Wednesday, July 6, 2011

exclusively breastfeeding the premature infant

I have breastfed all of my babies, except for my adopted daughter (who i pumped milk for), my step son, and of course Aquila. So having successfully nursed three babies through 2 years old, and pumping for 9 months for Ruby, I had no doubts that i would nurse Willow.

After losing Aquila, then having the frightening experience of almost losing Willow, i was determined that i would breastfeed her. For me breastfeeding is my normal as far as mothering goes. nothing is less normal than burying your newborn, and nothing is normal about delivering your child at 31 week gestation. So, upon Willow's early arrival i craved a taste of normal. I was plagued with the memories of my breasts engorged and leaking with no baby to nurse.

Due to the chorio infection and days of IV fluids, and on having been 31 weeks gestation it took 5 days for me to get my first drop of milk.
first milk- 5 days postpartum

i pumped every 2 hours for 20-30 minutes those first 5 days, weeping because i thought my milk would never come in. I thought, “how dammed ironic is this? here i am with no milk for this living baby, when 9 months ago i was overfilled with milk for a baby that needed no nutrition.”
luckily though, Willow was not put on milk till i had produced some, and i was able to keep up with her through a rigorous pumping schedule.
Willow was on a C-pap for the first 10 days of her life. for those ten days i was "allowed" to hold her for three one hour sessions a day. she was not able to nuzzle at all, as the equipment was finikey and would pop lose. she also was still having A's and B's which also made it hard to move her to much. so, for three hours a day i would sit, with my little Roo inside my shirt.

Finally, she was able to step down to the nasal canula , which allowed her to have her first nuzzle session, where to my surprise she latched for a few sucks.
willow's first nuzzle

she was moved down the nasal cannula and then down to no breathing equipment two days later. this made it possible for me to hold her anytime i wanted and once every three hours, while she recived her feeding from a gavage tube she could attempt breastfeeding.

And here entered the biggest fight of the NICU -exclusive breastfeeding.
See, i wanted to leave the hospital with Willow exclusively nursing.... But, as the lactation consultant told me that was never going to happen. every baby born at 31 weeks left the NICU on bottles. period. babies typically leave the nicu at 36-38weeks gestation and breastfeeding is too hard at that age. bottles are easier.

i researched and tried everything suggested that was allowed. my he is that in this post i can help someone else struggling with breastfeeding their preemie. information is hard to find and all over the place. and it seems that when one method (bottle feeding ) is the standard, you are paving your own road to deviate from that path.

i struggled for 3 weeks with breastfeeding before throwing in the towel and giving Willow bottles .

We went home 5 weeks after birth, but almost would have went home 4 weeks. see, one of the neonatolgists agreed that i could take her home still on gavage feedings, so that we could learn breastfeeding at our own pace at home. Willow was having no other problems at that point. However, the three other neonatologists ganged up on me and changed the whole plan, going as far as to threaten to call CPS if i took her home.
One thing you must know is having a baby in the NICU is not like any other time you might have a child in the hospital. you cannot call in another doctor for a second opinion (they are all partners and will not go against each other), and you can't transfer care to another hospital. and if you argue with their recommendations, you can get social services called on you.
my argument was simply this--- there was no benefit to introducing a bottle. And, at the same time there was no harm in letting her go home on the gavage tube- babes go home on gavage feedings everyday (babies with special needs that make them unable to feed well). I am a very competent person, who had proven my understanding of everything explained to me and many things not explained o me. i also had approval from my insurance for daily nursing visits to check the tube and anything else. at the time my husband wrote this blog post . that was after the first neonatologist told us we were going home and set everything in motion for discharge. then she was off for 5 days in a row and the other neonatologists decided that their control issues were more important than working with my family. so, i broke down and gave her bottles . She had no problem with the bottles and we went home 4 days later.
for the next two weeks we worked on getting her off the bottles. unfortunately she still wasn't getting a sufficient amount of milk from the breast so we used an SNS . we had to use the SNS for about 4 weeks before she could get enough from the breast. i pumped every 3-4 hours through all this. it was exhausting and draining, but i could see a light at the end of the tunnel.

during this time we visited a private lactation consultant who diagnosed Willow with a bubble pallet. this was causing (and continued to cause) most of her problems breastfeeding. She could not effectively nurse on one side till a few months ago. so i only nursed on the side she could do and pumped the other. i still continue to pump, not because i have to, but because i donate and wanted to continue. i have donated around 2000 ounces so far !

So- after all the hard work- Willow breastfeeds great. And you can get here too!

tips and links for breastfeeding in the NICU and beyond:

*as soon as possible hold your baby skin to skin , also called kangaroo care.

*As soon as possible let the baby nuzzle the breast. Preemies are VERY sleepy and have very little energy for feeding, so don't overstimulate them by rocking, singing etc while they are trying to nurse.

*Get comfortable. Use the crossover hold . Cradle hold will not give you enough control over their tiny and wobbly head, and football hold tends to 'drown' them and make them aspirate. Use pillows to bring baby up to you. Boppys suck for preemies. Just roll up blankets and fit them where you need them. Try doing reclined nursing this really helped us.

*get a scale. Get it now. The NICU has plenty- ask for one to be stationed in your baby's area. Weigh baby before a feed and directly after (don't change the diaper first!) the grams gained are equal (almost exactly) to CC's of breast milk. *this is s very effective method of judging amount taken in*. You can find out how much you baby needs per feeding here , but you neonatologist will tell you also. When you come home from the NICU , rent a scale. Google breast milk scale rentals for your area. It is worth every penny for the piece for mind of knowing your baby is or is not getting enough.

*If your baby is not getting enough, invest in an SNS. They really work. My NICU gave me one for free when I asked.

*Have your baby's mouth checked for tongue ties and pallet issues.

*Stay at the hospital if at all possible and try to be there for every feeding you can to practice nursing.

*If your baby doesn't get enough in a feeding – you must pump to maintain supply-especially in those first 6 weeks. This is crucial. When you have a preemie- your pump is your other baby.

* ask about cup feeding

*If your baby has no other problems medically except for feeding, ask about the option of going home on gavage. Studies have shown that it is not risky for the baby.

*If nothing works, give a bottle, get baby home and try everything in the comfort of your own home (with a scale!). You will amazed the difference in your breastfeeding once you are not in a stressful place like the NICU.

Pumping tips:

*start pumping right away.

*Until your milk comes in pump every 2 hours for at least 20 minutes.

*Once it comes in do not pump less often than 8 times in a 24 hour period.

*If you are having problems with supply try power pumping. It works wonders!

*You can take a 5 hour stretch of sleep at night, but you must make up for it by power pumping. I watched several moms lose their supply because they would not pump to sleep (which is fine) but would not make up for it later. Just remember you wouldn't be sleeping for 5-8 hours strait if your baby was home. Your breasts need that stimulation in those early weeks.