Adventures in NICU Nursing

Being pregnant is an interesting experience.  There is so much planning and research and care that goes into it, but so little of it is actually in your control.

When I had my first, nothing was planned- I was on birth control, in fact! Obviously, it did not work.   When I started bleeding at 30 weeks, I did not have a car seat, a name, diapers… anything. In fact I had not even planned on breastfeeding (I had planned to be a mainstream parent- look at me now as I nurse my 3.5 year old and my 20 month old at the same time!).

Princess in the NICU

My 40-week pregnancy was cut short. Three days after the bleeding started, my daughter was born… all 3 pounds of her. She was born on her terms. She was obviously a preemie, but did not act as preemie as she was. The day after she was born, I went to see her in the NICU. The nurse asked me if I wanted to try nursing her. She gently told me how important it was to my little lady to have my colostrum. I talked about feeling helpless. She pointed out that there was little I could do about Princess’ birth, but I could nurse her and “kangaroo” her; which would do so much good for the both of us. So I gently lifted my peanut out of the isolette and put her to my breast. She had a hard time latching at first, but she did it. For the rest of my life I will remember the feeling of her first nursing.

Princess today

Somehow, I changed then. I began pumping like a crazy lady, bringing in hundreds of ounces of expressed milk for her – more than she could ever drink. By the time she came home from the NICU, we had established a good nursing relationship. Everything was going great until I met with an unprecedented amount of stress and my milk dried up. Despite non-FDA approved drugs, new expensive pumps, and several different herbs, my stellar supply was gone.*  Princess was transitioned to formula which she hated, and I hated.

Stinky as a newborn

My son, while also a preemie, was not in the NICU because he was only five weeks early. He had some difficulties eating – mostly latch problems, mastitis, and being tired all the time. I had to remind him to eat even if he did not think he was hungry. Despite those challenges, he continued to nurse through my third pregnancy and after her arrival, until he was three and half years old. I ended up dumping eleven

Stinky today

gallons of milk down the drain as he never learned how to take a bottle. At the time, I did not know about milk donation- but several of my nursing friends were recipients of gallon jugs of milk as “party favors.”

Enter my third child – Peas – was also a preemie. All three pounds of her arrived six weeks before she was expected. At first they told me she was too young to eat orally. I was told that she could not eat on demand because the nurses had obligations (even though she was the only baby in the unit). I was told that I could not feed two babies at once. I was told that my milk did not have the nutrients for her. After some discussion (aka argument) and after presenting several evidence-based articles that indicated the importance of breastmilk for preemies, she was ‘allowed’ to try and nurse. I essentially moved into the NICU. I was there around the clock to feed her to prove that she would flourish.

Peas in the NICU (Lion's Roar Media)

Peas is now three and a half and still nursing, with no signs of stopping any time soon.  I do get a lot of looks when she latches on and even more comments: “When is she going to stop

Peas today

nursing?” “Isn’t it time to stop?” I have gotten better at shrugging it off or turning it into a joke. She’ll probably wean when she goes to college.

So, what have I learned while nursing four preemies?

  • Surround yourself with supportive mamas (it’s nice if they have similar parenting beliefs).  In my circle of friends, I am not the odd one for co-sleeping or extended tandem nursing.  Over time, even my mainstream mother has adjusted to the idea.  She has commented how happy my kids are and accepts that it is probably because I am choosing to parent them in this way.
  • Breastfeeding may be normal and natural, but it does not always come naturally.  Like everything else, the best-laid plans often go awry. Keep at it.
  • Nursing in the NICU adds an extra slew of challenges, so find the support you need to be successful. Special challenges include: babies who are often too sick or to weak to effectively nurse, neonatologists who are not versed in the latest research, nurses who don’t know how to help, lactation consultants who are not prepared to help preemies or NICU parents, and lack of a continuum of care after discharge. If I had not had the experience nursing my daughter that I did, and had not been blessed with the friends and resources to support my nursing, I can easily see how I would not have even tried to nurse with subsequent babies.
  • Fight for your baby. Breastfeeding in the NICU was not the easiest thing I have ever done.  I had to fight for my babies. I had to fight for me. Breastfeeding NICU residents is so beneficial to babies and mamas. Mama’s milk even changes to suit the preterm infants needs! For me, breastfeeding helped me bond with my babies, recover physically, and reduce my anxiety about the entire ordeal. This is a fight worth fighting for. Arm yourself with good information and don’t be afraid to use it! I love and often would print things from there to show the nurses and LCs.  I also invested in a copy of Hale’s Medications and Mother’s Milk as I constantly had to defend my choice to nurse while on anti-depressants.
  • Don’t be intimidated. The NICU has its own language.  Milk is measured in milliliters, not ounces. Weight gain is measured several times a day, in grams. Diapers are weighed. Vital signs are rattled off. As and Bs do not factor into grade point averages. Words like tachypnea and tachycardia are bandied about like nothing. Calories per ounce and debating the benefits of HMF are common. For a mother who has no training or experience in any of this, it is like being tossed into a foreign scary country where all you want to do is help your baby but you don’t understand a blessed thing. Soon though, the novice mother will be discussing with ease SPO2 saturations and NG feeds with the best of them. NICU moms are a special, dedicated, strong breed of mom, but they need all the help they can get.
  • Pass it on. With each baby I became more dedicated to nursing my preemies. I also became devoted to helping other NICU mamas to feel comfortable nursing. Most NICU mamas want to do anything they can to help their babies to recover, so when they are supported and encouraged, most are very dedicated to breastfeeding. I have answered Facebook questions, email questions, Twitter questions, message board questions, and phone calls from my circle of moms friends and their friends.   Also I have been known to go to NICUs to help moms if they are having a hard time- sometimes they need help from someone who has been there and done that.
  • Once a NICU mom, not always a NICU mom. Every baby is different. Despite a unique arrival for Pixie (number four) and a brief stay in the NICU, she has also taken to nursing. In fact she has no clue how to have a bottle and is not interested in the least. Babies grow up.

Now all of my babies are healthy, wonderful children, bearing none of the ill effects of preemies, and some of that has to be due to the breastfeeding.

Breastmilk: it does a preemie good.

*Upon reflection, I realized my milk supply was probably not inadequate- I just thought it was falling into one of the traps of a not so well informed new nursing mom- I believe in retrospect my supply was fine, I was just regulating to my baby not the pump, the drop in supply scared me.

Elizabeth is a mom of 4, expecting number 5 this spring!  I have a clotting disorder that caused me to deliver my babies early- this time we know about it and are treating it, maybe I’ll have a full term baby! Our house is loud, crazy, and full- but very fun and full of love.  In addition to the 4 kids we have 2 dogs and 2 cats. When I am not running around after my kids, you can find me on twitter @almostsinglemom on my blog Http:// or pole dancing- yes- really (for fitness).

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