Well, as I read posts about getting babies to breast in the NICU, I guess I will quit being depressed, thinking we are moving along too slowly. Maybe we're further ahead in our unit than I thought. If a mother has chosen to breastfeed (and most of our mothers do choose this after a little education) we watch the baby for feeding readiness as well as health status. Now, let's be realistic. Just because a baby can be held, doesn't mean he is ready to breastFEED. A 700 gm premie on a ventilator MAY be stable enough for the mother to hold skin to skin at the breast, but even if the endotracheal tube did not prevent breastfeeding, the baby does not have the maturity or stamina to coordinate suck, swallow, breathe. At that point, most babies are being given total parenteral nutrition (intravenous) and graduate from that to gavage feedings accompanied by "thumbie" pacifiers to stimulate their suck reflex. That's if the baby is lucky enough not to need vasopressors, chest tubes, a high frequency oscillating ventilator, paralyzing drugs, insulin drips, surgery, etc. etc. As the baby improves and matures, we progress to non-nutritive breastfeeding, based on a protocol, and from there to nutritive breastfeeding. No bottles are introduced for at least one week following the initiation of nutritive breastfeeding: ---bottles are NEVER offerred before breastfeeding and attempted breastfeeding is NEVER followed by a bottle. Thereafter breastfeeding progression is dependent upon the infant's illness, gestational age, post conceptual age, readiness to nurse, mother's preference and availability. This is based on a protocol which can be overridden by a consult by our OT or a lactation consultant. Nowhere in our protocol does it state that a doctor's order must be obtained, yet it was approved by four neonatologists and three neonatal nurse practitioners. We sometimes put breastmilk on a 4X4 by the baby's nose so the baby gets used to the smell of his own mother's milk. If the baby shows no willingness to root or suck, oral stimulation is done with the mother's finger if the baby is to breastfeed. It is done with a pacifier if the mother has chosen to bottle feed (preferably EBM) EBM is the preferred milk for supplementation by gavage, sometimes fortified, and if a mother and baby are able to breastfeed well enough NOT to need gavage supplements, yet some fortified human milk is necessary, we offer the mother the opportunity to choose an SNS if she would like, rather than adding bottles. A written discharge plan is worked out with each mother and we make a followup call the first week. A referral to the outpatient lactation clinic is made if the dyad is discharged before total breastfeeding is achieved. By the way, Danny, I just realized that the quick reference I sent you to our protocol, is the old one and doesn't agree fully with the algorithm. (dumb me!) I could tell you briefly the changes if you want. This is a simplified version of a very complex process. I think that any mother who chooses to cuddle up to an electric pump for months to maintain a milk supply for a sick baby, hoping the baby MIGHT eventually be induced to breastfeed after a whole lot of negative oral stimulation, needs our congratulations and a major pat on the back. Having a baby who needs the intensive care unit is certainly is not the ideal way to begin a successful breastfeeding relationship. The very equipment which has the potential to save the baby's life, interferes badly with the initiation of breastfeeding. Even if the baby were 100% healthy, immaturity and fragility alone make initiation and eventual success of breastfeeding a real challenge. Sometimes the residual problems left by prematurity makes breastfeeding difficult. At any rate, I have to stand up and defend those of us who kill ourselves trying to help moms preserve breast milk volume and the breastfeeding relationship for those babies in danger of losing their lives without modern technology. Climbing down off my soapbox. Deanne *********************************************** 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