For those mothers who repeatedly fail to put their premies to breast when the
LC is not there, I've found that in the face of good unit support for
breastfeeding, there are 2 likely scenarios--either mom is scared to death or
she really does not want to put her baby to breast. In the first case the
mother needs a lot of support. Her baby may experience bradycardia or apnea
while feeding, or may do just absolutely fine but mother is very anxious
about handling the baby. If the baby is at risk for episodes of bradycardia
while breastfeeding, I will reassure the mother that I am an ex NICU nurse
and that I will watch the baby and the monitor and that I feel very
comfortable in handling these episodes. Until the mother feels safe nursing
by herself I will encourage the bedside nurse to be there with her and will
strive to do follow up consults with her. We also take measures to limit the
stress for the baby--have mother pump first  or use a nipple shield if flow
is too fast and watch infant's cues--if he turns pale and stops breathing or
chokes we take  him off the breast and sit him up.  It's important to
encourage as much independence as the mother can handle. I will sit on my
hands while she changes the baby, gets him up and positions and latches him
by herself. This can happen in baby steps (pardon the pun) but eventually
mothers will get comfortable with this.

In the second case, I know I work with some mothers who put their babies to
breast just to please me. They are willing to pump but really never wanted to
make that final step to breastfeeding.  Some of them are able to articulate
this and some are not but I've come to be able to read the signs.  If they
are putting the baby to breast  just to please me they try to finish the
feeding early, they never initiate breastfeeding, they don't show up for
feedings. Much as I want them to have a breastfeeding relationship beyond
pumping my wishes are not paramount. I respect the effort and commitment they
put into pumping.

We can only take responsibility for poor breastfeeding outcomes in the NICU
when the unit practices and policies are unfriendly and inconducive to
success. I've met so many mothers who will move heaven and earth to bf these
tiny babies and I must say these mothers almost always get it accomplished. I
stand in awe of their dedication and commitment. They are strong advocates
for their babies and they are willing to buck the system.  In our unit most
of the time the staff will listen to the parents feeding wishes. One of our
missions is to help make the system work for parents.  But--we can't make
them breastfeed.

Kathy Boggs, RN, IBCLC

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