In response to Margery Wilson's post regarding NICU timed feeds etc. In our
NICU,  in a suburb of NYC, most of our preemies who are on oral feeds
,breastfeeding, are fed at least every 3 h. Many of them if not fully
established get supplemented after a BF. We are currently working on
inservicing all staff this month to get comfort levels up regarding the
alternate feeding methods so as to hopefully avoid bottlefeeds for
complements/supplements in many situations. If a baby is stable and getting
closer to discharge the mom is encouraged to board overnight  and room in  as
much as possible to facilitate more breastfeeding on a more cued basis. This
does happen frequently esp. with our more motivated moms but many times I am
the one encouraging the mom to stay. We have one semi-private room with 2
bedbath , rockers, and pump access where moms can stay. We are looking to
increase the space as construction for our new unit will begin soon. You are
absolutely right about going from this very scheduled, controlled feeding
pattern to unexpected frequent feeds overnight if she does not have the chance
to transition to the cue based feeding pattern. The key is dealing with the
transition more effectively. I must say it is hard for me sometimes to stay in
communication with staff, neo and moms as I am the only LC and the NICU is
just a part of what I do. I would love ideally for all NICU nurses to be
passionate enough about it to support the process even just a little bit more
to deal with the transitioning to more breastfeeding prior to DC. We do
kangaroo more now since staff was inserviced. There are a lot of variables
involved in getting higher rates of BF in the NICU. Our pumping rates are
great, our breastfeeding rates need improvement. The key is having mom
available a lot. They get cabin fever staying in the hospital all the time. We
don't always have facilities for everyone to stay overnight. Am I condoning
that? No . I'd want a bed for avery mother wo wanted to stay and we should
have it. But I don't run the hospital. Next comes having the amount of staff
needed to handle the critical load in NICU and having teaching time. We all
know how much time we need teaching and assisting, and supporting the
breastfeeding process. Ideally there should be NICU based LCs that just do
breastfeeding . I know some of the bigger units have those positions. And you
need physcians and nurses who are breasfeeding friendly and committed to the
process  within the constraints, understandably , in a NICU setting.

With all that said I am off to bed before I will be useless in my NICU setting
tomorrow am
Jane Ciaramella