The Magical, Mysterious, and Sometimes Messy Journey of Feeding Your Baby
Although my son is now mostly tube fed specialized formula, we started on this feeding journey with exclusive breastfeeding by pumping. While I believe breastmilk is the most amazing food on the planet, with incomparable benefits, I also believe that fed is best. At the end of the day, you have to do what is best for you and your family. I hope my story provides some insight into breastfeeding in general, and also shows what it is like to breastfeed a NICU baby. I wish nothing but a smooth and seamless breastfeeding journey for all moms out there, but if that doesn't happen, just know that you are not alone and that there are many different ways to provide your baby the nutrition he or she needs, and that is totally OKAY!
When I first learned I was pregnant, I dove head first into all the baby books and mommy blogs I could get my hands on. I was certain that I wanted to breastfeed and adamant that I would gladly do so in public without covering up. I would be an advocate to breastfeed whenever and wherever without shame. (For the record, I have breast fed, bottle fed, and tube fed my son in public and no one has ever shamed me for any of these things.) I attended Bradley Method birthing classes, as suggested by the labor and delivery nurses, since I wanted to have an all natural, unmedicated, vaginal birth. Even after learning the news that my baby had some health issues, there was no reason to schedule a cesarean section, and I put my trust in my doctor to make the call as to what would be the safest option to deliver the baby when the time came. I continued attending my Bradley Method classes with my husband, and we were doing everything we could to prepare ourselves for a natural delivery and breastfeeding.
Unfortunately, I didn't get my wish for a natural delivery. I was given an epidural, having gone into pre-term labor at 35 weeks, because if an emergency C-section would be needed, they did not want to have to put me under general anesthesia. In case you were not aware, the mother is awake during a C-Section and numbed from the waist down with an Epidural. The Epidural stays in the mother's cerebral spinal fluid, leaving the baby unaffected. If an emergency C-section is needed, and an epidural has not been administered, or a spinal block is not an option, the mother will have to be put to sleep under general anesthesia for the surgery. This method also delivers the medication to the baby, putting the baby under as well. If an epidural is administered just in case, as it was for me, you avoid the risks of putting the baby to sleep in an emergency surgery. It is important to note that if you have a healthy pregnancy, with no complications, a "just in case" epidural is not necessary or required. It is completely up to your preference. In my specific case, I went into preterm labor with a baby whose kidneys were already enlarged and pushing on the lungs, making an epidural the best and safest option for both me and the baby. General anesthesia would have further compromised my baby's potential respiratory issues, so me and my medical team decided on a precautionary epidural.
I'm glad I got the epidural, because I stopped progressing around 3 or 4 centimeters and had to have a C section. (I'll save the details for another post about my birth story, and will focus on the breastfeeding details for now.) The wonderful labor and delivery nurses knew that I planned to breastfeed and I had rented a hospital grade pump upon getting admitted to the floor that night. Everything was in place for me to reach my breastfeeding goals even if my baby had to be transferred to the nearest Children's Hospital Neonatal Intensive Care Unit, which he did.
When I first came to post surgery (those meds knocked me the f*4% out), I had big plastic cones on my boobs and could hear the whirring of the pump. "Yes!" I silently thought to myself. Those nurses were breast pump ninjas and had started the pumping schedule while I was freaking sleeping. Every three hours, they'd walk in the room and work the pump for me while I rested.
The next morning, I saw the first glimpse of colostrum, the most concentrated form of breast milk that arrives before the milk comes in. I had tiny little syringes that the nurses showed me how to use to suck the liquid gold off my nipples. My husband helped me out with this, as it's pretty challenging to maneuver alone, and would collect the "antibuddies" as he so fondly liked to call it, in the tiny syringes. We'd store them in the freezer to be used later in the NICU.
You'll be tired as hell, but keeping a schedule of 20min pumping sessions followed by hand expressing, every 3 hours is the best way to ensure milk production. Clearly, if you are lucky enough to have your baby with you from the very beginning, you will be feeding an actual baby, and not a machine. It will be a huuuge help if you have someone to help you wash your pumping supplies. You will never wash as many dishes as you will when you first have a baby and start pumping. If you're recovering from a c-section, having someone to help you do everything is pretty much non-negotiable for the first couple of weeks. Your body needs to rest to be able to heal.
Our breastfeeding journey continued with the use of those tiny syringes of colostrum that we would soak on a Q-tip and use for "oral care" while my son was still on the ventilator for respiratory support. We would swab the breast milk soaked stick on his lips and the inside of his cheeks while they fed him through the NG tube (nasogastric feeding tube that goes down the nose into the belly), that way he would associate the taste of the milk with a full belly. Pretty genius, huh?!
When he was able to eat orally after coming off of the ventilator, we "nippled" with a bottle. The doctors were worried that the latching process would make him burn more calories than he was actually consuming, and he wasn't gaining enough weight as it was. Nevertheless, I inquired about breastfeeding every day until they finally let me try. My (female) resident advocated for me, and eventually the (male) neonatologist caved in, knowing how important it is for bonding, and understanding that I was tired of breastfeeding a machine. Sometimes hospitals will refer a lactation specialist and/or a speech therapist to assist with feeding, since NICU babies tend to be on the smaller side and need help latching onto a breast that's twice their size, not too mention coordinating the tasks of breathing, sucking, and swallowing.
At first, my son didn't know what to do. I would hand express some milk on the nipple and he would just lick it off, like a little baby kitten. "Well that's one way to do it," I would tell him, "It's very creative, but it's gonna take a while to feel full, little one." I used nipple shields because they were more firm than the actual nipple and my son would actually notice there was something to suck on. I would put little drops of breastmilk or sugar water on the edge of the nipple to encourage him to drink.
It is worth noting that there is a specific way to attach a nipple shield. Invert the "nipple" part first and line it up over your own, then flip it down ensuring it's suctioned. Wetting the entire nipple shield can also help it stay on your skin. Also, if you are a NICU mom, ask if they will provide the pumping supplies for you. Although I had my own pump at home that I rented through the hospital, there were 2 hospital-grade pumps provided in the NICU in constant rotation between moms. They have sterile bags of all the pumping equipment you will need, and will gladly give it to you. USE IT! It's not worth lugging your home pump and supplies back and forth. Bring a small container of dish soap to keep in your NICU room to wash your accessories and just keep a set there.
Now, when you are exclusively breastfeeding, there isn't much of a way of knowing exactly how many ounces / calories your baby is getting during each feed. Breastmilk is said to average about 20 calories per ounce. If your doctor doesn't think this is sufficient, you can get a recipe to supplement formula to your breastmilk. I believe there are recipes to mix up to 26 calories an ounce. In order to get an idea of how much a baby is getting by breast, you would have to weigh your baby, completely naked, before and after the feed. The weight gained is assumed to be the amount consumed. You can also assume that the amount of milk you can pump in one session is probably the amount your baby gets in a single feed. In my particular case, my son did not gain enough weight with breastmilk alone. We had to supplement with formula, and mix it to the highest concentration allowed. We tried all types of formula, included predigested formulas that are easier on baby's tummy.
There was a two week period after my son came home where he just decided to exclusively breastfeed. Between 6pm and 11pm he would breastfeed every hour on the hour (cluster feeding). He still wasn't gaining enough, and we got him back on the bottle. Eventually, I ran out of my frozen supply of milk and kept up with pumping what he would eat in a day. By the time he reached 3 months, I just couldn't keep up anymore and the doctors were very concerned with numbers, so we switched to straight formula. It's important to make sure your baby is getting enough intake for brain and body development. We would learn after 8 long, grueling months, that my son would never get enough nutrition by mouth no matter what we tried, so we had to resort to surgery for a gastric tube. He has a mic-key button, also known as a G-tube or G-button.
There are many ways to feed a baby, and at the end of the day, the most important thing is that your baby is getting the nutrition they need to thrive. There are many lactation consultants and other moms who can help you with your feeding journey. There are moms who have an oversupply who are willing to donate their breastmilk, and some will sell it at a negotiated price. La Leche League is a great resource for breastfeeding, and they usually have meetings in your local area for expectant mothers as well as those who have already delivered. Usually, the hospital where you delivered your baby has a lactation team you can call with any questions. Use your resources, they will come in handy.
Re-lactating is also a thing, so if you've given up on breastfeeding for a while, but want to build your supply back up, it is totally possible. I've personally been able to successfully re-lactate once, and I attempted another time but couldn't keep up with the schedule I really needed. Drink plenty of fluids, especially ones like coconut water and Gatorade or Powerade, to replenish your electrolytes and to stay hydrated. Some women swear by fenugreek or Mother's Milk lactation tea. Pump, pump, pump! Power pumping can help get your supply up, too. Pump every 20 minutes, for 10-15 minutes, for a few hours at a time. There are lots of different power pumping schedules online that you can try, and a hospital grade pump is best.
There are many different breastfeeding positions. You can even breastfeed in a sling or wrap. When you have a "letdown", the milk rapidly flows out from both boobs. Sometimes, you'll leak. There are nursing pads for this, and if you don't wear one, you could leak -- like me at my very fancy birthday dinner (far right).
Pediatric Feeding Disorders are a real thing, and if you are concerned about your baby's feeding patterns and inconsistencies, or if your baby is screaming crying before, during, and/or after every feed, there could be an underlying issue. Make sure to communicate with your pediatrician, GI doctor, and nutritionist. Some babies have oral aversion issues, some babies have terrible reflux, and others (like mine) just won't eat enough to sustain life. It has nothing to do with you, these are medical issues that you have no control over.
My advice is to make sure you have a support system in place no matter what your feeding journey is, and keep an open communication with your baby's pediatrician. Remember, FED IS BEST!