Grace writes:" The length of stay patrol would like to see more breastfeeding 
babies
bottling earlier in an attempt to get them home sooner.  If there are
any studies that show  that the babies that then do not go on to
breastfeed will get breastmilk for a shorter duration than their
breastfeeding peers, it may help."

The length of stay police are alive and well in the NICU where I work as 
well. I am not aware of research that proves that the duration of breastfeeding is 
different between NICU graduates who receive breast milk by bottle v directly 
from breast, but I can tell you what I've experienced with many of the 
mothers I work with. Before breastfeeding is fully or even mostly established 
bottles are introduced and then pushed. The mother is made to feel guilty if she 
asks to limit bottles. "Don't you want your baby to get out of here?" The LC 
tells her one thing, the nurse something else and the neonatologist something else 
again.  All except the strongest mothers capitulate and so baby often leaves 
the hospital without breastfeeding fully established. Mom may have had a great 
milk supply in the hospital but now she's home with a fragile baby with 
special needs. She knows he can take the bottle--after all the nurses have proven 
that they can feed the baby better than she can. Now she's on her own. Baby may 
be on oxygen, needs breast milk mixed with fortifier, needs meds. She's 
overwhelmed. She used to pump 8 times per day but now she's lucky if she can fit in 
5 or 6. That once wonderful milk supply dwindles. Baby's not nursing and she 
panics as she uses up the store in the freezer. Most mothers can't keep up 
with caring for a high needs baby and pumping. When they see their babies gain 
wt. well on the bottle, they are reluctant to rock the boat and go back to 
breast. And as their milk supplies rapidly diminish the chance of successful 
breastfeeding declines, because premies do better when supply is high with resultant 
faster flow.  

I saw just such a mother today. Her baby born at 25 weeks gestation (1 lb-10 
oz.) left the hospital 2 weeks ago at 41 weeks adjusted age. Milk supply when 
she left was 30 oz./ 24 hr. This baby could take a full feeding from breast 
(by test wt.) but not consistently on the schedule his caretakers wanted. He 
left the hospital on breast and bottle and because mom, even with a scale at 
home, was so afraid he would not get enough to eat he was transitioned totally to 
bottled breast milk pretty quickly. Supply is now 18 oz. in 24 hr. and baby 
fights the breast. Her day is a round of pumping, feeding, giving meds, and 
watching the nasal cannula oxygen. She's running out of steam on the pumping. I 
think with a few more days and a lot of good support this baby could have been 
fully breastfeeding. I did get him on the breast today but it was a struggle. I 
don't know if even this very dedicated mom can keep it up.

I'm realistic--I know hospitals aren't the best place for anybody to 
live--but if a few more days and some really consistent support can facilitate the 
baby feeding at the breast, then I know we can lengthen the duration of babies 
receiving breast milk. Bottles are often pushed to get babies out of the 
hospital when other issues are still keeping them there. I find often that  when 
bottles are pushed baby is still not ready to go home or to take all of the feeds 
orally and so we've jeopardized breastfeeding and baby is still in the NICU. 
If the inability to breastfeed is the only thing keeping a baby in the hospital 
and it becomes clear that it can't be quickly accomplished, then we need to 
support the mother and baby at home. So many times, though, this is not the 
scenario I see.  We are currently working on a protocol in my hospital where we 
will at least have some consistent guidelines for when to introduce a bottle 
and how often. I'm anxious to see if it facilitates breastfeeding for premies 
and gives mothers fewer mixed messages and more confidence. And finally my hope 
is that these mothers who have dedicatedly pumped for weeks on end will have 
the reward of feeding their babies at breast.

Kathy Boggs, RN, IBCLC

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html