Kathy,
I fully agree. I work as an IBCLC in a NICU and I have seen a big
difference in how babies are discharged if the staff has confidence in THEIR
breastfeeding assessments. I have been doing this position for over seven years and
there are several keys to this:
1. Start breastfeeding as soon as the baby is extubated. There is NO reason
that a tiny baby--and I am talking 27-28 weeks--can't go to breast and give
it a try. As long as the breast is emptied prior to the feed, it is
perfectly safe. Premies have trouble with coordinating suck-swallow-breathe, so the
few drops that come from an emptied breast aren't going to hurt them. I have
a lovely picture of an ex-24 weeker breastfeeding with nasal prong CPAP in
place. As long as there is no tube in the airway, it is fine.
2. Use nipple shields!! Many premies can't latch properly to drink enough
milk to grow. When we first started using nipple shields, we followed about
40 mothers, and all but one were able to wean from the shield. Quite
honestly, I noticed a big change in nurses' attitude and mother's confidence in
breastfeeding because THEY COULD SEE MILK.
3. Use a scale for pre and post weights. This helps both of them again see
that there is something coming out and that it may be enough. I like when
they are used to show mothers about how much the baby takes as long as the
BEHAVIOR OF THE BABY is also discussed. For instance, that the baby feeds better
when he is awake and alert, versus sleepy and difficult to awaken. And that
the baby who seemed to feed well slept for a couple of hours after the feed
and peed and pooped.
Now, that having been said, we do send our small babies home with a fair
amount of bottles, mostly because our mothers are available for only a few feeds
a day. That way, the mother knows the baby is gaining weight at home, and
has been taught to discuss increasing breastfeeding as the baby becomes more
mature and she feels more comfortable. Again, the mothers who really want to
breastfeed do eventually breastfeed!
Happy Holidays to all of you!!!
Maureen Allen RN, BSN ,IBCLC
Brigham and Women's Hospital
Boston, MA
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