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I Had To Do Something
Breastfeeding in a Neonatal Intensive Care Unit

by Martine Engel, Thunder Bay, Ontario

The morning of the first day of my 33rd week of pregnancy, I reminded my husband we had an appointment with the midwife. He went up to get ready for work and I went to the kitchen to get some breakfast. First a trickle, then a gush of water. My waters had broken. I called the midwife and she met us at the hospital.

Five hours later I gave birth to a 5 lb. 13 oz. baby girl. I held her about two seconds and she was whisked away to Neonatal Intensive Care Unit. Although a good size for her gestational age, she was too young and struggled for every breath. She was quickly intubated and given surfactant to help her lungs develop more quickly. The pediatrician was relieved I was planning to breastfeed.

As my skinny little baby lay crying soundlessly because of the tubes down her throat, I knew I had to do something for her. The nurses were all too busy to show me how the breast pump worked but through my tears I figured it out and pumped a tiny bit of colostrum that I proudly brought to NICU.

Fortunately the surfactant worked quickly and by next morning she was breathing on her own with a small amount of oxygen through nose prongs. Her jaundice was high, so she was moved to an isolette and put under lights. She was fed my milk only, through a gavage tube inserted in her mouth or nose.

I was so excited when I could put her to my breast the second day, but I had no idea what I was doing. I felt a little engorged but nobody suggested I express a little milk to soften my breasts. After carefully arranging all the tubes and wires attached to my little daughter’s body, I put her mouth to my nipple. She didn’t do anything at first but after a couple of minutes she licked the end of my nipple and drifted off to sleep. We decided on her name: Rachel. It’s a good strong name, and she needed all the help she could get.

I was allowed to try nursing her just once a day for that first week, and all she did was lick and kiss my nipple ever so lightly. She remained hooked up to oxygen and other monitors and stayed in the isolette. I sat by her all day and evening, talked to her and caressed her gently through the portholes. The

nurses were good about letting us feed her my milk through the gavage tube. Usually she slept right through these feedings but at least we could hold her and she could hear our voices.

I pumped milk every three hours. Nurses’ information varied; some said five minutes each side, some said fifteen. I decided to pump as much as I could before switching to the other side. The electric pump at the hospital was good pretty good but made a terrible “mooing” sound each time it sucked. At home I set my alarm clock and got up once or twice in the night to pump. (Some wonderful friends chipped in and rented us an electric pump, but it was mean and really sucked my nipples hard. Within a few uses of it my nipples were cracked and bleeding. I gave up on it and used a hand pump my sister gave me.)

Night pumping was most draining, emotionally. I pumped in the room we had fixed up for Rachel, and often I watched a video of her we had taken. Although this always brought tears to my eyes, my milk flowed quickly. Before long, I had enough milk to feed the entire NICU. I was so proud of that!

By Rachel’s eighth day she was breathing on her own. During the day I was allowed to take her across the hall to the “parenting room”, a place exclusively for parents whose babies were in the NICU. I was able to put her to the breast twice a day, but at first she had to go back to NICU for feedings to she could be monitored. She held her own and I was able to nurse her without monitors and machines.

I had a terrible time keeping her awake for feedings at my breast: she would mouth the nipple, lick it, and doze off to sleep. I tickled her feet and palms to no avail. Her latch was terrible because she had no suction and didn’t open her mouth wide enough. I was virtually expressing milk into her. The nurses were helpful. A midwife and lactation consultant checked on us and her positioning was good. She was just too little and to weak to nurse well. The pediatrician didn’t want her at the breast for more than 20 minutes at a time for fear she would spend more energy than she would gain. She was a pound less than her low birth weight

4 lbs. 13 oz, it was a slow climb up.

After a week of barely noticeable improvement, I felt discouraged. Would I ever get Rachel home? Her inability to nurse efficiently was keeping her tube-fed in the hospital. Another mother told me bottle fed babies go home sooner than breastfed babies...My husband strongly encouraged me not to give up. My dream of a peaceful birth at the birthing center without bright lights or drugs had been blown apart. I had to breastfeed.

Around day 22, Rachel started to stay awake for longer periods of time and although still only mouthing my breasts, she did it more vigorously. By this time I was putting her to my breast at least three times a day, more often depending on what nurse was one. This was great; the more often she sucked, the less I had to pump, and I was beginning to hate the pump.

On day 24 the nurse suggested I stay overnight and feed her for all the feedings. I was excited! After the midnight nursing she gained 65 grams! Incredibly, she no longer needed to be supplemented by tube. I stayed a second night and she gained weight again. Twenty six days after her birth, we finally took our 5 lbs. 2 oz. baby home.

At home we had to wake every four hours. A couple of days later she was waking on her own every two hours. She still only mouthed my nipples. There really was no feeling of suction. If I didn’t hold my breast in her mouth, it would fall out. She usually nursed an hour, then was wide awake for an hour. I tried to nurse her lying down, but since she couldn’t hold the nipple at all, it didn’t work. I wasn’t worried about her weight-gain since there were lots of wet diapers.

A couple of weeks after we got home a friend encouraged me to attend a La Leche League meeting. It was our first outing and I was happy to get out, but once I got there I felt horrible. All the moms and babies seemed to be nursing so effortlessly, and they could have a cup of tea with their free arm. I broke down and cried. The leader and some moms reassured me it would get better.

Two days before Rachel’s official birth date, seven weeks after her birth, when I sat down to nurse, I felt a tug at my nipple. She was actually sucking! Over the next few days the pull increased and I could actually have one free hand too. When she was 11 weeks old she finally managed to nurse lying down and we started getting some sleep at night.

She cried often, and when she cried I always offered her a breast, but it wasn’t always the answer. I wore her in a sling, danced with her, (she still like Stevie Ray Vaughn) slept with her, changed my diet for her, but I guess she just needed to cry. Maybe it was our cruel early separation. She had breastmilk only until seven months. At that time she was already 24 pounds.

Now Rachel is 17 months and nurses like a pro. She sleeps in our bed and nurses every two hours, which drives me crazy but I believe will stop eventually. She’s pretty clever.

I still get mad when I read about wonderful birthing stories. Establishing a good breastfeeding relationship was the most challenging thing I’ve ever done, and the best thing I’ve ever done.

If you have a premature baby, my advice to you is this:

If your baby is hospitalized, make sure the nurses know you want to do as much as possible. You can change diapers, bathe baby, give your milk through the tube, touch your baby as much as possible. Be sure the pumped milk your baby is receiving is given in chronological order.

Surround yourself with people who believe breast is best. Find La Leche League. They can help.

Know you will be able to nurse this child. It will be worth it.




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