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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