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Our new NICU policy–>Breastmilk IS our babies food!

Yes! This HAS been accepted!!!


Here is an excerpt from our NEW NICU policy:

Policy Statement: It is the policy of the NICU to provide all mothers with factual information regarding the superior nutritional, immunological and therapeutic beneficial effects that human milk and breastfeeding will have on the health outcomes of their preterm or sick newborn so that their feeding decision will be evidence based. The healthcare professional has an ethical responsibility to avoid withholding information because of any unfounded concerns that informing mothers of research-based options may make them feel guilty if they choose not to breastfeed. The mother’s informed decisions will be totally supported and her infant will be provided nourishment in accordance with her decisions.  All mothers should be considered breastfeeding candidates until they specify intent to bottle feed.

Purpose: To promote and support human milk as the preferred method of providing nutrition. Provide assistance to the mother in establishing and maintaining breastfeeding.

Policy:

  1. Any mother desiring to breastfeed or provide breastmilk for her baby will be given consistent current and correct evidence-based information, emotional support and encouragement she may need to reach her individual goals. Healthcare professionals will avoid conveying information based on any personal breastfeeding experience as it may not be appropriate or applicable in discussions with mothers.
  2. Mothers may be asked/encouraged to temporarily pump/express and provide colostrum for their infant’s immediate protection and health needs regardless of their feeding choice.
  3. The mother will be involved in all feeding plans as soon as possible.
  4. All NICU infants will be fed according to their nutritional requirements as ordered by the physician.
  5. Early trophic feedings of colostrum/milk to stimulate intestinal maturity will be utilized as ordered and when there is colostrum available. It is beneficial for infant to wait a day or two until colostrum is available to maximize the transfer of protective components. Colostrum should be given to infant in the order it was pumped.
  6. Oral care/ mouth swabbing will be done using colostrum/ breastmilk.
  7. A multidisciplinary approach involving the physician, NICU team, the mother and a lactation professional to develop an individualized feeding plan will be utilized as soon as feasible in accordance with each infants requirements and feeding abilities.
  8. Cue-based feedings will be encouraged and utilized as soon as possible. All mothers will be provided educational information and encouraged to understand and participate in reading their infant’s feeding cues.
  9. Kangaroo care and/or skin-to-skin will be utilized and encouraged as much as possible..
  10. Stable premature infants should be allowed to go to mother’s breast during gavage feedings to ready infant for transition to breastfeeding.

Etc etc etc……………………………….. much more……………..

The policy I submitted was written using Marsha Walker’s  “Breastfeeding Management for the Clinician. Using the Evidence” as a major guide. I think I even used her words a lot. (Seriously-who can say it better?)

YAY! Thank you to my team and thank you Marsha!

DUE TO REPEATED REQUESTS FOR THE WHOLE POLICY… HERE IS WHAT I HAVE… I HAVE INCLUDED THE REFERENCES

 

Policy  Statement:      It is the policy of the Special Care Nursery/NICU to provide all mothers with factual information regarding the superior nutritional, immunological and therapeutic beneficial effects that human milk and breastfeeding will have on the health outcomes of their preterm or sick newborn so that their feeding decision will be evidence based. The healthcare professional has an ethical responsibility to avoid withholding information because of any unfounded concerns that informing mothers of research-based options may make them feel guilty if they choose not to breastfeed. The mother’s informed decisions will be supported and her infant will be provided nourishment in accordance with her decisions.  All mothers should be considered breastfeeding candidates until they specify intent to bottle feed.

 

Purpose:         To promote and support human milk as the preferred method of providing nutrition. Provide assistance to the mother in establishing and maintaining breastfeeding for optimal growth and development.

 

Policy:

  1. Any mother desiring to breastfeed or provide breastmilk for her baby will be given consistent current correct evidence-based information, emotional support and encouragement she may need to reach her individual goals. Healthcare professionals will avoid conveying information based on any personal breastfeeding experience as it may not be appropriate or applicable in discussions with mothers.
  2. Mothers may be asked/encouraged to temporarily pump/express and provide colostrum for their infant’s immediate protection and health needs regardless of their feeding choice.
  3. The mother should be involved in all feeding plans whenever possible.
  4. All SCN/NICU Infants will be fed according to their nutritional requirements as ordered by the physician.
  5. Early trophic feedings of colostrum/milk to stimulate intestinal maturity will be utilized as ordered and when there is colostrum available. It is beneficial for infant to wait a day or two until colostrum is available to maximize the transfer of protective components. Colostrum should be given to infant in the order it was pumped.
  6. Oral care/ mouth swabbing will be done using colostrum/ breastmilk.
  7. A multidisciplinary approach involving the physician, SCN/NICU team, the mother and a lactation professional to develop an individualized feeding plan will be utilized as soon as feasible in accordance with each infants requirements and feeding abilities.
  8. Cue-based feedings will be encouraged and utilized as soon as possible. All mothers will be provided educational information and encouraged to understand and participate in reading their infant’s feeding cues.
  9. Kangaroo care and/or skin-to-skin will be utilized and encouraged as much as possible..
  10. Stable premature infants should be allowed to go to mother’s breast during gavage feedings to ready infant for transition to breastfeeding.
  11. Promoting non-nutritive suckling at mother’s recently pumped/drained breast will be encouraged whenever applicable. Although pacifiers are not routinely used for healthy term breastfeeding infants, preterm infants in the Special Care Nursery/NICU or infants with specific medical conditions may be given pacifiers for non-nutritive sucking.
  12. Feeding at the breast will be introduced as soon as possible for those sick or preterm infants as they improve and display appropriate feeding readiness cues.
  13. Supplementation, complimentary feedings and use of alternative feeding devices including nipple shields will be individualized in accordance with the multidisciplinary feeding plan above. (#7)
  14. Human milk fortifier may be indicated and will be added as ordered by the physician.
  15. Breastfeeding Policy  #6250-OB-B-3 and Breastmilk Collection and Storage Policy #6250-OB-B-3A will apply wherever applicable.
  16. If a mother is unavailable for feeding and/or has chosen to pump and store her breastmilk for infant feedings, she will be provided with written pumping instructions. These pumping practices to maximize early production and volume include:
  1. Begin pumping within 6 hours after delivery whenever possible (as clinically indicated by infants and/or mothers medical condition). Early and frequent pumping in the first week is crucial.
  2. Double pumping with high quality hospital grade pump (or pump which cycles 48-50 times/minute and with vacuums not exceeding 240mm Hg.)
  3.  Simultaneous pumping with properly fitting flange and added breast massage yields more milk and higher fat content.
  4. Pump at least 6 times in 24 hours (100 total minutes/day). Mothers pumping at least 8-12 times in 24 hrs yielded higher milk output.
  5. Evaluate any mother’s concerns over low milk volume promptly to promote maximal adequacy of milk expression.
  6. A mother may be encouraged to use the breast pump at the infant’s bedside as a means to increase milk production.
  7. Collect milk in plastic tightly lidded containers (ie Snappies) which are self labeled by mother with infant’s name, date of birth, MR#, date and time milk was pumped.
  8. Freshly expressed milk that can be immediately given to infant provides optimal protection factors.
  9. Milk must be promptly stored in the refrigerator if it is to be used within the next 48 hours.  Breast milk may be placed in the freezer for 3 months or in a deep freeze for up to 6 months.  If the infant is preterm or a sick term infant, frozen breast milk should be used within 3 months, however, it is preferable to use outdated breast milk as opposed to artificial milk.
  10. Mother should transport her milk to the hospital frozen in a cooler with an ice pack.  Thawed breast milk must be used in 24 hours.
  11. If milk brought by the Mother is thawed, it must be placed in the refrigerator.  It cannot be refrozen.

 

 

References:

Bakewell-Sachs, S. and Brandes, A. (2003).  Nutritional Management. In Verklan, M.T. and Walden, M.  Core Curriculum for Neonatal Intensive Care Nursing, 3rd Ed. St.Louis,MO: Elsevier Saunders.

Crosson, D.D and Pickler, R.H. (2004). An Integrated Review of the Literature on Demand Feedings for Preterm Infants.  Adv Neonatal Care. 4(4): 216–225.

Dougherty, D.  and Luther, M. (2008). Birth to Breast—A Feeding Care Map for the NICU: Helping the Extremely Low Birth Weight Infant Navigate the Course. Neonatal Network. (27) 6.  Pp 371-377

Kirk, A.T., Alder, S.C., King, J.D. (2007).  Cue-based oral feeding clinical pathway results in earlier attainment of full oral feeding in premature infants:  Cue-based oral feeding clinical pathway.  Journal of Perinatology (27) 572-578.

Meier PP, Engstrom JL, Patel AL, Jegier BJ, Bruns NE. Improving the use of human milk during and after the NICU stay. Clin Perinatol. 2010 Mar;37(1):217-45. Accessed via PubMed July 17 2010

Walker, Marsha (2011). Breastfeeding Management for the Clinician- Using the Evidence 2nd ed. Jones and Bartlett, Sudbury MA

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43 Comments Post a comment
  1. Awesome!! What a great step forward 🙂 Congratulations!

    July 23, 2010
  2. I love it! Absolutely awesome!

    July 23, 2010
  3. Woohoo!

    I wish my own NICU had such a policy in 2005 when my daughter was in there. She was given a bottle of formula without checking with me, and before we had a chance to even try breastfeeding. I’m still angry about it 5 1/2 years later.

    July 23, 2010
    • StorkStories #

      I know Amber, I know…. hoping we as a team can prevent any or all of what you and thousands of other moms have endured.. To the future! Cheers!

      July 23, 2010
  4. Karen #

    /
    The NICU my son was in was extremely pro-breastfeeding, taking the lead from the very pro-breastfeeding head neonatalogist. I have heard that she is influencing and working with ALL the local NICU’s on promoting breastfeeding and breastmilk in the NICU.
    My son never had formula in his week in the hospital. It was TPN or breastmilk in a feeding tube. As soon as he could he was on the breast and co-sleeping (with neonatalogists blessing) in my room.

    July 25, 2010
    • StorkStories #

      Excellent news!!! We have a transition room for preparing for discharge which allows for co-sleeping. Thanks for sharing!

      August 13, 2010
  5. Thank you so much for posting this information. My second daughter was in the NICU for three days and the staff was incredibly supportive of my wish to breastfeed. They followed the exact steps described on your post. I wish more women could have had the same experience that I did. I have heard too many stories of women who were told they weren’t making enough milk or that the baby needed to be put on formula. Such a shame. Thanks again!

    August 5, 2010
    • StorkStories #

      Excellent news!!! Thanks for sharing!

      August 13, 2010
  6. Shawna #

    Wow,fabulous! Can I get a full version of your policy? I am a NICU nurse currently heading up the breastfeeding task force to help initiate like changes. We just this year changed our policy to INFANT DRIVEN FEEDINGS; but need to do alot of work with integrating breastfeeding policies!

    August 10, 2010
    • StorkStories #

      I emailed you
      🙂

      August 13, 2010
      • Mary Chafin #

        Could I also get a full copy of your hospital’s policy.

        April 4, 2012
  7. Angel #

    I didn’t get the chance to breastfeed my triplets who were in the NICU and only 5wks early. I was never asked nor was it ever brought up to me as an option. I wish someone would’ve taken time to answer questions but everyone urged me to FF and all I heard was that it wasn’t possible. I could’ve atleast done one or two and rotated bottles I never even knew it was an option! It’s something I regret not being more forceful about.

    August 12, 2010
    • StorkStories #

      I’m sorry that you experienced that void in your educational offerings from the healthcare professionals providing your care. The human body can adequately produce milk for mulitples. Think about wet nurses in past history. Glad your triplets did well. Try not to feel bad, the system failed you and I apologize for that. We keep trying to get better. I hope for improved education across the continuum of providers and consumers.

      August 13, 2010
  8. That is so great! I wish there was such a policy when my son was in the NICU. That was 12 years ago.

    August 18, 2010
  9. Amy Macke RN, IBCLC #

    I would love to have a full copy of your policy. This is fantastic. We are currently developing a cue based feeding program in our NICU. I am writing a NICU BF policy I have been using Marsha;s book and Nancy Wight and Jane Mortons Best NICU Practices. I love how straight forward your wording is in the opening statement.
    Thanks for sharing and if you would be willing to send me a full copy, I would love it!
    Amy Macke RN, IBCLC

    September 21, 2010
  10. Anna Koralewski RN, C #

    Great job. We are currently persuing Baby Friendly Status for our institution and I have been searching for more information to continue that initiative in the NICU. Simlutaneously, the hospital has approval to be a human milk donor site. Separately, the NICU is embarking on the deveopment of human milk feeding protocols for the preterm infant. I am working with the Baby Friendly Initiative committee and the NICU hman milk project. I would like to ask for a full copy of your policy as it has such a positive tone and I am going to need all the positive available to promote the changes we are embarking on.
    Sincerely,
    Anna Koralewski RN,C

    October 21, 2010
    • StorkStories #

      Thanks! Where are you located?

      October 22, 2010
  11. Amanda Miller #

    Thank you for sharing your initiative. I am a nutrition fellow working in the NICU and am in the process of developing a breastfeeding procol for the medical care team. This information will be given to all of the team working with these infants. We all want to be on the same page especially when working with mom on breastfeeding. I would love to have a full copy of your policies. This would be a great resource for my use.
    Thank you!
    Amanda Miller, RD

    November 19, 2010
  12. Janice Newman RN IBCLC #

    I am currentlyl working on policy revision and would love to have a full copy of your policies. What an amazing job your have done. It is all about supporting the mother baby dyad.
    Thanks
    Janice Newman

    November 29, 2010
  13. Alga kifleRN IBCLC #

    Wonderful! Thank you so much for writing this policy. Early initiation of colostrum, the importance of skin to skin is well written I can not wait to share with my NICU colleagues.
    Thanks
    Alga Kifle

    January 5, 2011
  14. Myrtle Illiano #

    Hi. Thank you for making this available. I am also a NICU RN trying to help keep our NICU doing the best for our babies. Please email me the full policy. Thank you very much. Myrtle

    February 20, 2011
  15. Kathy Mason #

    Can we get the full copy?? I’m a NICU LC. Thanks!

    March 7, 2011
    • Reba Lee, RN, CLC #

      In researching and updating breastfeeding policies for both our well-born and NICU nurseries, I came upon your site. There are so many “interesting stories” that I could relate to…from the RN to Lactation educator to the Mommy and then the Grammie role! I actually laughed and cried as I read a few of your stories… In the almost 20 years that I have worked in this area, there have been many, many changes/improvements; but, there is SO much more room! If possible, please send copy of your entire policy. I would love to review the complete work!

      March 8, 2012
  16. Joy #

    Is it possible to get a copy of your entire policy. It looks great. Nater2210@live.com

    March 24, 2011
    • StorkStories #

      Sorry what type of organization are you associated with.. RN?

      March 30, 2011
  17. Rachelle Butler, RN #

    I am a NICU Rn and amcurrently working on revising our NICU Breastfeeding and Breastmilk Handling policy. Would it be possible to get a complete copy as a reference.
    Thank you, Rachelle

    June 5, 2011
    • StorkStories #

      Sure Rachelle.. I can send you what I have!

      June 5, 2011
    • StorkStories #

      Sent you an email … please let me know you got ok!

      June 5, 2011
  18. Connie #

    I am very interested in your policy regarding breastmilk and mouth care. I am RN IBCLC in a level 3 NICU. I want to write a policy regarding breastmilk and mouth care. Can I have any info you may have? Thank you in advance. cnolet@childrensnational.org Sources, policies etc

    July 25, 2011
  19. Jessica Callahan #

    I too would love to get a copy of your policy. The NICU that i work at thinks it is pro breastfeeding but they are far from it. Although i feel sometimes the neo’s feel they know everything and no other NICU hospital is doing any of the things that i suggest. So i would love to see your policy so that i could show it to them and ‘prove’ that more can be done.
    sugarmy3@yahoo.com
    Thank You so much

    August 22, 2011
    • Jessica Callahan #

      Sorry forgot to add – I am an RN/IBCLC, i work the entire maternal child health unit and outpatients as well.

      August 22, 2011
  20. Jennifer Hill RN, BSN, IBCLC #

    I would also love a copy of your policy, if possible. I am trying to educate our NICU and establish a consistent breastmilk first policy. So far it is hit or miss, depending on who’s working! I love that you use Marsha Walker’s book. I have a supportive Neo, but I am the only LC and have very little time….. Thanks if you can help.

    September 5, 2011
  21. Mary Chafin #

    I would also be interested in your full policy. I am a NNP in a Level III nursery trying to get a breastfeeding policy instituted.

    Thanks

    November 13, 2011
  22. star siegfried #

    Hi,
    I love your NICU hospital policy.
    Would it be possible for you to share the entire policy with me?
    Star Siegfried RN, IBCLC

    December 17, 2011
  23. this is great!..breastfeeding promotion in NICU staff is an interesting topic and your policy will help me a lot to disseminate such information to all my colleagues.Is it possible for me to avail a copy of your policy? Thanks for your help..

    February 2, 2012
  24. Leila Castillo #

    Our facility is in the process of BFHI…I think we have put in a lot of great practices towards being baby friendly in our maternal child department however our NICU has not initiated any practice change towards this initiative. This wonderful policy will be a great start. Can you please send me a copy of the complete policy?
    Leila Castillo RNC, MBA

    February 29, 2012
  25. Amy Liong #

    Thanks for sharing. I would love to have a copy of the complete poicy if possible. Many thanks in advance.
    Amy
    amyliong@gmail.com

    April 21, 2012
  26. Molly Whitaker RN IBCLC #

    Excellent information. Please share complete policy with me as I work in a Level 3 NICU. Our policy is in desperate need of updating. Any other policies you can share are greatly appreciated. Kangaroo care, cue based feeds, etc. Thanks so much for your help.

    May 10, 2012
  27. Ryane Plaster #

    I am a NICU nurse in MS and am doing a policy change project. We currently have no policy in for swabbing the mouths of infants with breastmilk, but I’ve been researching it and hopinh to make this our policy… Can you please send me some information?

    May 14, 2012
  28. Kathy Mason #

    What hospital or organization does this come from?
    thanks!

    June 29, 2012
  29. Kris Harwood #

    I am updating our policy which is a mish-mash of collection, storage, preparation and administration of EBM. I’d love to see this & your other related policies. There’s alot to be said for not re-inventing the wheel! Thanks so much!

    August 7, 2012

Trackbacks & Pingbacks

  1. World Breastfeeding Week 2010 « Woman to Woman Childbirth Education
  2. Breastfeeding Evolution amidst the NICU Technology « Stork Stories… Birth & Breastfeeding

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