When Baby Is Hospitalized
Amherst, New Hampshire, USA
From: LEAVEN, Vol. 35 No. 2, April-May 1999, pp. 32-33
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
Many Leaders become apprehensive when the mother of a hospitalized baby calls. Often their first instinct is to refer the mother to someone else, perhaps to a more experienced Leader or lactation consultant. Even if a mother also needs the hands-on, in-depth help that a lactation consultant can give there is a great deal of additional support that a Leader can provide.
Leaders provide mothers of well babies with support and encouragement to keep breastfeeding, suggestions for coping with the outside world and information about breastfeeding management. Helping mothers of sick babies is really no different.
Support and Encouragement
A mother whose newborn is hospitalized usually feels overwhelmed and vulnerable. She may have had a difficult birth or feel she was responsible for giving birth prematurely. In many cases the mother is discharged while the baby remains in the hospital. Sometimes the mother and baby are in separate hospitals. This separation can increase her anxiety.
A Leader can be of great help by actively listening to an anxious mother just as she listens to any other mother. The mother may need a sounding board to brainstorm ways to mother and breastfeed in a hospital setting. She may need support for wanting to breastfeed a seriously ill child. Providing information about the special value of both human milk and skin-to-skin contact can help a mother feel confident about her commitment.
If the Leader is able, frequent communication with the mother over the phone or in person can be most valuable. A mother in this situation needs ongoing support of her desire to breastfeed. Sometimes a mother is encouraged to give up her efforts in the mistaken belief that it will relieve some of her stress. Yet many mothers find a great deal of comfort in knowing that their milk is the one thing that they alone can provide in a situation that is otherwise out of their control. Leaders can support a mother's efforts and validate her feelings.
Leaders can also help a mother to view whatever breastfeeding relationship she has with her child as a success. As with adopted babies, sometimes success means partial breastfeeding. Helping a mother adjust her expectations can give her more realistic and achievable goals and go far toward boosting her self-esteem.
Coping with the Hospital Environment
Most physicians and hospital personnel now recognize the value of breastfeeding but they may not know how best to facilitate breastfeeding in the hospital environment. Leaders can listen to mothers talk about their situations with an open mind and be on the lookout for ways in which the hospital setting can be made more conducive to breastfeeding. Could the mother pump at the baby's bedside so she doesn't have to be separated from her baby during that time? Could she be provided with hospital meals since she is providing the food for the baby? Is water available for the nursing mother? What nighttime accommodations are made for the mother if the baby is feeding at the breast? What kind of privacy does the mother-baby pair have? Is there a quiet, darkened room where they could retreat for nursing? Are procedures and medications timed to minimize interference with the breastfeeding relationship?
Creativity is the key. The Leader can help the mother determine what, if anything, is hindering her efforts to breastfeed and brainstorm ways to overcome obstacles.
The Leader can encourage a mother think of herself as part of the team responsible for her baby's care. Parents may be apprehensive about dealing with medical staff, especially when the baby requires a team of specialists. The Leader can reassure a mother of the critical importance of her presence to her baby. Taking care not to make the mother feel guilty about any unavoidable absences, the Leader can suggest ways to minimize separation. Skin-to-skin contact or "kangaroo care," now common in many hospitals, can be of incredible benefit to both baby and parents. See the BREASTFEEDING ANSWER BOOK, page 247, Kangaroo Care (No. 358) or BREASTFEEDING YOUR PREMATURE BABY (No. 262) for more information. /p>
A Leader can help a mother be an effective advocate for her child by suggesting appropriate techniques from the BREASTFEEDING ANSWER BOOK and Human Relations Enrichment (HRE) and by offering to role-play with her until she feels confident. If the mother views the hospital personnel as adversaries, the Leader might remind her that she and the hospital staff are working toward a common goal, even if their ideas of how to achieve that goal differ. A firm, determined approach will often accomplish more than a confrontational approach. Contact a Professional Liaison Leader or HRE Instructor for assistance and see the sidebar for suggested publications. /p>
A mother of a hospitalized baby needs information yet her ability to take in that information may be limited by her level of stress. A Leader may need to share only a few ideas at a time as well as cover the same material more than once. She can encourage the mother to write down the information so she can review it as needed. She can offer the mother printed materials to read at her leisure or to share with her baby's doctor. Leaders can help the mother begin pumping, provide facts about the special breastfeeding issues associated with her baby's condition and suggest sources of additional support. As always. a Leader should remember to note in her log what has been said as well as what printed information was provided.
If a baby is unable to feed at the breast, the mother will need to express milk to establish her supply. Mothers of weak or ill babies who nurse very little may need to pump to further stimulate their breasts. In both cases, a hospital-grade automatic double pump is the most suitable pump. Leaders can refer a mother to places that rent pumps and sell needed attachments. Even if the hospital has a pump available, the mother may want a second pump for use at home.
According to the BREASTFEEDING ANSWER BOOK, the mother will need to express at least five times a day, pumping both sides simultaneously for 10 to 15 minutes each time or until the milk stops flowing, whichever is longer. Just as with nursing at the breast, if the mother is experiencing difficulty maintaining her supply, more frequent stimulation can help. Some mothers will need to pump at night, while other mothers will find that a night's rest is more beneficial to their milk supply. A mother whose baby's intake is increasing as well as the mother whose baby is coming home within two weeks should pump more often, 7 to 8 times a day and once at night. The Leader can help each mother create a plan that will enable her to fit pumping sessions into her already over-burdened schedule of visiting baby, caring for any other children and trying to find time for a shower or bath.
A mother who is expressing milk will need to store it until the baby is ready to use it. THE WOMANLY ART OF BREASTFEEDING, the BREASTFEEDING ANSWER BOOK, A Mother's Guide to Milk Expression and Breast Pumps (No.30) and Storing Human Milk (No. 4692) provide up-to-date information about milk storage that a Leader can share with the mother. Many hospitals have places to store milk so that it is available whenever the baby needs it. A mother must be scrupulous about labeling and storing her milk according to the hospital's protocols; Leaders can encourage a mother to investigate the hospital's requirements.
A baby who is in the hospital commonly experiences setbacks. These setbacks can be very upsetting to the mother and can influence her milk supply. If the Leader has established rapport, she is in a good position to reassure the mother and help her find ways to keep herself calm.
When it's time to put the baby to the breast, the Leader can give hands-on help. If the Leader is unable to assist, referral to a lactation consultant may be necessary. If this is the case, the Leader can still be of help to the mother. Even sitting with the mother while she tries to breastfeed or listening to her concerns by phone can be important sources of support.
It's important to view early nursing sessions as learning opportunities; it might take some time for breastfeeding to become well established. Expressing a little milk so that there are drops on the nipple can help the baby become more interested in initial sessions. Just as with well babies, it is preferable to offer other feedings by mouth from a dropper, cup, spoon or other device rather than from an artificial nipple. Additional suggestions for helping a mother get baby to the breast are described in the BREASTFEEDING ANSWER BOOK, pages 258-63.
Our Unique Help
While it is true that a mother of a hospitalized baby can require more help and support from a Leader, the rewards are potentially great. Mothers are often extremely grateful to have had the support of another mother during a trying time. Leaders may not be these mothers' only source of breastfeeding assistance yet much about the support that Leaders provide is unique. The mother-to-mother aspect of La Leche League is of special comfort. A Leader's understanding of the importance of the mother-baby relationship can be refreshing. After placing her initial call to LLL, an exhausted, overwhelmed mother might not have the energy to make a second call. Instead of referring her elsewhere, Leaders should feel confident in their ability to give the mother the assistance she seeks.
The LLLI Online Store contains additional resources on this topic, written for both Leaders and parents.
The pamphlet, Babies and Children in the Hospital (No.198), is an excellent resource to give to parents whose child is hospitalized. It lists several support organizations that parents may wish to contact. Additionally, it offers a wealth of ideas for parents to use when advocating for their child. Of particular interest is the section that suggests HRE-like techniques, providing effective language for parents to use when conveying their needs and wishes to medical professionals.
For the Leader who is interested in learning more about helping parents of hospitalized children, The Hospitalized Nursing Baby: Meeting the Needs of Mothers, Babies and Families in Health Care Settings (No. 298-1) is the first unit in the LLLI Lactation Consultant Series II. It contains the entire text of Babies and Children in the Hospital, the pamphlet for parents mentioned above, as well as information about family-centered care and promoting breastfeeding success in the hospital.
Finally, Children in Hospitals is a wonderful organization that can be of great help to parents. For more information, contact Children in Hospitals Inc., 31 Wilshire Park, Needham, Massachusetts 02192 USA. Phone 617-482-2915.
Babies and Children in the Hospital LLLI, May 1998. Publication No.198.
Gotsch, Gwen. BREASTFEEDING YOUR PREMATURE BABY, LLLI, 1999.
Mohrbacher, N. and Stock, J. BREASTFEEDING ANSWER BOOK, revised edition. Schaumburg, Illinois: LLLI, 1997; 178-83, 247, 258-63.
Popper, B. The Hospitalized Nursing Baby: Meeting the Needs of Mothers, Babies and Families in Health Care Settings. LLLI, Jan. 1998. Publication No. 298-1.
THE WOMANLY ART OF BREASTFEEDING, 6th revised edition. Schaumburg, Illinois: LLLI, 1997; 271-96.