The feeding of Joshua evolved through his NICU stay but I will put it all in one post.
He started out purely on IV nutrition for about a day, then when I was released from American Fork Hospital and was able to go visit him at UVRMC they had me sign a release form for him to have pasteurized human milk until my milk came in. Within a couple of days he was eating just my milk, but it was all going in through a feeding tube. Sometimes a nurse would give him a taste of milk so he could get used to the taste and like it. We learned not to ask the nurses because other nurses would look at us like we were crazy when we asked. The weird part about the beginning of his feedings is that they needed to know if he was digesting the food or not. So before every feeding they would suck stuff back out of his stomach and if it didn't look too bad they would put it back in, but if it looked nasty they would throw it away. That was not my favorite part.
In preparation for breastfeeding they had me do skin to skin holding with Joshua. Brian also held him skin to skin for bonding purposes. A couple of weeks before he would be old enough (based on gestational age) to try nursing Brian was holding him and Joshua started rooting around looking for something to suck on. The nurses and we decided that we could start him on the nursing path a little early.
The NICU has several lactation consultants to help the mothers learn how to nurse. Nursing a preemie is more difficult because of their size and age. They helped us get correct positioning which is even more crucial with the preemie, and they gave me a nipple shield to let Joshua get a better grip to suck since his mouth was so small. He was so small when we started, my boob was significantly larger than his head. I had imagined nursing to be fairly easy and I would just hold him in the crook of my arm, but it was fairly complicated.
The first part of working on nursing is non-nutritive nursing. This is where I would pump right before I went to visit Joshua so I would be empty, then they would hook up his feeding tube and feed him while he practiced nursing. Well that is what is supposed to happen. That night we had a little bit of a frazzled nurse so by the time I actually got to sit down with Joshua it was quite a while past his original feeding time. Then she forgot to hook him up. Brian and I were confused about exactly what was supposed to happen so we just let him suck for a while. Then she came back and we realized that she thought that he was going to do a nutritive feeding instead. I didn't think he had nursed that much, but when she hooked him up he spit up most of his feeding. That was the only time he spit up in the hospital (he came home and spit up a ton, I don't know what the difference was), so I think he was hungry and actually nursed.
After that he got a little cold and after he recovered we decided to try nutritive feeding. To figure out how much the baby was eating we would weigh him before the feeding and after the feeding, and the weight difference would be how much he ate. A milliliter of milk weighed 1 gram, so the conversion was super easy. The first time I nursed him for real, a full feeding for him was 32 ml, the nurse said to be happy if he got anything, and not to expect anything too far over 10 ml. Well Joshua nursed 30 ml that first time. Totally rocked it.
When the babies started nursing they are only allowed to try twice a day. When they nurse at least 3/4 of a feeding twice a day, then they can try three times a day. Then comes four a day, but with a break in between feedings, then 4 in a row/12 hour, then for 24 hours, then on demand.
It only took Joshua a week to go from 2 a day to 3 a day nursings, then we got stuck. One of the reasons is I didn't cut back my pumpings at all and with 3 added nursings my milk supply went from a lot to out of control. So I started choking the poor baby. He had this thing that if he would choke he wouldn't try to nurse for like a week. It took us like 3 weeks to get over 3 a day. He also ended up being fairly anemic during this time (it is normal for preemies to be anemic), and was borderline needing a blood transfusion, but with the lack of blood he was sleepier and less interested in eating. During the 3 a day, he was also able to start drinking out of a bottle. Brian got to give him the bottle, and even though it was really hard for Joshua at first, he soon was rocking the bottle too.
When he got to four a day he was finally nursing consistently. During this time he was able to come off oxygen except for during feedings. A couple of the nurses got it in their heads that he didn't need oxygen during feedings even though he needed the oxygen turned up every time he was fed. So they wouldn't let him have oxygen while he at, and he choked and went on strike again. I was quite annoyed.
The NICU has a baby feeding guru named Annie. She didn't spend tons of time with us, because even though Joshua was slow moving along, he had some really good nursings, and was obviously capable of doing well, and there were alot of babies with more difficulties. When we got to four a day, she left for vacation for a week, and planned on us being home when she came back. She was surprised to come back from vacation and find us in the same place as we were. She promptly gave Joshua back his oxygen for his feedings and within a week and a half he went off strike and we ended up home.
He went home with blowby oxygen for his feedings, where instead of hooking up a cannula with oxygen for his feedings we just blew oxygen in the general area of his nose and mouth. I would just weave it through my bra when I was nursing, but Brian came up with an ingenious way to blow the oxygen on his face when he fed Joshua the bottle. 
He just taped the tubing right to the bottle.
He just taped the tubing right to the bottle.That is how feedings went with a preemie. I had no idea how complicated it was, until I had my second and she just nursed without any contraptions. Good thing Joshua was my first.
