Lang, S., Lawrence, C.J. and L�E Orme, R. Arch of Dis of Child 71:365-369, 1995

The primary purpose of cup feeding is to provide a safe method of feeding low birthweight and premature infants until the infant is strong and mature enough to take the breast. A second reason is to avoid the use of bottled and artificial nipples and to prevent the increased mortality and morbidity associated with bottle feeding. Thirdly a feeding method is needed that does not interfere with appropriate sucking techniques. Cup feeding has been used successfully in developing countries for many years and is not yet fully accepted by neonatal units in industrialized countries. The Royal Devon and Exeter Hospital in the UK gradually introduced cup feeding in its neonatal unit and since 1989, 500 infants had received one or more cup feeds. Six groups of infants were found to benefit:

1. Infants nearing discharge who had established breastfeeding and whose mothers were not resident,

2. Breastfed preterm infants not mature enough to complete a breastfeed,

3. Infants with a cleft lip or palate,

4. Infants with an uncoordinated suck, swallow and breathing pattern,

5. Infants born by cesarean section, until mother able to breastfeed,

6. Term or preterm infants to tired to complete a full breastfeed

The authors suggest a strong association between cup feedings and successful breastfeeding outcomes.

pretty good, but it made a terrible �mooing� sound each time it sucked. At home, I set my alarm clock and got up once or twice in the night to pump. (Some wonderful friends chipped in and rented us an electric pump, but it was mean and really sucked my nipples hard. Within a few uses of it my nipples were cracked and bleeding. I gave up on it and used a hand pump my sister gave me.)

Night pumping was most draining, emotionally. I pumped in the room we had fixed up for Rachel, and often I watched a video of her we had taken. Although this always brought tears to my eyes, my milk flowed quickly. Before long, I had enough milk to feed the entire NICU. I was so proud of that!

By Rachel�s eighth day she was breathing on her own. During the day I was allowed to take her across the hall to the �parenting room�, a place exclusively for parents whose babies were in the NICU. I was able to put her to the breast twice a day, but at first she had to go back to NICU for feedings so she could be monitored. She held her own and I was able to nurse her without monitors and machines.

I had a terrible time keeping her awake for feedings at my breast: she would mouth the nipple, lick it, and doze off to sleep. I tickled her feet and palms to no avail. Her latch was terrible because she had no suction and didn�t open her mouth wide enough. I was virtually expressing milk into her. The nurses were helpful. A midwife and lactation consultant checked on us and her positioning was good. She was just too little and to weak to nurse well. The pediatrician didn�t want her at the breast for more than 20 minutes at a time for fear she would spend more energy than she would gain. She was a pound less than her low birthweight. At 4 lbs., 13 oz, it was a slow climb up.

After a week of barely noticeable improvement, I felt discouraged. Would I ever get Rachel home? Her inability to nurse efficiently was keeping her tube-fed in the hospital. Another mother told me bottle fed babies go home sooner than breastfed babies...My husband strongly encouraged me not to give up. My dream of a peaceful birth at the birthing center without bright lights or drugs had been blown apart. I had to breastfeed.

Around day 22, Rachel started to stay awake for longer periods of time and although still only mouthing my breasts, she did it more vigorously. By this time I was putting her to my breast at least three times a day, more often depending on what nurse was one. This was great; the more often she sucked, the less I had to pump, and I was beginning to hate the pump.

On day 24 the nurse suggested I stay overnight and feed her for all the feedings. I was excited! After the midnight nursing she gained 65 grams! Incredibly, she no longer needed to be supplemented by tube. I stayed a second night and she gained weight again. Twenty six days after her birth, we finally took our 5 lbs. 2 oz. baby home.

At home we had to wake every four hours. A couple of days later she was waking on her own every two hours. She still only mouthed my nipples. There really was no feeling of suction. If I didn�t hold my breast in her mouth, it would fall out. She usually nursed an hour, then was wide awake for an hour. I tried to nurse her lying down, but since she couldn�t hold the nipple at all, it didn�t work. I wasn�t worried about her weight-gain since there were lots of wet diapers.

A couple of weeks after we got home a friend encouraged me to attend a La Leche League meeting. It was our first outing and I was happy to get out, but once I got there I felt horrible. All the moms and babies seemed to be nursing so effortlessly, and they could have a cup of tea with their free arm. I broke down and cried. The leader and some moms reassured me it would get better.

Two days before Rachel�s official birth date, seven weeks after her birth, when I sat down to nurse, I felt a tug at my nipple. She was actually sucking! Over the next few days the pull increased and I could actually have one free hand too. When she was 11 weeks old she finally managed to nurse lying down and we started getting some sleep at night.

She cried often, and when she cried I always offered her a breast, but it wasn�t always the answer. I wore her in a sling, danced with her, (she still like Stevie Ray Vaughn) slept with her, changed my diet for her, but I guess she just needed to cry. Maybe it was our cruel early separation. She had breastmilk only until seven months. At that time she was already 24 pounds.

Now Rachel is 17 months and nurses like a pro. She sleeps in our bed and nurses every two hours, which drives me crazy but I believe will stop eventually. She�s pretty clever.

I still get made when I read about wonderful birthing stories. Establishing a good breastfeeding relationship was the most challenging thing I�ve ever done, and the best thing I�ve ever done.

If you have a premature baby, my advice to you is this:

If your baby is hospitalized, make sure the nurses know you want to do as much as possible. You can change diapers, bathe baby, give your milk through the tube, touch your baby as much as possible. Be sure the pumped milk your baby is receiving is given in chronological order.

Surround yourself with people who believe breast is best. Find La Leche League. They can help.

Know you will be able to nurse this child. It will be worth it.

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