How do we successfully support the mom of a preemie if we are not on
> staff at the hospital?   Sorry to ramble, just feeling for the mom :-(
> P.S.  This is a well known Boston area hospital that is supposed to be
> breastfeeding friendly!

Even in breastfeeding friendly hospitals, unfortunately, things don't always
go as they should for premies.   A 34 week gestation baby, without
respiratory distress, should be able to go to breast almost immediately and
certainly before it ever gets a bottle. I would not expect that the baby
could get a full feeding from breast or nurse completely for every single
feeding (although occasionally a baby at that age can), but there is no
compelling reason to give a baby at that gestation a bottle.  I would
recommend skin-skin holding, breastfeeding when infant is showing feeding
cues and gavaging by indwelling tube the rest of the time.  Once the infant
is showing nutritive sucking, test wt.s can be very helpful.  Milk should
come in quickly for this mother and she should soon be making more milk than
the baby needs--a good thing for a premie mother because a high supply
facilitates milk transfer.  I would encourage the mother to pump 8 times in
24 hr. (after breastfeeding and in lieu of breastfeeding).  I would also make
sure she has a hospital grade pump.   Mom should ask that her baby not be
given a bottle for now (something it sounds like the LC has already
accomplished), and I agree that it would also be a very good idea for her to
speak to the baby's nurse at the beginning of each shift to let her know that
she does not want the baby to have a bottle.  A very polite, matter of fact,
request is best.  I would also use the hospital LC to advocate for her.
Being at the bedside as much as possible helps also.  You can support her
while not on staff, by listening, by giving good information, and by talking
to the LC if appropriate. There's not much you can do to impact policies if
you are not on staff.  Come to think of it it can be darn hard to impact
policies when you are on staff.  Good luck with this mom and baby.

Kathy Boggs, RN, IBCLC

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