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Breastfeeding Evolution amidst the NICU Technology

 

 

Powerful Skin to Skin

Evolution

I love babies. I love being a nurse.

I love all the evolution of technology through which I have practiced. I love how I have had to continually evolve myself. I love helping mothers help themselves, advocating for them and their infants, facilitate when needed to support them making their own choices and watch as they evolve….. becoming the best mother they can be!

I know I haven’t blogged lately and it is because I have been having a bit of a rough transition… my latest evolution…  in my new NICU job. Orientation is somewhat difficult for me. I had previously been arriving at work already at the top of my game (for the last 25 years or so) and I have now found myself a student…. every. single. day. It is almost like I have gone to a totally new facility! EVERYTHING seems new or different. All new equipment/monitors/procedures/policies/protocols/doctors/practitioners/and staff.

The babies are the same. Since some are much more preterm than we have cared for in the past… their issues are more complex. Some are the same as we have always cared for, but with neonatologists now on board, the approach to the care of these babies is evolving.

I am unlearning some of what I have always known and relearning things in new ways.

Evolution

I was able to prepare and submit the mission statement and policy on Breastfeeding for our NICU population. The neo’s are extremely awesome on breastfeeding or breastmilk feeding promotion and support! So we have a very good start for breastfeeding support in our new unit. Excellent actually! I am happy to report that since opening our unit, most of the babies thus far have had a total exclusive diet of breastmilk or fortified breastmilk! I think that is fabulous! There have been some moms who after discussion and encouragement to provide breastmilk, wished to formula feed and their choice was supported without further discussion or question. My new co-workers have been very professional about that. There were a few who provided colostrum initially and then decided not to continue. This was also supported.

Coming from my previously comfortable world of lactation in the full term nursery, I find myself on a journey to find a balance between technology and nature……  precision, absolutes and finite accuracy vs the inconsistency, variables, and imprecise intake of an infant at the breast. We are calculating daily the actual fluid and kcal energy intake of each baby and comparing that with the kcal/fluid requirement per kilogram of weight. Changes are then made accordingly. Most of the preterm population is unable to take in their required fluid and caloric needs solely by mouth. Most have parenteral nutrition in the form of a glucose/ Amino Acid protein and Lipid (fats) at first by a central line or an IV (TPN) and gradually switch over to taking all their requirement by their GI system (Enteral). They don’t have the stamina to take it by sucking/drinking and they require a nasogastric (NG) tube so the remainder of food can go in by gravity or feeding pump (gavage feeding).

 

NG tube

I actually love learning all this. I thrive on having a detailed clear clinical picture of my patient. I am very detail oriented which is a good thing. Because of this precision, the measurements and the calculations—> actual breastFEEDING is not often seen until much later in the game. I understand this. I do. I want so much to be very helpful at transitioning to full feeds at the breast. I have to wrap my head around it each time (all the while being a student in all other aspects of the infant’s care) researching how to best advise each mother. We range from visits every other feeding to visits once or twice a day. Skin to skin is the most powerful tool I can use when faced with limited exposure or opportunity. Sometimes when the mom is arriving for my patient, I’m involved in other things and unavailable to do anything other than providing some private skin to skin time. Encouraging any licking, suckling or other feeding behaviors at the breast during gavage feeds is also good. When the baby gets more and more ready to take oral feeds… what I’ve seen so far is that they are already preferenced to the bottle nipple. The weight gain has been established, the precision of measurement seems to have become slightly less rigid. It seems that there is adequate physician support to encourage full feeds at the breast. There are hundreds of experts out there who have gone thru this, and reorganized policy and procedure to protect breastfeeding in the NICU.

I have to evolve myself again and re-learn more about transitioning to feeds at the breast before the bottle becomes a primary feeding implement. Once I can  find my footing- I hope to be strong and confident enough to start teaching moms and my co-workers.

Breastfeeding is NOT an exact science!

I need to figure out when the exact science of Neonatology can accept that….

into the feeding plan for each individual baby!

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6 Comments Post a comment
  1. My daughter was born at 34 weeks, and able to take all of her feeds orally. However, she was offered a bottle of formula before I had a chance to try breastfeeding. And she was given a pacifier before she was offered a bottle of formula. There was a definite preference for the artificial nipple before I had a chance to try.

    That was 5 1/2 years ago, and in speaking with other moms who’ve gone through the NICU locally, things have changed. But there are still so many barriers to breastfeeding in the NICU. The separation alone is huge. When you can’t be there at every feed, you can’t exclusively feed at the breast, and there are so many complications from that. In the current hospital structure there is no way around that, but as a former NICU mom, I think my ideal for premature infant care would be some sort of family unit, that gave parents the option of being present around the clock, like many pediatric wards do.

    November 3, 2010
  2. silver #

    My daughter wasn’t premature, but she was in the NICU. They offered her a pacifier dipped in sugar water for procedures before I was even able to hold her for the first time. That upset me that they did it without even asking me. Even though she was full term, they fed her by IV for her first day and a half of life. Their reasoning was that when babies have rough starts that they can’t handle actual digestion.

    They did have private rooms for each neonate. So after I was discharged I was able to stay in her room and nurse her with every feeding. That was nice, because they were going to refuse to release her until she could prove that she could nurse well enough to gain weight. Knowing that caused *me* to wake every 3 hours at night (without any alarm or the baby waking) in order to make sure she nursed enough.

    November 3, 2010
  3. Debbie #

    My son was born at 30 weeks 6 years ago. I really wanted to breastfeed him and was so scared that I wouldn’t be able to because my body wouldn’t be ready, never thought that he might not be ready-I really had no clue. Luckily I was at an awesome hospital and when I asked if I could feed him the neo said that was highly encouraged but that I would have to pump at first. Within minutes of his birth the nurses brought me a breastpump and helped me get started. They told me I wouldn’t get much at first but that every drop was gold. And most importantly, they told me to pump every 2-3 hours for 20 minutes, around the clock. It was awful having to get up to go to a machine instead of a baby, but I never had supply issues and I felt like I was doing something for him during the night when I couldn’t be with him. I didn’t have other children or commitments at the time so I was also able to spend just about every waking hour at the NICU, holding him during his feeds. I think I was there from 9-5 and 7-11 (pumping at the side of his crib when I needed to) at least most days of his month stay and really got to know all of the wonderful staff. I look back at that time and think how crazy I must have been but how worth it all of that hard work was-15 months of breastfeeding and a happy, healthy baby. Keep up the good work with all those NICU mommas. It is tough to leave your little one in the care of others when he/she is supposed to still be inside of you in your care.

    November 3, 2010
  4. The Academy of Breastfeeding Medicine just had a “mini-post” in the past day or two in which they said that when babies are having trouble breastfeeding, mothers should look to “4 days past the due date” as the goal for when b/f should go smoothly. When babies are born early, even if it’s just a week or two, by induction or C/s, mothers and babies may have more problems with b/f. So, giving the mom a goal to look at, to realize that the difficulties she’s going through are not uncommon, may help give her the willingness and fortitude to persist in pumping and other breastfeeding efforts, when she may otherwise be discouraged after just a few days.

    November 3, 2010
  5. Wow great post! I think your hypothesis is correct. Happy New Year!

    January 2, 2011
  6. This is a beautiful post. I had a friend who recently had her baby at 29 weeks- she was able to give him her breast milk “through the tube,” and it was such an encouragement for her to be able to do so even though she couldn’t actually nurse him yet. I’m glad that moms of preemies are being provided the help that they need to give their little ones mommy’s milk.

    January 6, 2011

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