Hi Cassidy,
This is an ongoing dilemma in nicu's.
What I would suggest, since mainly the staff are pro-bf and
supportive, is for mom to come up with what she wants to do, maybe in
consultation with the nurse who has helped her before. And maybe not
something drastic like "I'm ready to take him home today and nurse on
demand." (He might actually do great with that, but....) Premie babies
such as this one, in hospital over 3 wks, are often re-hospitalized
with wt loss, dehydration, so they'll be reluctant to make a big
change. And I don't know what baby's medical problems might have been,
temperature regulation at this point etc.
Mom can ask to meet with the neonatologist and come to a meeting of
the minds. It seems baby is getting closer to discharge and rooming in
may be an option at that nicu, where mother can stay several days with
baby before taking him home.
There is some literature, I believe, in neo journals, regarding doing
cue-based feedings instead of timed feedings for babies in nicu. I
don't have any citations, but I bet the doctors have heard this. The
reason babies are scheduled in nicu is really for the convenience of
the staff, to make sure things get done and the nurse can do all she
has to do for 2 or 3 sick babies.
Someone else mentioned that some people believe the baby uses up lots
of calories/energy feeding for longer than 20 or 30 min. While I know
there is calorie expenditure, the biggest reason babies are not
gaining is volume. They need to be able to take in enough volume and
due to their prematurity, illness, this does involve fatigue, but they
consume 20 mls at a feeding instead of 35, for example.
If mother has 'proof' (pre/post weight change) that baby can take in
more than 30 mls, that is good evidence to present. Perhaps mom can
suggest a half day where she does cue-based feeding and gets a
pre/post weight on each of those feeds. That would give an idea of
what baby is taking. It could be determined what 'top up' amount baby
might need. Lots of kangaroo care would be great, that puts the weight
on too. Mother can stress that she feels ready to do more mothering
and is ready and willing to be with the baby as much as he needs.
This post sort of rambled, but I hope it helps some.
Laurie Wheeler RN MN IBCLC - former nicu nurse
Mississippi USA

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