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Subject:
From:
Teresa Pitman <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 16 Dec 2001 09:37:01 -0500
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I'm pleased to report that my grandson (Sebastian Rhys Pitman) went home
from the hospital on Thursday afternoon. He was born prematurely on November
24th, weighing 4 lbs. 8oz.

This has been quite an experience for me - helping my daughter-in-law
navigate through the challenges of breastfeeding a premature baby. I thought
some of you might find our experiences interesting. Esmaralda (my dil) had
planned a home birth (at my house) but when she went into labour at around
35 weeks knew she'd need to be in the hospital. However, the midwife
attended the birth, and Es walked through labour, used the birthing ball and
finally pushed her baby out on a birthing stool. I was holding one leg, her
mother the other leg, she had one foot on my daughter's shoulder and the
other on the midwife's, and my son Matthew supported her back. It was
lovely, but the funny part was the expression on the pediatrician's face
when he came into the room and looked towards the bed (where I guess he
expected the mother to be!) and then saw all of us on the floor...

After a very brief period of skin-to-skin cuddling, the pediatrician took
the baby to examine, then said he needed to go to the nursery as soon as
possible. Matthew carried him to the nursery. I stayed behind and helped Es
hand-express colostrum into a sterile container - we were able to get a fair
bit. When the placenta was delivered and Es cleaned up a bit, we took her in
a wheelchair down to the nursery to see her son.

The nurses there announced that they were going to have to give the baby
formula by gavage tube because his blood sugar was low. At this point I
whipped out the colostrum we had gathered, and they looked surprised but
agreed to use that instead. His blood sugar was normal the next time they
tested. We said, with the midwife's support, that we did not want him to
have formula at all, that he could have expressed colostrum, an IV, or
donated breastmilk. They said we would have to sign a waiver to have him
given donated breastmilk, and we agreed.

One of the nurses came over to where we were standing by the baby's
incubator and said to Es: "I'm sure the midwives are pressuring you to
breastfeed, but breastfeeding isn't always the best thing for a premature
baby." Similar comments were heard throughout the hospital stay: premature
babies gain better on formula, most mothers of premies don't have enough
milk (understandable, given their recommendations that they not pump "too
much"), breastfeeding is too hard and tiring for a premature baby, etc.

Over the next few hours, baby Sebastian's breathing became more laboured,
and the decision was made to move him to McMaster Hospital in Hamilton
(about an hour away) so that he could have a respirator. He spent the next
week there: three days on the respirator, and another three with just the
little tubes in his nose. He didn't feed at all on the respirator but had an
IV (and lost a lot of weight). I had started Es taking fenugreek and blessed
thistle right after the baby was born and she was pumping every two to three
hours. She had LOTS of milk. Once the respirator was out, he started to get
her milk through the gavage tube. The nurses told her not to pump too often
as it would be tiring for her and suggested she not bother pumping at night.
She continued to pump anyway (Matt would get up in the night, set up the
pump and bring it to her so that she got the maximum amount of rest).

I was encouraging them to do kangaroo care with Sebastian, but they had a
lot of resistance from some hospital staff who seemed to feel that holding
the baby "too much" would be harmful to him. Since he was on about a million
monitors, we could easily see that when he was held, all his vital signs
improved.

Things got worse when he was breathing well on his own and moved back to the
hospital in Guelph. The staff in the nursery there felt even more strongly
that he shouldn't be held too much - a maximum of one hour in every four was
the rule one nurse told us. They did not want her doing kangaroo care,
feeling that if he was out of the incubator he should be fully bundled up.

Es had been trying him at the breast on occasion in Hamilton, but now he
seemed to be showing some interest in sucking so we increased this. The
nurses said he could only be offered the breast once every three hours
(their feeding schedule). Although Es had so much milk that we were bringing
it home and storing it in my freezer, on two different occasions she stopped
the nurses from giving him formula. One time the nurse said  she thought the
baby was getting both breastmilk and formula, like the other babies, and the
other time the nurse said she'd forgotten to thaw out any expressed
breastmilk so figured she'd just use formula. Es had just been out of the
room pumping so was able to hand over a fresh, warm container of milk, and
from then on she had them use the freshly-pumped milk each time. And she
made sure she was present for every single feeding, day and night. They also
told her she was pumping too much.

Once Sebastian began to nurse, the staff put a lot of pressure on Es to give
him bottles. They told her that nursing was more tiring, that bottles were
easier, and that she'd be able to take him home sooner if she gave him
bottles. She told them she was a very patient person. He did very well at
the breast right from the beginning (I suspect because she had such a good
milk supply), latching on well and gulping down the milk. At first, she was
told she could only nurse him once a day (with a reminder that if she would
give him bottles he could have those more often). Then they allowed two
feedings at the breast each day. At this point, when Es was kangarooing him,
he would nuzzle at the breast, obviously rooting and wanting to latch on.

I had to bite my tongue on many occasions as the nurses "helped" mothers
learn to breastfeed. One example - the mother put her baby to the breast and
actually screamed from the pain. The nurse told her that it always hurt like
that in the beginning, and that she had fair skin so she could expect it to
be worse. The mother attempted to take the baby off, and the nurse said "No,
no, he's latched on fine. It's going to feel like this until your nipples
toughen up."

Es asked the pediatrician if she could use a lactation aid at the breast or
even cup-feeding to give him any supplement needed. The pediatrician said
"There are only three ways to feed babies. Breast, bottle or breast and
bottle. If you want to supplement him with a bottle, that's fine and you'll
be able to go home earlier. Or you'll have to wait until he can feed at the
breast completely. There are no other options."

She began nursing him more often (there was a small sitting room connected
to the nursery where she was allowed to take the baby so she would go in
there and breastfeed where the nurses couldn't see her). The more she
nursed, the more weight he gained at his daily weigh-ins. Finally, she just
nursed him for 24 hours, refusing any top-ups with the gavage tube. When he
had gained another ounce (30 grams) the next morning, she announced that she
was going home. The doctor said he should stay in the hospital two more days
for "observation." Es said that she would sign them out against medical
advice then, because she did not see that as a valid medical reason, and the
doctor sighed and agreed to release them.

As they prepared to leave, one of the nurses said to Matthew "Your natural
approach is unusual and kind of threw the nurses for a loop, but it seems to
have worked out." Matthew was not impressed.

Anyway, they took him back in to be weighed on Saturday, and he'd gained 3
ounces since Thursday. He's now 4 lbs. 11 oz. and still very tiny of course,
but nursing frequently and happily.

We were lucky to have some great support from Jack Newman (through emails
and phone calls) and Dr. Joyce Barrett, the doctor I wrote a pregnancy and
birth book with. But it was very discouraging to see that breastfeeding was
not supported by many of the nursing staff or by the pediatrician in Guelph,
and that formula was used so routinely. I should add that the Lactation
consultants who work in the breastfeeding clinic at the hospital were
extremely helpful and supportive, although the time they could spend with Es
was naturally limited.

It has been a very stressful and hectic time for our family - I spent a
significant chunk of each day at the hospital with them - but we are joyful
and relieved to have him home.

Teresa Pitman
Guelph, Ontario

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