Breastfeeding My Premature Baby
From New Beginnings, Vol. 28 No. 3, 2009, pp. 20-21
When I discovered I was pregnant with my third child, I was excited and confident. I had two older children and couldn't wait to add another little being to our busy household. When my water broke five weeks early, I was thrust into a world of unknowns. With the help of a doula, my labor and delivery went smoothly. George David was born ten hours after my water broke and handed directly to me. I held him for 30 minutes before he became "too grunty" and was taken to the nursery for monitoring and extra oxygen.
As time passed, he required increasing amounts of oxygen. Our family doctor ordered a series of tests and decided to transfer Georgie to our local Level III Neonatal Intensive Care Unit (NICU).
Thanks to my overall health and medication-free birth, I was able to leave the hospital less than ten hours after I had delivered. Before I left, the nurses gave me several bottles, a kit to a double breast pump, and instructions to get the pump itself when we arrived at the NICU.
We encountered more problems when we got to the NICU. We were told to "scrub in" and then we were left to sit in the family waiting room. Ten minutes later, we had to wash our hands again and go to the parent's lounge. I told every nurse I saw that I needed a pump.
Finally, we were taken to Georgie's room. I found my newborn hooked up to beeping machines, with an intravenous drip in his arm, and a tube down his throat. Warned not to touch or even speak to him, I was given a breast pump and left alone.
Crying, I managed to hook up the pump, only to have one side not providing much suction. The nurse told me she "really didn't know much about pumps" and I think I managed to get a few drops of colostrum. Feeling the need to do something, my husband went off to find a rental pump or a lactation consultant, only to find the LCs were not around and the hospital did not rent pumps.
Emotionally exhausted and frustrated, we went home. Immediately, I called my good friend, a La Leche League Leader, for advice. She put me in touch with a lactation consultant at another NICU. When I said I wasn't worried about pumping because I had experience nursing two other children and always had enough milk, she warned me to get a pump as soon as possible -- my breasts needed the stimulation and my baby needed my milk. She also gave me a better idea of what to expect from a premature baby, leaving me relieved and comforted.
The next morning, after a fitful night's sleep, my husband and I went back to the NICU with a bag full of pump parts and a rented pump. When we arrived, we found our son in contact isolation. No one could go into his room without wearing gloves and a gown.
I started crying when I saw the lactation consultant. She apologized for the confusion of the previous day and took the time to explain the monitors to me. She gave me labels for the bottles, fit me with new flanges, left a sheet of pumping tips, and showed me how to troubleshoot the pump. Through information and kindness, she gave me some control over a situation that was slipping from my grasp.
The next few days were a flurry of pumping, freezing, and storing milk. The staff at our NICU didn't believe babies ever suffered "nipple confusion" from using artificial nipples. They would only feed premies from the mother's breast, a bottle or a naso-gastric tube (a tube through the nose and into the stomach). Although I had stacks of evidence that premature babies can be fed via syringe, cup, or other non-nipple means, I chose not to fight that battle. I pumped and hoped and prayed that I would have the resources to correct any problems. All I wanted was to get home!
By day five, Georgie was able to nurse with a nipple shield. He would nurse for ten minutes and then be given a "chaser" of breastmilk through the naso-gastric tube. Although the nurses expected we would need to supplement with formula, my breasts took that as a challenge -- and we won! I ran out of space in the NICU freezer and had to store my milk at home.
Nine days later, Georgie was nursing well and released to go home. We left happily, thrilled to be doing something normal. However, two days later he had lost a little weight. I was upset and a little scared. The next weight check brought more bad news -- he was now below his birth weight and he needed his bilirubin levels checking. When I told my doctor I was communicating with LLL, he smiled and said, "Wonderful organization!" then directed me to supplement after each feeding with breastmilk.
A few days later, baby Georgie was still at the same weight. I nearly broke down. I was doing everything everyone suggested. Georgie was nursing frequently, being supplemented, I was doing breast compressions, warm compresses, eating oatmeal, pumping, trying to wean off the nipple shield … all while taking care of two other children. Although I had a lot of support I was stressed and scared that my baby would end up back in the NICU. I couldn't think of anything other than getting my baby to gain weight. What was wrong? The only things that kept me going were the support of my LLL Leaders and the knowledge that I had nursed before, so I knew my body "worked."
After a lot of pumping, bottle feeding and nursing, Georgie finally began to gain weight well. We reduced the supplements, he weaned off the nipple shield, and he began to gain weight rapidly.
Six months later, no one else notices the slight delays that are related to his prematurity. He was exclusively breastfed for six and a half months before he started solid food. He's chubby and roly poly, making up for that first month when he gained weight so slowly. After so much uncertainty, I am now in a familiar place: breastfeeding my seven-month-old.