Nursing in the NICU
Lincoln NE USA
From NEW BEGINNINGS, Vol. 23 No. 5, September-October 2006, pp.213-214
Upon arrival at the hospital, nurses flew fast to get me hooked up to the monitors and to have consent forms signed as a cesarean was inevitable. I remember being very calm despite the chaos and fear swirling around me. I managed to get a kiss and an "I love you" from my husband as we passed each other in the doorway. Thank God I didn't know what was happening or what our potential outcome could have been.
A couple hours later I awoke to excruciating pain as the nurses were attempting to contract my uterus to stop the bleeding. Shortly after surgery I was taken to my postpartum room. On the way, the nurses stopped by the neonatal intensive care unit so I could take a peek at my son, Lance. From across the room I watched him struggling to breathe under an oxygen hood. It still had not dawned on me to ask what happened to cause this traumatic delivery. I only cared that Lance and I were okay.
Soon after I was taken to my room, the neonatologist arrived to tell me that Lance had aspirated a large volume of blood because my placenta had abrupted. He was stable, but the next 24 hours were critical. The only question I had was, "When can I start breastfeeding?" His response was, "That is the least of your concerns right now." Little did he know it was my only concern -- I knew how vital it was for my newborn in the neonatal intensive care unit (NICU) to have my colostrum to build his fragile immune system. I immediately summoned a nurse and requested a pumping kit and a hospital grade pump. I am so grateful to my friends who stayed at my side. They assisted with phone calls and putting the pump together. Courtney, my friend and coworker, graciously stayed with me the first night and every couple of hours she took my expressed colostrum to the NICU for Lance.
On day two, I finally I got to hold my new baby! Immediately, I requested the assistance of a lactation consultant to help me start nursing. Lance had other ideas. He was contented to just nestle in at my breast and lick any milk off that happened to be expressed. I was just thrilled to be able to hold my baby and know that my milk was slowly coming in.
The next day, the neonatologist informed me about Lance's weight loss and confirmed that he did indeed have aspiration pneumonia. Antibiotics had been started on day one, but now we needed to start supplementing him with formula. I can still remember the anger building inside me at that very moment when I asked what in the world had been done with all the milk I had been sending to the NICU for the last two days. The neonatologist looked at me in amazement and said "You're getting milk already?" It was as much as 20 cc at times! As a dietitian, I should have thought to ask for a diet order, but it never dawned on me that the hospital would have made my newborn infant NPO, which means nothing by mouth. I refused to let formula be used and instead insisted that I be allowed to work at getting Lance to nurse at the breast. Reluctantly, the doctor wrote the order for 20 cc of my milk every three hours. Since Lance would not latch on at first, my husband and I went to the NICU every two to three hours to syringe feed Lance in an attempt to help him get stronger.
By the next morning he was nursing at the breast. The nurses weighed him before and after each feeding to find that he was receiving 20 to 75 cc per session. I was hopeful that I had climbed my last hurdle, but I wasn't finished yet. I had to battle with a portion of the nursing staff who did not respect my right to breastfeed my baby.
Because of my breast-baring activities in the NICU, my stable baby and I were relocated to a less intense nursery located on another floor. This gave us more room and privacy. After five days in the hospital, I was discharged. My husband and I chose to stay until midnight because that was how long my insurance company would pay for the room. I fed Lance for the last time and instructed the nurses to syringe feed him during the night until I returned the following day.
The next morning my husband and I left at 8 am to head to the hospital, which is 30 minutes from our home. We were prepared for a day's worth of feedings every three to four hours. Luckily the hospital had two lactation rooms that were equipped with pumps and space for us to relax between feedings. Much to our surprise, during the night he had been put under lights to reduce his elevated levels of bilirubin, so this became a new obstacle to nurse around.
After a week in the NICU, Lance passed his breathing test and the neonatologist said he was able to come home with us. Finally I would be able to nurse on demand and relax in my own home. My worries were over, or so I thought. Five days later, Lance's first weight and color check at the pediatrician's office didn't go well. I was not prepared to hear that Lance had lost a half-ounce since his discharge. He was already down 10 ounces from his birth weight. The clinic let us go with the understanding that we needed to return in 72 hours for a recheck.
At the recheck appointment, Lance's weight was up two ounces. He weighed six pounds, six ounces. I was surprised that Lance had only gained two ounces because all we did was stay in bed all weekend and nurse. I began to think something was wrong, but couldn't put my finger on it. I asked my husband to drive me 45 minutes across town to a breastfeeding support center so I could weigh Lance and talk with one of the on-site lactation consultants. I explained that Lance was not satisfied unless he was at the breast, but he wasn't staying awake long enough to nurse. I was devastated when the lactation consultant and La Leche League Leader, Suzy, suggested that I supplement. To me that meant I needed to use formula. She must have seen the fear in my eyes and she grabbed my hand and told me that I could finger feed Lance my expressed milk. What a relief!
As if I didn't have enough to worry about, I had also noticed my milk supply dwindling. I tried to pump between feedings but was not producing anything. I was exhausted. Another lactation consultant, Ann, suggested a new technique that required an hour of my time and would consist of five 12-minute sessions: pumping for 12 minutes and then resting for 12 minutes through an entire hour. Within 24 hours of just one session, my milk supply was back. Ten days after he was born, Lance weighed six pounds, 15 ounces. On day 12, Lance awoke next to me and latched on with much gusto. He has been nursing at the breast ever since.