Ryan Can Nurse Today...
By Jodie Gordon Lucas
Middle Island NY USA
From: NEW BEGINNINGS, Vol. 14 No. 1, January-February 1997, pp. 24-5
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
I have what has been insensitively labeled an "incompetent" cervix. My son Ryan was born eight weeks premature following a high-risk pregnancy, three-and-a-half months of bedrest, and many episodes of premature labor. When I was 32 weeks pregnant the placenta pulled away from the uterine wall, and Ryan was dying. In what seemed like minutes, I had a cesarean and Ryan was being resuscitated. Once he was stabilized, I got to see him through the side of an incubator. Then he was transferred to a neonatal intensive care unit (NICU) 30 miles away.
Ryan is now a healthy, breastfeeding l4-month-old, and I have had a year to think about our breastfeeding relationship and the many obstacles we faced. There were many times when I nearly gave up, but support from my husband, doctors, nurses, lactation consultants, and LLL kept me going. I want other health care providers to know how very little it takes to make a major difference in a mother's decision to breastfeed her premature baby.
My initial commitment to breastfeeding was tenuous. Luckily my husband read about breastfeeding and encouraged me to try it. He educated me about the benefits while acknowledging that the decision was ultimately mine to make. I decided to try it although secretly I didn't believe it would last very long. Ryan can nurse today because of his Daddy.
When I first went into labor at five-and-a-half months, my resolve to breastfeed was affected. I had decided that if Ryan made it to term, I would try breastfeeding. If he were premature, I knew I could pump, but I had decided it wasn't important enough to bother with. I had just seen my son for the first time when the nurse from the NICU came in to tell me about his tubes and monitors. Then she asked, "Had you planned to nurse Ryan?" I was surprised and said, "Yes" because I had planned to nurse him if he had been full-term. If she had said, "Do you want to nurse Ryan?" I would have answered, "No." Ryan can nurse today because the nurse asked me in a way that didn't allow me to give up before I started.
That was the only time I was asked if I intended to breastfeed. Everything I needed to begin pumping was in my room when I returned from the recovery room. That nurse must have communicated my wish to breastfeed to the rest of the staff because no one else asked me about it. Had I had the chance to reconsider, I might have decided not to go through with it. Instead, a gentle, knowledgeable nurse showed me how to pump, and when she saw the colostrum I had pumped, she told me how much my premature baby needed the antibodies he would get from it. I was reminded when to pump, which was necessary because Ryan was in such bad shape and I was in so much pain I was unable to keep track of pumping schedules. My nurses were supportive, patient, educated, knowledgeable, and most had personal breastfeeding experience. I quickly lost my embarrassment and gained confidence that I'd be able to keep pumping.
The nurses who cared for Ryan also shared those wonderful characteristics. I finally made it to Ryan's side at midnight, two days after his birth. I was vertical for the first time in nearly four months, recovering from major surgery, and I had a spinal headache (from the anesthetic used during the cesarean). I was in agony, and the confidence I had had earlier in the day was gone. I had just managed to get to my son, and it was time for me to pump again. I was prepared to give up but I had with me several bags of frozen colostrum that I had pumped earlier. Ryan's nurse put it in the freezer and assured me he would get it as soon as he was able.
Because she was excited that Ryan would be getting my milk, I mentioned that I should pump again. I figured it would be impossible because it was late and everyone seemed too busy to show me where I could pump. But even in the middle of the night I was immediately taken to the pumping room. A knowledgeable, supportive nurse made pumping easy by getting things set up, helping me to get hooked up, watching the time, labeling the colostrum, and helping me get dressed. Ryan can nurse today because of those nurses and because the hospital where they worked actively supported breastfeeding.
During that first week when Ryan was seriously ill I was more committed to human milk than breastfeeding. I was promised that he would receive nothing but my milk when he started feeding through a nasogastric tube (a tube from his nose to his stomach). At the time I felt that providing his nutrients was the only thing I could do for him. Every other need was attended to by his doctors and nurses. I couldn't even hold him. I was overcome with guilt. My cervix was "incompetent"--Ryan was on a respirator because my body was inadequate. This emotional struggle was hard, but I was dedicated to pumping.
Unfortunately I then ran into two pumping problems. First, I did not have an electric pump at home. The first time I tried to use the manual pump that came with my kit, I found I did not have the strength to use it. My husband responded to my frustrated crying by gently removing my hands from the pump and taking over. It was perhaps our most intimate and loving moment ever. Second, I lost a piece of my pump kit necessary for connecting to the electric pump. I immediately called a lactation consultant at the hospital and told her we were on our way to the NICU and that I couldn't pump until I found this piece. By the time we reached Ryan's bedside, the lactation consultant had found a replacement part and left it with his nurse.
After several more days of pumping every three hours around the clock and keeping vigil at Ryan's bedside, I was getting burned out. It seemed as if I were constantly pumping. I got up, pumped, dressed and packed as quickly as possible, left for the hospital and arrived in time to pump again. Pumping took around 25 minutes each time. I wanted to go to Ryan, not the pump room. Again, my resolve was wearing thin. One day Ryan's nurse took a break to go pump for her nine-month-old baby and was back again in just 11 minutes. I was flabbergasted at how quickly she had returned when my pumping trips seemed to last an eternity. She figured out that I wasn't double pumping and showed me her kit and tracked down the extra tubing and "Y" adapter that I needed. The psychological difference between spending 11 minutes pumping instead of 25 was profound.
After several weeks Ryan started oral feedings. At this point, I was anxious to put him to the breast. His doctors and nurses also wanted to get him to the breast as soon as possible, but they thought that the coordination of sucking, breathing, and swallowing was overstimulating for a premature baby and wanted a nurse to give him a bottle of my milk during the first oral feeding. They were particularly concerned about apnea (stopped breathing) and bradycardia (slowed heartbeat). I agreed with these concerns and was willing to wait. Ryan took his bottle with no medical problems. [Ed. note: Research shows that feeding at the breast is actually less stressful for premature babies than bottle-feeding. Their breathing patterns are more regular and they have fewer episodes of bradycardia. (Meier 1987)].
As promised and without my having to ask, I was able to nurse him soon after his first bottle feeding. I was petrified. He was so tiny. His head was the size of an orange and he only weighed around four-and-a-half pounds. How would I ever feed him? At his scheduled nursing a lactation consultant showed me how to hold him and get him to root. He didn't latch on at first, but he nuzzled and licked my nipple. My milk let down, enabling him to taste the milk pouring into and around his mouth. After that, he opened his mouth, latched on, and started sucking. I was overcome. He only nursed for a few seconds, but my fears were gone. I had nourished my son. I was his mother and my son knew I was different from everyone else caring for him. Ryan can nurse today because the lactation consultant showed me how.
Nursing Ryan those first two weeks when he was still in hospital was idyllic. When I brought him home, the honeymoon was over. We came home with instructions to nurse every three hours. If Ryan didn't nurse at that time or if he didn't nurse well, I was to offer a supplemental bottle of breast milk. The neonatologist's priority was Ryan's health and for him to gain weight. However, following this advice nearly sabotaged our nursing relationship. After several days of increasing difficulty with breastfeeding due to nipple confusion, I consulted THE WOMANLY ART OF BREASTFEEDING and another lactation consultant and made some changes. I waited longer to offer a supplement, I never put Ryan down (I used a sling), and if he nursed at all, I did not offer a supplement. I found it helpful to drip breast milk from a bottle onto his upper lip to start him suckling. I also switched to a NUK nipple on the bottle when it was absolutely necessary to give him a bottle. After about 10 days of extreme difficulty, Ryan and I finally established a good breastfeeding relationship and left the bottle behind forever. Ryan can nurse today because of the lactation consultant's support and because of the many mothers who shared their experiences in THE WOMANLY ART OF BREASTFEEDING.
I must add that the advice I received from Ryan's doctor was not bad advice. It was necessary initially to supplement his feedings and nurse him on a schedule. Ryan was still very frail and did not cry. He was not able to "demand" a feeding until he was about seven weeks old. He would sleep eight hours and still not be interested in nursing when he awoke. Until he could both nurse well and demand well it was necessary to keep a schedule and supplement if nursings did not go well.
If I were in this situation again, I would use a medicine dropper instead of a bottle for supplemental feedings. I would maintain a closer dialogue with a pediatrician who was supportive of our breastfeeding attempts as we made the transition from nursing on a schedule to nursing on demand. I would also check my baby's weight frequently. If I had known at the time that Ryan was still gaining weight, I would not have been as quick to supplement (thereby continuing his nipple confusion). I would also not have received visitors or gone to others' homes. Changes in environment or the presence of other people seriously distracted Ryan from nursing. Finally, I would have contacted a La Leche League Leader for information and support as soon as Ryan was born.
So many times I hear how health care providers have thwarted breastfeeding relationships with well-meaning but inaccurate advice. I'm so happy to say that my experiences were different. I have a lot of people to thank for Ryan nursing today, many of whom probably have no idea they made a difference. I know I am responsible for Ryan's nursing tomorrow, but my loving husband and help from knowledgeable, supportive, and encouraging health care providers are the reasons why Ryan can nurse today.
Meier, et al. Responses of small preterm infants to bottle- and breast-feeding. MCN 1987; 12:97-105.