowing down to focus on nursing and nothing else was the most difficult transition to motherhood for me. I told her not to focus on anything else but nursing, that feeding her baby is her only job right now. She is still resistant to that idea, but I know she wants to nurse, so maybe it is sinking in.   What's really strange about all of this is, both her lactation consultant AND her doctor told her to STOP PUMPING AND ONLY NURSE. So she is getting very good advice, but she doesn't trust it. Basically, I don't think she trusts her body to take care of her baby (understandable on some level since she had an emergency C-section because the cord was wrapped dangerously tight around her baby's neck), and I don't think she trusts herself to be a good enough mother. So it is all coming together in her belief that she simply can't nurse a preemie enough to make her thrive.

• My twins were only a month preemie, but both were low birthweight, sleepy and hard to feed at first. The first milestone your friend's baby will pass is the due date - around that time, many early babies seem to suddenly "wake up" and become more active and alert. Everyone else's advice is excellent - I just wanted to add that probably the biggest help I had was a very supportive and understanding DH and mother, who both did absolutely everything in their power to help me cope with nursing. DH would wake up for every feed to help change, burp and cuddle the boys and my mother spent four days of every week with me for the first three months. Both of them supported my decision to b/feed 200% and the word formula was never mentioned. That support helped so much in allowing me to focus on getting the feeding to work and to believe that I *could* do what so many other twin mothers had told me was "just too hard". Looking back, it also made me believe that there was no b/feeding obstacle I couldn't overcome - a pattern of self confidence has been formed. I'm now b/feeding #4, who is 16 mos and loves her milk.  Maybe your friend's family also needs some education about b/feeding? Could you talk to her DH about his feelings and see where he stands? If he shows some doubt, it might be worth giving him the research which proves the multiple benefits of b/milk. When things are tough, particularly with added complications like prematurity, strong family support can make all the difference in persevering. You are doing great work in helping your friend along - wonderful that she's decided to cut down the formula and focus on nursing. You might like to remind her that like everything else, weight has a strong genetic component. My two skinny little babies have grown into skinny, active, highly energetic children - just like me and my brother were, and even my mother.  Finally, I just wanted to add what my cousin was told when she had an emergency C-section at 28 weeks with a baby in serious distress. The neo-natal intensive care specialists said "just make sure she gets your milk - there's almost nothing more important for a preemie baby". I believe that all babies deserve their mother's milk, but babies with any problems need it even more if that's possible.

AN UPDATE:

I printed off several articles and personal stories about nursing preemies, nursing frequently, benefits to nursing, detriments to formula, etc. etc. etc., and took them to her yesterday. (I arrived before yet another dinner party; they entertain frequently, which must be exhausting.) She was appreciative, and told me that after our talk she decided to cut the formula back to 2 ounces a day (she was giving six ounces a day). Hooray! She also said she is going to stop pumping and just nurse. Another hooray!

I talked to a friend of mine who is a midwife, and she told me about a support group for new nursing moms at a local health clinic. So I am going to call about the times and try to take her and her baby to one of their meetings. Maybe introducing her to other moms who are nursing newborns will help.

I have met several of their friends, and I think we are the only ones who are parenting young children. All of the rest are older, childless, or have adolescent children. Maybe this explains why their lifestyle doesn't seem to have changed much. To be perfectly honest, I am concerned about how they are going to cope with the reality of parenting. They wanted their baby, but the reality of having a baby seems not to have sunk in yet. I know this is common with new parents. I guess I never realized that we had become "old" parents until now! *LOL* Thanks again for your help. I appreciate it!