I recently had a patient in much the same situation, 37 wk. gestation but
IUGR (intruterine growth retardation) weighed barely 3 #. The first day
after birth we put this baby to breast. Infant did little more than nuzzle.
Meanwhile mother pumped, made a wonderful milk supply and we continued
offering the breast each day when infant showed feeding cues. This baby was
able to latch but did not seem to have the muscle strength to maintain
suction and freuqently lost the latch. On test wt. she was removing very
little milk. After several days we tried a nipple shield and low and behold
infant took 28 ml (almost her entire feeding). During this time her
supplements were by indwelling gavage tube. Mother was taught how to do test
wt.s on her own and because she could prove to the staff that baby was
getting enough milk they allowed her to breastfeed ad lib. Mother hated the
nipple shield but this baby was unable to successfully bf without it. She
returned to our outpt. clinic at adjusted age 41 weeks and still under 5 #.
Mom tried her without the shield and voila...infant breastfed wonderfully,
maintaining the latch and getting a great intake....end of shield!!! If we
had not used the shield my guess is the staff would have gotten antsy, pushed
bottles and things would not have gone as well. What we did have going for us
in this situation was a mother who was 150% committed, a staff who for the
most part supported her and a nice overabundant milk supply which made the
shield work.
We can't always make bf work in the NICU but I feel sad that so often we
don't even try.
Jack's mother writes:
"Hi. I don't know if you can help me or at least give me a definite answer,
but here's my story. I gave birth to my premature daughter 5 weeks ago.
She was only 4 weeks premature but she only weighed 3lbs. 7oz. I guess due
to an incompetent placenta. I had an emergency c-section. She was placed
in the NICU where she stayed for the next 12 days. I didn't start pumping
until about 12 hours after my c-section. I wanted to breastfeed right away,
but the doctor and nurses didn't want me to, I guess because they were
afraid for her health? They gave her formula in a bottle. Anyway, the
entire time she was in the nursery, I was pumping. I was getting very
frustrated and stressed, not to mention exhausted by having to pump every
three hours and going to see my daughter, because I wasn't producing much
milk. I had tried breastfeeding her twice while she was in the nursery and
she latched on well, but I really didn't have much support or encouragement
from the nurses, so I didn't push the issue. I figured that I could
establish breastfeeding when I got her home. When she finally did come
home, I was given strict instructions to feed her so many oz. of formula
every 3 hours so I was afraid to try to breastfeed, afraid that she would
spend too much energy trying to get milk out and that I wouldn't know how
much she had gotten, that I didn't really try breastfeeding. The few times
that I did try, she latched on well, but started crying and getting
frustrated, I suppose because she wasn't getting the milk like she could out
of the bottle. I kept up pumping for awhile and even took fenugreek, but my
milk supply kept dwindling. I think part of it was that I wasn't pumping on
a strict 3 hour schedule, sometimes I would go 4 hours or even longer before
being able to pump. Anyway, I finally gave up pumping and took back the
rented pump, but now I think that I could've and should've kept trying. My
husband really wasn't supportive of my efforts (because he saw how stressed
out and exhausted it was making me). I am feeling so depressed because I
wanted to breastfeed so badly. My breasts still leak every once in a while
and it makes me wonder if I could try it again? So I guess my question is,
even though I stopped pumping almost 2 weeks ago and my daughter is now 5
weeks old, is there a way to start up again and be successful? I also
wondered if a nursing supplementer would help my milk supply without
frustrating my daughter? Any advice or suggestions you could offer would be
so appreciated."
This is a sad story, indeed, and was probably completely avoidable. If this
mother had received timely, factual info re pumping to build and maintain
supply, had put the baby to breast before a bottle was ever mentioned and had
received consistent support I would wager this baby would be exclusively
breastfeeding now. We have lots of tools in the NICU to support BF...what we
often don't have is informed, comitted staff.
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