Persevering with a Premie
By Lisa Albright
Allison Park, Pennsylvania, USA
From NEW BEGINNINGS, Vol. 11 No. 3, May-June 1994, pp. 76-7
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
My second child, Kevin, was born seven-and-a-half weeks early and was in the Neonatal Intensive Care Unit of a local hospital for three weeks. He came home a nursing baby and received only one bottle during his time in the hospital. I would like to share my story with other mothers who may experience similar challenges.
Kevin's birth was both a surprise and an emergency. He was born four minutes after we arrived by ambulance at the hospital nearest to our house. As it turns out, we were very lucky that we ended up at the hospital we did. Its facilities were adequate as long as Kevin didn't need active respiratory assistance. Thankfully, he didn't require transfer to one of the big hospitals in Boston, and we were a short drive from him during his stay.
I have never felt so helpless as when I first saw that baby hooked up to what seemed like a million tubes and monitors. I knew that if there was one thing I could do for him, it was to do my best to see that he got breast milk while he was in the hospital so that he could come home a nursing baby. We made it clear to the neonatologist and the nursing staff that I was going to breastfeed Kevin. I started pumping in the hospital and rented an electric pump once I got home. Initially, Kevin was only able to receive IV fluids, but after a few days, he was able to receive breast milk by gavage, a tube that went through his nose down into his stomach. Once he was strong enough to suck, instead of introducing a bottle when I could not be there to nurse him, he was "finger-fed": the breast milk was fed to him through a tube taped to the nurse's little finger. He sucked on the finger and swallowed the milk. This method was supposed to lessen the chances of nipple confusion which can result when a bottle is introduced.
Since my first child, Colin, was still nursing, there were two concerns. The first (from La Leche League) was that the baby get enough colostrum and breast milk. I decided to pump before I nursed Colin, and I never had a problem with milk supply. I think that my milk came in faster and more abundantly because of his nursing. The second (from the medical people) was that nothing infectious be passed from Colin to Kevin from the outside of my nipple. I decided to wash my nipples before pumping. That lasted about a week because the soap was so drying. After that, I used a very warm washcloth with no soap. Fortunately, Colin did not get sick during the time Kevin was in the hospital, so there was never any serious concern.
We were lucky that the nurse assigned to be Kevin's primary nurse, coordinating his care with the neonatologist and the other nurses who took care of him, was extremely supportive of breastfeeding. She gave us literature about finger-feeding. This technique was just making its way into this hospital, and, as is often the case with new techniques, was being met with some resistance by the staff (it is a little more time-consuming than bottle feeding). Our primary care nurse made sure that the nurses who were assigned to Kevin were willing to do the finger-feeding. My husband, David, was indispensable in this effort, too, going in every night to finger-feed Kevin. He became quite an expert at finger-feeding and by the end of Kevin's stay was giving demonstrations to the nursing staff in the NICU!
The neonatologist had the final say in Kevin's care, and his attitude toward breastfeeding made a tremendous difference. This hospital has a staff of neonatologists who rotate through for a month at a time. Kevin came to the NICU at the end of the rotation of a neonatologist who, while claiming to be supportive of breastfeeding, was resistant to the idea of finger-feeding. The primary care nurse told us to "lay low" for a few days until the next neonatologist began his monthly stint. He was, as she said he would be, very receptive to the idea of finger-feeding and truly appreciative of the benefits of breastfeeding. We had no problems after that.
Kevin's primary nurse also gave us literature about "kangaroo care." It was introduced in Bogota, Colombia, in response to a lack of warming incubators and staff. The infant is placed inside the mother's clothing, where it is kept warm and close to her heart, and provided with skin-to-skin contact. Both my husband and I "kangarooed" Kevin whenever we visited him. For me it was just a matter of resting with him on my breast after nursing him. But David always made that extra effort to partially disrobe. I think, for both of us, being able to do that helped us immensely to bond to the baby that we couldn't bring home yet. After Kevin came home and up until about his due date, he seemed to need kangarooing to get his best rest.
Kevin's problems were almost trivial by today's medical standards. Many mothers who would like to breastfeed a premature infant struggle with hospitalizations which are many months long, major medical complications, and dwindling milk supplies. Kevin had no major medical complications, and his stay was relatively short. I had two other advantages over most of the mothers I met in the NICU. Because of my previous nursing experience, I was fairly confident that I would be able to nurse him, and both my husband and I were highly motivated that I should do so. Kevin seemed so much more deserving of the benefits of breastfeeding because he was premature.
I think our motivation and perseverance impressed the medical staff and made them take our requests and questions seriously. So often "hospital routine" has evolved to make it easiest on the staff, not on the patient (i.e., finger-feeding vs. bottle-feeding). I kept trying to emphasize, without being adversarial, that it was so important to us that Kevin be a breastfed baby and that we were willing to be flexible and come in at odd hours if necessary to do things like finger-feeding if they weren't willing to take the time to. I made sure I wrote a letter to the hospital after Kevin came home praising Kevin's primary nurse and the neonatologist in charge for their support and flexibility in Kevin's care, so that they knew that somebody appreciated those qualities in the staff they hired.
After Kevin came home, I nursed him exclusively from the start. For some time, my milk supply was much more abundant than his requirements, due to all that pumping I did while he was in the hospital. I didn't seem to feel that softening of the breast I had always felt when Colin nursed, so I was worried that Kevin wasn't nursing adequately. However, his weight checks relieved that anxiety. A more difficult and long-lasting problem was that Kevin seemed unable to nurse unless he was in a quiet room, along with me. This situation was extremely hard on Colin, who felt rejected. (It also limited our public excursions.) The solution that finally worked best for us was to let Colin watch tapes of children's TV shows while I nursed Kevin in another room. This lasted until Kevin was almost a year old and he thankfully outgrew that phase.
Kevin is now a robust two-year-old and is still an avid nurser. I have been rewarded many times over for my efforts to see that he became a breastfed baby.