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Preemie Books
Living Miracles: Stories of Hope from Parents of Premature Babies
by Kimberly Powell &
Kim Wilson
Life on the Reflux Roller Coaster
by Roni Maclean
The
Pregnancy Bed Rest Book by Amy E Tracy, Richard H Schwarz
The
Preemie Parents Companion: The Essential Guide to Caring for Your Premature Baby
in the Hospital, at Home, and Through the First Years by Susan L Madden M.S,
William Sears MD, Jane E Stewart MD
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***Because
preemies have very specific issues, I have not addressed their special needs in
this context. There is information available from La Leche League International
on the special situation of breastfeeding a preemie.
Breastfeeding the Hospitalized Baby
by Cyndi
Egbert
While
it is a blessed fact that babies come in two genders, for the sake of clarity,
mother is referred to as "she" and baby is referred to as
"he" for the purposes of this information sheet.
None of the information contained herein
is meant to provide medical or legal advice. These are merely suggestions. All
decisions should be discussed with your health care provider.
This information is a guideline, a
starting point for discussion with your child's caregivers. Because each child's
condition and situation is unique, anything affecting the child's overall
well-being should be agreed upon by all involved. It must be stressed that,
ultimately, the parents have the final say on all aspects of their child's care.
Index:
Breastfeeding the Hospitalized Baby-Main Text
Appendix A:
Glossary of Useful Terms
Appendix B: Chain of Command
Appendix C: Where to Find Help
Quick Checklist: At-a-Glance Reference
Pregnancy is generally a time of
anticipating wonderful things to come. Even when the pregnancy was unexpected,
most mothers are eager to greet and come to know their new child by the time of
the birth. The thought that there might be a problem occurs to all of us at one
time or another; but it is usually dismissed quickly as unfounded.
Sometimes it is apparent during the
pregnancy that something is amiss, but more often it is at delivery or within a
few days after that problems suddenly show up. An older baby may suddenly become
very ill and require hospitalization.
As unfortunate as these things are, it is
more unfortunate still that many mothers, overwhelmed by their child's
condition, the medical staff and the hospital setting itself, conclude that
breastfeeding is no longer an option. Breastfeeding may be abandoned or never
initiated.
Following are a few guidelines that may
help breastfeeding remain a viable option.
- If your baby is unable to nurse for a
time, the main priority in regards to nursing is to establish or maintain a
milk supply. Pumping as often as possible is advisable. The reality of
pumping is that it is likely to take a half-hour or so for each session.
Pumping, labeling the containers and washing your equipment is time
consuming. If your child has a private room, you may be able to keep a pump
with you so that you don't have to go to a pumping station. Hand expression
can be invaluable in this situation because of the minimum of equipment, but
it's a learned art. If your child is in an open ward or ICU, you may be able
to draw the privacy curtain and either hand express or use a battery
operated pump without having to leave your child. Obtaining the cooperation
of your child's nurse is often as simple as asking.
- Be sure to check on the hospital's
storage policies. They vary from hospital to hospital and may include
special storage containers or a time limit on how long milk can be stored
before use.
- Do not ever discard expressed milk.
When your child is unable to receive milk because of intubation (being on a
breathing machine) or other problems, it may seem ridiculous to be storing
ounces and ounces of milk that can't be used yet. When the baby is able to
receive your milk, it can disappear at an amazing rate. The more milk you
have in reserve, the less pressured you'll feel if your baby is unable to
nurse well as he recovers. Often, as they slowly regain their strength,
babies will be tube-fed through their nose (NG tube) to conserve energy
needed for healing. Pouring two ounces every two or three hours down that
tube can add up very quickly.
- Once you can hold and cuddle your
baby, put him to the breast even if he's too weak to nurse. The stimulation
to the breast will aid in your pumping efforts and it will help your baby to
learn or relearn that not all touching is bad. Some babies have an aversion
to anything touching their face or mouth after being intubated for a time. You may be able to help prevent this by allowing him the chance to suck on
your finger even while intubated. In any case, do not force the issue if the
baby doesn't want to nuzzle the nipple. You may need to start slowly,
perhaps letting him rest his head on your chest with your shirt down and
gradually working up to more skin contact until his face is lying on your
chest with your shirt up. Eventually he'll get the idea.
- This always seems to be redundant
advice, but it is important and bears repeating. Try to rest and eat. When
you're worried about your sick baby you may not feel like eating or be
unable to sleep for more than an hour or two at a time. Inadequate rest and
nutrition may interfere with your milk supply. Don't expect perfection.
Sleep as much as possible and try to eat at least two small meals a day. On
the ward it will be possible to keep a snack or nutritious drink nearby. In
ICU you may be able to keep at least a cup of water handy. It depends on ICU
policy and also the nurse on duty, but it's worth asking.
- Try to avoid rubber nipples, bottles
or pacifiers. A baby that is unable to nurse for a while may get even more
confused if given rubber nipples to suck on. Drinking from a bottle is more
physiologically stressful than nursing and requires a whole different set of
actions. Sometimes there may be a hospital policy involved. In the cardiac
ICU we were in, it was policy that a baby be able to suck from a bottle,
lying down, before being transferred to the ward. The theory was that if the
baby could accomplish such a physically stressful feat without going into
cardiac arrest, it was probably safe to move him into a less supervised
setting. I finally had to go to the Surgeon to request that this policy be
waived in my daughter's case. He agreed and that was the end of it, but no
one under him had the authority to agree to my request. You can start by
asking a nurse, but always take your requests to the top of the command
chain if you are not getting the answer you want. (See Appendix
B)
Once your baby is physically able to
nurse, different issues come into the picture. Your baby may have some difficulties
with the act of nursing. This may be due to being intubated, an aversion to
being touched around the face or mouth, congestion, weakness or congenital
abnormalities of the mouth. Some problems, such as weakness or congestion, may
just take some time to resolve. A very weak baby will likely be tube-fed to
conserve energy, and in that case nutrition will not be the main concern. Other
problems may warrant a consultation with the lactation consultant on staff or a
local La Leche League Leader. She will be able to offer concrete suggestions,
perform an evaluation, or refer you to an appropriate therapist and/or other
resources.
- You will hear more about calories
during this time than you have heard throughout your entire life unless
you're a weight loss counselor. Breastmilk is calculated as having 20
calories per ounce. High calorie formulas, containing 24-27 calories per
ounce, are frequently advised for use in compromised babies. Human Milk
Fortifier (HMF), developed for use with premature infants, is often used as
a "filler" when an infant is being tube-fed expressed breastmilk.
HMF is cow's milk based and as such may cause an allergic reaction. A
full-term baby on HMF may also need to be monitored for electrolyte
imbalances because they don't have the same nutritional deficiencies as
preemies. Another commonly used filler is Ploycose. It is basically a simple
carbohydrate, but may also cause allergic reactions. Various studies have
concluded that the caloric content of human milk varies from mother to
mother and may also differ in a single mother through the course of the day.
Any analysis of your milk to determine how many calories per ounce your baby
is receiving may be an option.
- If your baby won't nurse and is being
tube-fed, try to avoid giving medications by mouth. Oral medication can
usually be put down the tube. This avoids any additional negative oral
stimulation and may make efforts to breastfeed go a little more smoothly.
- Try to find at least one contact
person who is supportive of your efforts to breastfeed. The isolation of
being in the hospital with a sick baby is very stressful. Trying to nurse
your baby without anyone to encourage you during this time is doubly
difficult. The hospital staff are often so caught up with calories and
"ins" (milliliters taken in each day), not to mention the dreaded
daily weight check, that breastfeeding may be viewed as an inconvenience. It
is much more difficult to measure. Someone who can pat you on the back when
you're discouraged and celebrate with you when you've made progress, no
matter how little, can be invaluable. If you have no close friends who would
fit the bill, contact a local La Leche League Leader.
- Finally, try not to get too
discouraged. There are some babies who will never physically be able to
nurse. They are the exception rather than the rule. Most babies, with
patience and perseverance, will eventually be able to reap the many benefits
of breastfeeding.
I know how difficult it is to breastfeed
in adverse circumstances. My own daughter would not have been breastfed were it
not for my background as a former La Leche League Leader. Even with my
determination, there were many obstacles to overcome. I am thankful for the
friends who were able to support me through the six weeks we spent at the
hospital. My daughter did not successfully nurse until after she was discharged
at six weeks of age. At two months of age she still had not regained her
birthweight! Two months after that, however, she was actually plump.
She is frequently ill and has had
pneumonia a number of times. Many of the pediatric nurses at her hospital know
us on sight. Yet, when I talk with other parents of children with her problems,
I realize how very lucky we've been. I am sure that breastfeeding has prevented
far worse complications than the ones we deal with. So while no one can promise
that your child will never get sick again if you breastfeed, you can be sure
that the benefits will still be tremendous.
Appendix A:
Glossary of Useful Terms
Appendix B: Chain of Command
Appendix C: Where to Find Help
Quick Checklist: At-a-Glance Reference
Copyright © 1998 Cyndi Egbert. All rights reserved. Please e-mail all reprint
requests to Cyndi at: CyndiMom23@aol.com.
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