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Premature Arrival

Yehudit Sherman
San Diego CA USA
From: NEW BEGINNINGS, Vol. 20 No. 3, May-June 2003, p. 98

My wondrous, problem-free pregnancy went quickly downhill when my blood pressure suddenly, inexplicably shot up at six months. By 32 weeks, my preeclampsia had progressed to HELLP syndrome, which is a rare condition of pregnancy that can cause liver failure. HELLP stands for Hemolysis, Elevated liver enzyme levels, Low Platelet count. HELLP stands for Hemolysis, Elevated liver, Low platelet. The doctors apologized for my situation being too grave for induction and told me I needed an immediate cesarean section. I told them that there was no need to apologize. I knew that I could not last much longer. I was experiencing both agonizing liver pain and contractions. Apparently my body was making a last-ditch effort to save itself and was thus trying to expel whatever was expendable: my baby. For the only time in our four years together I saw fear on my husband's face.

As the situation avalanched, at each point I asked, "Will this affect my ability to breastfeed?" While each decision needed to be made in haste, I was determined to have the staff investigate alternatives to anything that might preclude my ability to breastfeed. They were sufficiently knowledgeable on the effects of each medication and procedure, and I was relieved that none would adversely affect breastfeeding.

When my daughter emerged she cried! Such a promising sign for a 32-week infant! But they almost forgot to let me see her as they whisked her away to neonatal intensive care.

Instead of dropping into the dead sleep that I had craved, I was energized! And, I was obsessed. "When do I need to start pumping in order to ensure that my milk comes in?" I don't know whether anyone had the answer, but I knew I needed to start pumping as soon as possible. My daughter was born at 8 pm, and some time in the middle of the night I was pumping. The result, less than one milliliter of liquid, was disappointing, but I was assured that this was normal. My nurse rushed it over to the neonatal intensive care unit (NICU), and we repeated this every three hours. When she was ready for a gastronasal tube, my milk was the only thing that my daughter was ever fed in the hospital.

To know that I was producing milk was a great relief, but the adventure had only started. When I was moved a few days later to a less-critical care ward, the pump available there caused me so much pain that I couldn't imagine any mother with ambivalence toward breastfeeding sticking with such a horrible endeavor. I should have asked for a different pump, but I felt lucky enough to get the only one on the unit.

If I hadn't initiated the pumping effort, I don't know whether anyone would have come to me and suggested that I start and maintain my milk supply. But there were La Leche League posters in every room in the midwife and obstetrics clinics, labor and delivery, and the antepartum and postpartum wards. "An awake baby is a hungry baby; please call your nurse for help with breastfeeding," was posted in every room. A couple of weeks later, I heard one of the NICU nurses counseling a very new, very young mother to start pumping. I don't think that the young lady had ever thought of breastfeeding. The NICU had a comfortable pumping/nursing room with rocking chairs donated by grateful parents. Two lactation consultants were always on duty, and several of the neonatal nurses also specialized in lactation. Military medicine can have a bad reputation, but having since heard the experiences of women who gave birth elsewhere and were discouraged from nursing, it is clear that the naval medical center where I gave birth is very forward-thinking in terms of breastfeeding support and postpartum care.

A week to 10 days later, Tikvah (which is "Hope" in English) was ready for my nipple. We were fortunate that a nurse with patience and experience helped me learn to nurse and to help Tikvah latch on. I sat next to her "crib" behind a screen (made by another grateful mother) with all her wires dangling and tangled. Although Tikvah latched on, it was hard for me to hold and position her properly. She frequently let go and jerked her head wildly from side to side. It was hard to watch. I was glad that my husband, who worked at the hospital and thus came by to smile at our daughter many times a day, was not there to see our distress.

For the next 10 to 14 days I nursed Tikvah just twice a day and pumped the rest. As long as bottle feedings of my pumped milk did not outnumber nursings, I thought we would be okay. Recovering from HELLP, making two trips to the hospital each day, spending two to four hours at each visit, and pumping every two to three hours consumed all of the energy that I possessed. Most of the time we had to go through 10 to 15 minutes of trying to wake Tikvah enough to nurse, and then she would fall back asleep after just a few minutes. To me, she seemed to be nursing fine and was content to sleep on me. The NICU staff wanted to feed her as much as possible to keep her gaining enough weight to go home. After all, she had been born just under four pounds and had dropped to almost three pounds.

I found that by working with the nurses and letting them know how much I appreciated them, they were always happy to see me and made a special effort to work with me. Some days Tikvah nursed well. Some days she practically didn't latch on at all. I was excited and then frustrated, even despondent. Then suddenly one day Tikvah, no longer a critical case, was no longer receiving the care of the most experienced nurses. She was taking almost all of her feedings from breast or bottle. And my feelings of gentle acceptance ended when a substitute nurse, following a feeding, took Tikvah from me and topped her off with a bottle!

I talked to the lactation supervisor, and she immediately wrote on Tikvah's chart that my baby was not to receive supplementation. The next day, we were ready to leave the hospital an hour after a small nursing when Tikvah started screaming for the first time! We were rushed to the nursing room, and Tikvah breastfed for twenty minutes straight. I was euphoric! This was how it was supposed to work and how it would work at home. When she was hungry enough, Tikvah would awaken and nurse.

The next day the hospital staff sent Tikvah home with us. She did not meet absolutely all of their technical requirements for release. But by this time I had learned that the NICU staff also gauged when the parents were ready, and we were.

My husband was always enthusiastic about my breastfeeding our daughter. When I first tried to nurse lying down but found that I did not have enough hands to make it work, he was so proud that he could latch Tikvah on in the middle of the night. He was always eager to bring pillows, towels, water, pads, or whatever else I didn't realize I would need until Tikvah was nursing away and I couldn't get up.

Tikvah is now 21 months old. Her "premie" status is apparent only to other parents of premature babies, her petite size the only difference between her and full-term children. We are still nursing several times a day.

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