Tag Archives: premature infant

Breastfeeding: Part 2: The NICU

This is where the hard stuff begins.

When I became pregnant with my first child, I was determined to feed the baby breast milk. Since this was all pre the Obama-care free breast pump days, I researched pumps, I had my IBCLC-to-be/doula friend on speed-dial, I got all psyched up for the whole kit and kaboodle. My baby registry was stocked with breastfeeding items. I was ready!

Then, at 35 weeks gestation, my daughter made a completely unexpected entry into the world. She came out of my womb, stopped briefly in my arms, and went into the neonatal intensive care unit (NICU).

I was completely unprepared. I hadn’t even had my baby shower.

But, after she was deemed pretty ok, just small and yellow, I went up to the NICU to try and feed her for the first time.

Premature infants are born without the layers of fat that make babies all roly-poly and keep them satiated with small feedings until a mother’s milk comes in. They also often experience difficulty self-regulating their own body temperature, and having unstable blood sugar levels. Mothers of premature babies often experience a longer wait time for milk to come in because your body has to catch up with your baby. Also, you have just experienced a majorly stressful event, which also is difficult for the body.

Therefore, you have to feed them something. The protocol for feeding premature infants address all of these issues. At the NICU I was at, and at most NICUs, that something is what I call “milkshake formula,” pumped up with extra calories preemies need to compensate for their early arrival.

There are NICU programs now that only feed preemies pasteurized donor breast milk. This is a good thing, but it was not an option for me the night my daughter was born.

To help with making the milk come in, lactation meets you at the NICU immediately. My IBCLC was brusque, but incredibly helpful. She hooked me up to a syringe system where I could simultaneously breastfeed and formula feed until my milk came in. A little hose was taped to my nipple and my baby sucked while I slowly let formula down the tube.

This went okay. At that time, however, like with many preemies, “suck, swallow, breathe,” was not a strength for my baby.

This is an important fact that comes up later, so remember it.

Then, I got schooled in The Pumping.

When your baby is in the NICU, you are told to pump at least 8 times per day if you are intending on breastfeeding. Also, your baby is fed on-demand, or woken up after 3 hours to feed. To increase supply, and to make sure the nursing staff has breast milk when you are not there (sometimes you have to shower, and you often can’t sleep over,) you are instructed to pump about 15 minutes after each feeding. Feeding my daughter took at least 30 minutes at a stretch, because I had to wake her up, keep her awake, and slowly dispense the formula while she nursed on what colostrum I had. Then I waited 15 minutes and went to pump for 20 minutes. Then, I had to wash everything, because the NICU is sterile, and turn in my tiny bottles of almost nothing. When I was at home, I set my alarm for every three hours through the night (not that I could really sleep) and hooked myself up to my hospital-grade free rental pump (oh, the perks of preemie birth) and pumped away.

When my milk finally came in, we stopped the formula, but I gave permission for it to be used if I wasn’t there and she drank more breast milk than I had provided. As suck, swallow, breathe continued to be a challenge, the IBCLC gave me a nipple shield to use until her latch became more powerful.

This helped.

But it was rough. I spent 12 hours a day sitting in a grey room basically naked from the top down holding my baby on my chest and watching my baby sleep, and feeding, pumping, washing-labeling-rinse-repeat.
Then I went home and woke myself up every three hours for more pumping-washing-labeling.

And this was my breastfeeding life. Not exactly the pillows-snuggles-and Enya experience I had pictured.

And that’s what I can give today. More tomorrow.

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