Breastfeeding a Preemie?

My twins were preemies and breastfed. They stayed in the hospital, which meant pump. The NICU will give the baby the breast milk if you bring it, they will also offer pumps there and let the baby start to breast fed once she is strong enough. It might take longer for the milk to come in, my milk didnt come in for 2 weeks, there are vitamins you can take to increse milk flow. Hope this helps.

grab Dr Jack Newman's book ("The Ultimate Guide To Breastfeeding"?? i think is called) as he is a FUND of info and the best in North America for breastfeeding advice. You can go to his website as well and email him questions! He's great!! good luck...its worth it!!!

Make sure that her feeding goals are well established. Then have her get in contact with a lactation specialist ASAP!!! Where does she live? Bottom line, she needs to pump. It is recommended, but not limited, to pump every 2-3 hours.

Tell her she can email me too if she wants.

M. B.
Registered Nurse
Certified Lactation Educator
Loma Linda University Medical Center

I delivered my son 6 wks. early and they told me to only nurse twice a day and pump the rest of the time and feed him the breast milk through a bottle. They stated the reason being was to make sure he was eating enough and to monitor the amount, but yet still getting the benefis of breast milk. I know that it is difficult to have a preemie and you want that bonding experience, but I think that it is more important to get the benefits and worry later if they will take to the breast. Luckily my son was 5 pounds at birth and now at 2 years old, he is in the 100% for height and 92% for weight, so it must have worked. Good luck to them both.

Well, I guess that I was lucky cuz my preemie was born @32 weeks but weighed 5 pounds 11 ounces. He did have to stay in the NICU and a hard time with latching on and sucking reflex at first. I had to pump as well as breastfeed. Don't give up! I was able to go to the hospital 3 times a day, pumping in between so that the nurses could feed him only my breastmilk. It was an easy transition for him once he got home cuz he didn't have formula to compare to.

My son was also born at 32 weeks 3lb 7oz at that time the doctors had me pump for about a month until he could catch on to breastfeeding. He did very well and to this day never has had any medical problems. My son is now 23 years old 6'2" & as healthy as can be. Good luck & God Bless

My 5 year old son was born 6 weeks early (34 weeks) and weighed 3 pounds 6 ounces. My little guy was healthy but stayed in NICU for 3 weeks. I wasn't allowed to breast feed at first, they were feeding him through a tube they put down into his stomach. They wanted to record any little drop he ate. So I pumped like crazy..it was all I could do for my little guy. They let me breastfeed once in awhile. But they moved to bottle feeding. So when he came home at 4 pounds, he loved breast milk from a bottle...it was easy for him. I did everything you can imagine to help him learn to breastfeed. I even rented a scale so I could see how much he ate (before and after feeding weight) and make sure he wasn't loosing any weight since he was so tiny. I did a breastfeeding system where you fill a special bottle with breast milk, hang it around your neck and tape these small tubes to your nipples so he would get instant milk but also practice breastfeeding. The tape hurts so bad when you have to peel it off. So we (my husband and I) started taping it to our finger which gives them the same practice as on the nipple. I think he finally decided he didn't the tape feeling in his mouth and the day I thought I'd give up, he took right to my breast. I worked with a lactation specialist which helped. She had a clinic women go to to breastfeed and she gives pointers and weighs each baby. I don't know if your cousin has any brestfeeding resources near her. But my biggest advice is to be patient and if she's losing the joy of being a mom because of being frustrated, her baby would still be fine if she has to bottle feed. It would not be the end of the world!! :) It's so hard for mom with the hormones out of wack and the lack of sleep! I've been there!! Good luck!! Hope I've given helpful info.--A.

My first son was also born at 32 weeks. He weighed in at 4lbs 3oz. I saw the lactation specialist at our hospital, and they tried everything with my son. I had a tube taped to my nipple than ran from a container of breast milk around my neck. That didn't work so well. Then they gave me gadgets to put on top of the nipple to make it easier to latch on. That didn't work. By the end of all these "tricks" to get him to breastfeed, he took the bottle the best. I didn't want to put him through anymore struggles. After 3 months I switched to formula, and he is one of the healthiest children I know. The doctors said that he could have developmental delays because he was so early, but I am proud to say he tested in the top 3% in the country! Tell your cousin to do what feels right. The bottle IS NOT a bad thing. I bonded with my son like any other breastfed baby. Bonding is about the love you share and give to your child, not wether they feed off the nipple or the bottle.

Check with your PedMD, but you'll probably have to pump and use preemie nipples for now. Latex makes a great nipple for this... Our preemie is now 20 years old.

My son was a 34 weeker who weighed 3 lbs 14 oz. Breastfeeding was not too easy as I anticipated it to be. Being that small they burn a lot of energy doing it so I decided I would rather pump and bottle feed him so that I could monitor how much food he was getting and make sure that he was gaining weight. I pumped non stop and only latched him on once a day for a short time just to keep my milk coming in. The key is to pump regularly and still get them to nurse just a little to keep the milk coming. I was not good at this and my milk ended up drying up a month later. Good luck to your friend. Also let her know that that little 3lb baby will grow to be a 23lb baby before she knows it! Trust me. . .A.

Hi R. - My daughter was also a premie and was only 4 pounds when I brought her home. I found the easiest way for both of us was to lay down on the bed facing each other that way my breast didn't sufficate her tiny face. If I had to be in a chair I would use my boppy and keep her propped up so she was in a sitting position. Both of these worked great for me and she gained weight at a rapid pace. Just let your cousin know that since she is so little she will eat at smaller intervals. My daughter was hungry every two hours for the first three months. My best wishes.

To help with the suckling our dr told us to try to use a pacifier to help work the muscles and the motion with our premie. It was a little rough because he had no interest in the pacifier. You did not speciphy where she was actually having problems, so I will toss this out there because it worked for me...I was having trouble with latching. Each nurse & specialist had a "secret" method - and it was becoming too much for me trying out all the different ways. Then my husband sat down and watched me feed our son and he realized that when the breast is filled with milk the nipple does not point straight ahead, nor does it sit perfectly in the middle of the breast. Once we solved the angle of positioning the baby he took right to the breast. Something else I did for the first few weeks was to pump just before feeding to help enlarge the nipples making it easier for him to grasp. Before long he was a natural at it.

It can be done. If the sucking reflex is there the baby will usually respond.
My daughter, born at 30 weeks, was gavage (sp?)tube fed for 2 weeks. This was done to conserve her energy so she did not burn calories while feeding.I pumped and gave the hospital the breast milk to give her so by the time she was ready to nurse I had enough milk. Be very careful not to pump too much.

the most important thing you can and need to do , is make sure YOU are getting the proper nutrients into your body.
Diet alone cannot provide the essential minerals your baby will need to develop.
I was taking EXTREME X20 throughout my prgnancy. You add it to your water. It is based of Calcium, Magnesium, Potasium, and over 70 minerals..This product does NOT have to be digested as because of its structure, it INGESTS straight into your body the moment it enters your mouth.
Tyler was a preemie at
5 lbs 11oz....3 months later, he is 15lbs and so healthy and developed, the Doctors and Nurses are dumbfounded, and he is going to be featured on the Miracle health network.
send me an e-mail, ____@____.com, or go to the website www.xooma.ca

My daughter was born at 30 weeks. She's now almost five now and healthy, smart, and beautiful. While in the hospital, I pumped and she was feed first through a feeding tube and then with a bottle. Once home, she would breastfeed in the middle of the night but not during the day. I pumped for six months to keep her on breast milk. It was very time-consuming and demanding and difficult. Your cousin may be lucky and her daughter will breastfree with success. However, it is more common for preemies to never breastfeed because they have the bottle in the hospital (necessary to determine exactly how much milk the baby is receiving). Your cousin may be in for lots of pumping if she's committed to giving her daughter breastmilk.

Hi R.,
I had a premie, he was in NICU for about three weeks and got used to the bottle. I pumped like crazy while he was in there because it took a while for me to get milk. Tell your cousin to make an appointment with a lactation counsaltant as soon as she knows when her baby is going home. The counsaltant will help her and the baby make the transition from bottle to breast. I had to take "more-milk plus" tea and used a nipple shield. It took my son about three weeks after he was home to be breast fed. I still use the nipple shield because he has the tendency of holding his tongue up and it makes it hard with just my nipple to bring his tongue down. He also doesn't finish eating in 15 min. , he takes 20 to 25 min. per side. Let her now that her preemie might take longer because the sucking tires them out.
Tell her to be super patient and if after she tries she doesn't succeed is okay. If she has Kaiser insurance, tell her if she can purchase the pump from them. I got my Medela for under 200 and free nipple shields.
good luck,

Hi, there - My son was born @ 29 weeks and weight 2 lbs 8 oz. He was in the hospital for two months, but, they didn't let me breastfeed until he was just about 4.5 lbs and off all the crazy tubes (approximately 1 week before he came home). In our NICU, and hopefully in your cousin's, they usually provide you with a great lactation specialist to help teach you how to breasfteed such a small baby. In fact, if I'm not mistaken most hospitals should have a lactation specialist, even for the regular maternity ward. She should definitely look into it as I found it extremely helpful!

My son was also born early and the best thing I could have done was to breastfeed. The only thing I can recommend is to have patience and to rememeber that in time things will get easier. The 1st couple of weeks were the hardest for me.

What really helped me was going to a weekly lactation class. It was run by a wonderful lacation consultant who was very supportive. Also meeting with other moms who were also breastfeeding and had issues was a wonderful support group. Even though breastfeeding has gotten a lot easier I still attend the sessions at least 1-2 times a month. I go in now mainly to get him weighed to make sure he is gaining the proper weight.

Let me know if you want the information on the classes. You can email me at ____@____.com

hi,

my daughter was born at 29 weeks and was 2 and a half pounds. i had to pump my milk until she got the hang of breastfeeding which was right around her due date. we also did lots of kangaroo care in the hospital which saved me (and her)!!! my milk supply dwindled a bit at the end and we had to supplement with some formula. but she got it eventually and we are still breastfeeding at 22 months! i'm glad i perservered because i hated pumping, but it was worth it!

take care,

R.

My daughter was also a preemie baby at 32 weeks. She weighed 4 pds 12 oz and dropped down to 3 pds 7 oz that was scary... She was in the hospital for 2 weeks which should of actually been 2 months. I was pumping and freezing my milk and when i would go visit her in the hospital i would take it with me and they/I would feed her breast milk. My advise to your cousin would be pump don't give up and you will see how strong and how much weight she will gain and as well see how healthy she will be.
Ihope this helps.......

Dear R.,
First of all congratulations on the new birth in your family! When babies arrive so early they are so much more vulnerable and need to be cared for in as close to 'still being in the womb' as it is possible. Have your cousin research Kangaroo Mother Care to optimize her new baby's growth and get her off to the best start possible http://www.who.int/reproductive-health/publications/kmc/.
Best of luck!

G. Andrews, Mom, IBCLC
The Lactation Connection
Redlands

Hi R.!
I gave birth to my daughter at 34 weeks. She weighed a 3 lbs and 2 oz. It was hard for her to latch on. What you need to do is be patient and don't let anyone discourage you from breastfeeding. It takes time for baby to latch on. Other than that, you may want to pump your breast and feed through the bottle every other feeding. That way she will be trying to latch on and at the same time she won't get so hungry. Hope this helps to encourage you to keep on.

My youngest daughter, now 28 and married, was a 28 week premie, so this is something I remember well! She was in the NICU for 3 months, and during that time, I had to express milk, freeze it in tiny amounts and transport it to the hospital in batches they kept on hand. Once she got home, weighing in a a whopping 4 lbs., the thing I remember was that she needed to be fed more often than my other two children were and that breastfeeding took longer. My pediatrician encouraged me to express milk (I used a breast pump) and continue to store it in the freezer so that she could also be fed by bottle, using tiny premie nipples on the bottles. Do tell your cousin that when her baby comes home (if she isn't home already) she should expect feeds to take longer, happen at more frequent intervals, and that she should be VERY patient with herself! If her house isn't perfect, the world won't come to an end, but she will need to allow lots and lots of time for a premie's care, and she'll need to get a lot of rest to do it! I hope her baby is healthy and strong and that everything goes well. Tell her that my little gal came home at 81 days, was an A student in high school and college, played volleyball, got a college degree in political science and is a beautiful, healthy young woman! Most babies born at 32 weeks turn out just fine!

Good luck...C.

Hi R.,

Breastfeeding a premie is a real challenge and Moms who are doing this need lots of support. Some of the challenges are keeping the milk supply up, working with a baby who will run out of energy to suck.

Here are some suggestions. I'm assuming baby is still in the NICU? If so, mom needs to try some special techniques. Here's what I know works.

1. Mom's need to take care of there own needs in order to successfully care for the others around her. Good nutrition and lots of fluids is a must. Mom's trying to get breastfeeding started need to drink at minimum half a gallon of water each day. That's aside from other fluids she might drink like juice, milk, etc. Also keep taking those prenatal vitamins over the months that you breastfeed. Some foods that help stimulate milk production are oatmeal and an herbal supplement called Fenugreek. It comes in tea form or capsules. The capsules seem to work better but you have to take 1 to 2 three times a day. Check your local vitamin store.

2. Keeping up the milk supply is a challenge for every mom who's beginning breastfeeding. It gets better as both mom and baby catch on. Have a regular schedule for pumping milk or feeding, about every 2 - 3 hours during waking hours. Don't pump right before feeding though only when baby isn't available (in the NICU), or immediately after a feeding. Mom needs her sleep at night; and if she can steal a nap during the day, all the better.

3. If baby is still in the NICU, arrive for visits 1/2 hour before feeding. That gives Mom a chance to take some time with baby (change diapers, etc) and interact with baby to bring him/her to an awake state by talking, touching and having fun. Do cuddling right now, baby needs to know there is a job to be done. Then he/she will be more focused on nursing.

4. A. When baby is rooting, or when it's time to feed (premie sometimes aren't that assertive), place the baby tummy to tummy with mom's exposed breast. It helps to tuck the baby's arm that's hanging down under mom's arm, and baby's other arm can cuddle Mom's breast. Baby's face, and particularly his mouth, should be lined up with Mom's nipple so his head isn't tilted too much; up or down. (try drinking something with your chin tucked down onto your chest, not so good, right?) This position allows plenty of room for baby's breathing and comfortable swallowing.

4. B. Okay, here's the fun part. First, Mom needs to grab her nipple with the thumb and forefinger of her free hand and pull the nipple out. (It needs to be hard and elongated. Baby's find the nipple by smell and the feel of a hard nipple against their lips.) Once that's accomplished move your free hand (Palm up) and place all four fingers under the breast with your pinky toward your chest, and the thumb around toward the top. Don't squeeze the nipple because it will retract, and baby might have a hard time latching.

4.C. Sit upright and bring the baby to the breast. (a pillow under the arm craddling baby helps to elevate baby to a good position and saves Mom's back) Brush Mom's nipple against baby's lips. When baby's mouth is open and is tongue is out, try to get the nipple into the baby's mouth on top of his tongue. Now hold baby close. **A premie, and even a brand new baby, might not begin sucking immediately. They sometimes even have a perplexed expression on their faces like,"what the heck is that". Don't remove the nipple and don't worry, baby is not rejecting you. He's just getting his barrings. Keep talking to him, encourage him, stroke is cheek, his head and keep him awake. A premie might need a little chin support to start sucking. Chin support is when you take you finger and place gentle pressure in the soft part under the jaw. You might gently stroke that area from back to front of the baby's jaw. This elevates baby's tongue,brings it forward and stimulates the sucking reflex. That usually does the trick. Now you see why your Mom always said she needed an extra pair of hands? Once baby starts sucking, sit back, relax, and keep talking with baby. Mealtime should be a time to talk and interact. ***Premies have to be careful not to use burn more calories than they take in, so feedings need to be time limited to conserve calories. Nurse 10 - 15 minute on one breast, burp the baby and switch to the other. This is a challenge for premies because they usually "run out of gas" with the first breast and are less vigorous, or just too tired for the second one. That's okay. The whole feeding should be limited to 30 minutes. That means from step 1 to now) is 30 minutes. Once baby grows more and is more efficient with breastfeeding, you can hang in there a little longer. Once he get a couple weeks older, he'll demand it.

5. Baby will likely be asleep as you finish the feeding. Put the baby to bed and go to the breast pump. Get as much milk out as there is left from each breasts and allow the pump to stay on an extra few minutes each side to stimulate more milk production. Freeze the extra milk in disposable baby bottle bags. Date and time them. These can be used by nurses at night for baby's feedings (if in NICU) and by Granny when she babysits when Mom and Dad have a date (also very important). Frozen breastmilk is good for about 3 months in the freezer. Rotate the use of the frozen milk using the oldest first. Never rewarm breastmilk in the microwave oven. Just set the frozen bag in a bowl of hot tap water. You might need to change the water once to warm the milk to your body temperature.

Well, R.. Are you sorry you asked?!! I could yammer on and on. Anyway, best wishes to you, your cousin and your the new addition to your family.

Cindythenurse

My daughter was also born at 32 weeks, 3 lbs 3 oz, Oct 2006. I had the blessing of having a wonderful lactation consultant at the hospital, who helped me get my daughter home in 1 month. There is a technique called "kangaroo Care" where the mother puts the premie against her bare skin ( you can wear a big t-shirt or button down shirt), your baby has on only her diaper and you "envelope her" skin to skin under your shirt. Her head should be exposed of course and you then put a blanket over the both of you. This not only creates warmth for the baby, and bonding for you both, but it increases your milk production and your baby miraculously, because she is near your breasts, is comforted. You can do this for as long as the nurses allow ( I did it for 1 hour everyday), then I put my baby to nurse after that and each day she improved without any coaching. Another thing that helped was an item called a nipple shield. It is a soft, plastic nipple that you place on top of your nipple and it is easier for them to latch on to...similiar to a bottle's nipple. Some hospitals have it or you can get it at a pharmacy. I hope this helps you. I am still nursing, my baby is 16 months old, very healthy, petite, but strong and has not been sick. Nursing is amazing if you can stick with it and try not to give up. There are also tinctures for nursing that help boost your supply. www.growinglife.com

I will be praying for you and baby and hope this helps you.

L. ( Molokai, Hawaii )

My daughter was born at 35 weeks at 4lbs 10ozs. I had planned to breastfeed but it was difficult because her lungs were underdeveloped and she had to stay in NICU for 9 days. At first she was (gavaged?) using a tube down her nostril to feed her, which almost eliminated her desire to suck at the breast.

Secondly, before she left the hospital, she had to weigh at least 5 lbs (they lose weight initially) and she had to be able to suck, breathe and swallow at the same time. Because she had such a weak suction, we end up having to give her a bottle, which is much easier to suck.

By the time my daughter left the hospital, she was very much attached to the ease of sucking from a bottle, and she cried in frustration whenever she was put to the breast. I even had a La Leche consultant work with the two of us to get the breastfeeding established but it never really panned out. I end up expressing my milk and giving it to her in a bottle.

So, if your sister wants a decent try at breastfeeding, do NOT let the hospital give her bottles, and hopefully, she won't also be used to feeding on a certain schedule. Your sister should also diligently do her pumping until her milk is fully in, especially if her daughter doesn't quite take to breastfeeding at first.

I wish her much luck!

Call your hostpital most have great Mommy & Me support groups and breast feeding help. THe lactation nurses are great. Apple Valley has one every Wed from 10-12 or you can make appointments.

Hi R.,

I have 4 year old twin boys who were born at 31 weeks (3 1/2 lbs). Your cousin really needs help from the lactation specialist in the Hospital, because the baby is so premature there may be problems in getting her to suckle properly (my boys were helped with pacifiers). Also, she may have to pump milk for a while to make sure she keeps producing.

You didn't say if the baby is in the NICU or not, if she is then they should be helping your cousin with all of this because each preemie has it's own set of problems. Tell her to talk to the nurses or the pediatrician they will advise the best course of action.

Good luck!

Breast feeding is the best source of milk especially for a premie. Breast feed as long as possible up to one year old to 1 1/2 years old.

I have had 4 premies and they need all that can be given to them.

Dear R.,
Congratulations on the birth of your new cousin! Compared to other preemies, 4 pounds is pretty good for 32 weeks (3.15 is as clost to 4 as you can get!) The baby would probably do better feeding in the football hold. This is where you place the baby, with its tummy touching mommy's side. It looks like you are holding a football, getting ready to run for a touchdown. This position works well because little babies have a hard time in the cradle hold, sometimes. Also, have her use standard size pillows, stacked two or three, under the baby, rather than one of those "Boppy" Pillows, since the regular pillows are flatter and have more surface area for the baby to lay. You can also "poof" up the pillow where you need to, to lift the baby's head to a better position. Also remember that it takes the little one very little fluid to fill its stomach; the baby's stomach is as big as its little fist - and the milk digests quickly - so feeding frequently is best. Don't expect this baby to drink 4 oz. at a feeding - it'll be more like 1.5, which is all it needs. Lastly, if she is having any problems, have her visit her birthing hospital to see if they have lactaion support, or see a lactation specialist privately.
Good luck.
J.

try looking on la leche league website. also the lactation consultant at th hospital will help you. the most important thing is don't give up!!! she will be big and healthy and all troubles behind her soon!

My son was born at 34 weeks - a significant difference, but a preemie nonetheless! He also was much bigger than anticipated at 6lbs 2oz. Anyways, tell your cousin that the NICU nurses are super-helpful - she just has to ask. After having difficulty getting him to eat for more than a couple minutes, one nurse finally suggested that I hold him in the "football hold," because it's easier to get the nipple into a good position for them to nurse. Amazingly, it worked wonderfully - he went from nursing for a couples minutes to nursing for 10 minutes! Keeping her awake will be the other difficulty - tell her to unwrap the baby, change her diaper, etc. to get her going again - they just love the warmth of mommy!

I'm sure the NICU will have told her this, but if they're doing any gavage feeding (through the feeding tube) (which I'm sure they are), she can give her baby a pacifier to work on her sucking reflex and build those muscles while she's getting that "easy feed." I don't particularly like pacifiers, but hey - whatever gets them going, right?

And pump, pump, pump! Make sure she's keeping her milk supply up, of course! They'll freeze it all for her and give it to her when her baby girl goes home!

Anyways, tell her good luck! I had nurses repeatedly tell me that girls tend to gain weight and get out of there faster than boys, so at least she has that!

you should have her contact a member of La leche league, I am breastfeeding my second daugter. I have read a lot about nursing in special circumstances, and there is a lot of help. If the baby is not strong enough to suck right away your cousin can perhaps pump and then feed the baby with a syringe or tubing or even a spoon. I have read that using a bottle can pose a problem later on when the time to latch onto the breast comes. The baby may experience nipple confusion. ( sucking from a bottle is a different mechanism than nursing at the breast.
I hope this helps, encoiurage her not to be discourage, is she is physically able it is the healthiest thing she can do for baby. :)

I gave birth to my son at 32 and a half weeks and he was 3 pounds 7 ounces. Unfortunately, he was never able to successfully breastfeed, BUT, here are some things to consider.

Your cousin's daughter may not have developed a sucking reflex yet. When I got to see my son the day after he was born, the NICU staff already had a pacifier in his mouth to get him to work the muscles he needed in order to feed. I don't know whether the baby has any other problems but if she's doing okay, but the doctors don't want her to try nursing yet, your cousin should ask if she can do non-nutrative nursing to get her used to the idea. This is where she pumps her breasts before trying to put the baby on. The baby gets the right idea but doesn't get too much milk. This is what the doctors recommended to me because they didn't want him to get too much milk at one time at first. Think about it. Her digestive system is not really fully formed yet. The concern is about something called Necrotizing Intercolitis (I don't know if I spelled that right). It's where the baby's digestive tract is overwhelmed and part of the intestines stop functioning and die. NOT something you want to happen, but that could be a reason to discourage her from trying to breastfeed at first.

If they don't want her to try breastfeeding her yet she should get a pump and pump often. That'll get her supply going. Tell her not to stress out if it seems like she's not getting much at first. It'll come. She can always freeze the milk for later use.

One of the best things she can do when the doctor's give her permission to try is to ask for help if she needs it. If she doesn't get help from the nurses, be persistent and insist. There are also lactation consultants out there who coach women on how to breastfeed every day. Find one!

One thing to keep in mind though, is that preemies often don't really develop a good sucking response until their due date. If she just delivered, that's a good 6 weeks off. Be patient and keep pumping. The best things she can do are trying to finding a way to be comfortable when pumping and keep well hydrated. That will increase production.

Lastly, please help her to understand that her little one may never nurse, like mine. It's nothing to be ashamed of. If she can continue to pump, that's great! I pumped for 7 months, until I had to go on a medication that made my milk unusuable. My son never successfully nursed though we tried for 4 months. He's now a tall, strong boy who no one would ever guess had been premature.

Hang in there and keep asking for help.

Good luck! M.

I had a preemie too, and it was really hard for me to nurse,I almost gave up so many times. But it does get easier and I think it takes about 6 weeks to really get it down. Here is what I did:
I pumped to get my milk flowing good (about 15 mins each side after each session), and using a nipple sheild. It pools the milk, and they can learn to control the milk flow. I also used the "smoothie" pacifiers to help build up their sucking muscles and a medicine dispensor to give them the milk I pumped. ( I even put my pumped milk in the end of the shield so they would get the idea.) Its hard to find a nipple that is a true slow flow, but I just recently saw preemie nipples and I would have tried those as well. Good luck! hang in there its worth all the hard work!
p.s. I recommend using a "breast friend" supporter vs. the boppy, that thing saved my life!