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Thursday, April 12, 2012

"Booby traps" in the NICU

Photo credit: Benjamin Earwicker.
I've never had a baby in the NICU, but I've run across more painful, heart wrenching stories of women desperate to nurse their babies who were offered little, if any, support. Then others have nothing but glowing reports about how wonderful and supportive their staff was, how caring and understanding the nurses were. It leaves me wondering: why is there such a disparity of care and support for these mothers and babies?

Obviously premature babies have special needs and issues, and often times they are born too young to even have a strong sucking reflex down yet. Not all babies, though, who are in the NICU are premature, and even some that are don't have the same problems other babies do. While obviously the sucking reflex is a common problem among preemies, I can't imagine that it exists with all of them, and I start to wonder, is this a self-fulfilling prophecy? That because it can be a problem, we're just going to go ahead and treat it like it is one?

Popular breastfeeding websites like and the Best for Babes Foundation both posted this article on their Facebook fan pages, and the response from some mothers was nothing short of heartbreaking. Some of the comments included:
"I was flat out told by a nurse that it's nice to try but don't be afraid to give up - formula is just easier."
"They were very pro-milk, but not pro-breastfeeding. I had no support after."
"I am VERY thankful my preemie was my second breastfed child. If he had been my first I am confident that the hospital would have ruined any efforts to breastfeed...they were supportive (somewhat) of providing breast milk to my baby, but not of my baby breastfeeding. I had to push very hard on the doctors and nurses in the hospital to make it happen."
"My son went for 3-4 hours. I literally told the nurse "you can take him but if anybody gives him formula I will kill them." An hour later, the same nurse said, "His blood sugar was low so I gave him a little formula."
This also happened to me with my third child, who was born at term weighing 8 pounds, 7 ounces - nothing huge. The nurse flatly told me, "We gave him formula because his blood sugar was low," and when I shot her a look of surprise, she said, "We don't ask, we just do it." I received no other information whatsoever about my son's condition, nothing - and wondered, What is it about my breast milk that can't solve this problem but formula can? I don't think so.

Much like the schedules and strict feeding routines have been encouraged among term infants, the same exists in the NICU. One mom told how the nurses would only let her put the baby to the breast for short periods, then wanted her to give a bottle so they could see how much he was getting. Like this mother, I remember being almost obsessed about wet and poopy diapers and the length and time of feedings, to the point where it was almost making me crazy. And like her, I had an almost epiphany where I asked myself, What am I doing?! and threw them away, which made the nursing relationship so much easier and more relaxed, for both of us.

In the case of infants who were there but weren't premature, it seems that formula was often still pushed.
"I had some nurses forcing formula if she wasn't finished nursing after ten minutes on each side."
"I'm surprised we didn't have issues establishing a nursing relationship! They constantly 'forgot' to tell me when he was hungry so i could come and breastfeed him (I was recovering from a very traumatic birth) and *sneaked* formula. I was SO MAD."
"My youngest was automatically put in the NICU because he was a vaginal breech delivery. He was born a day short of 41 weeks. He was 9 pounds. They told me they didn't now if they could "allow" me to breastfeed."
Many said the same thing: that the idea of breast milk itself was readily accepted, just not breastfeeding. Why? I have to wonder if it's not so much because of 'cultural norms' but because they don't want to see you - and don't want to run the risk of others being offended because of an inability or lack of desire to breastfeed. I've often thought there were serious psychological and control issues when it came to some nurses and breastfed babies. And while most nurses would happily turn over care to the preemie mom, some, I think, almost develop a complex - because they are so engrained and entrenched in the care of these babies that they get defensive of their territory when someone - even the mother - steps in. Our cultural attitudes about public breastfeeding can also spill over into healthcare professionals - the very people who should know the most about it, and facilitate it the most, can also be the same ones to totally undermine and completely destroy that relationship.

I came across this link to a blog post where a nurse overhears a potential NICU job candidate announce, during the interview, "I don't DO breastfeeding." In her post, she mentioned an article posted on the Breastfeeding Moms Unite! blog, "Do nurses learn about breastfeeding in nursing school?" She confirmed our worst fears - that they don't, or at least didn't when she was in school, learn much about either the physiology or the mechanism behind it. As she put it, "The nurses owned the babies back then..." I argue they still often think they do.

Why would someone make a public declaration of this? Especially a person who is responsible for the care of patients who could benefit the most from breast milk? The nurse who overheard the exchange actually felt that this person would be hired, and I can't imagine why. Unless we're praising formula strictly for the sake of convenience, instead of seeing breastfeeding as a public health issue - especially among those most at risk. Her poor attitude could - and probably will - compromise the care of some - maybe all - babies, and I just don't see how anyone could want that person on their staff.

And if you actually question their authority, take charge of your baby and defy their "orders," you just might run into this problem:
"I think the only reason I established a successful nursing relationship, despite NICU nurses who threw away my "extra" expressed milk and gave her formula because the "refrigerator had no space," who scoffed at the "trendy" idea of kangaroo care, who chastised me when I nursed in the open, busy main room in front of her isolette instead of in the curtained-off "family room" that was almost always in use and locked (the hospital social worker actually reported me to CPS for my "public indecency" in the NICU and my "troubling attitude!"), the doctor who insisted on "plumping up" my expressed milk with preemie formula and sent me home with two massive cases of free liquid samples of the nasty stuff, was that I have a hypersensitive bullshit detector and a hyposensitive reaction to the advice of outsiders."
More reading:
When should I give my baby formula? regarding hypoglycemia and the newborn
NICU nurse in job interview: I Don't DO breastfeeding"- StorkStories
Gettin' your baby fix on, Similac Style
The nurse's role in promoting or undermining breastfeeding
Anti-breastfeeding NICU - post


Recovery Guru said...
This comment has been removed by the author.
MentalMom said...

I have had a baby in the NICU. He was term but sick. He didn't nurse until he was 5 days old. I didn't hold him until then either. I had a spectacular neonatalogist and NICU. I didn't nurse or hold my baby not because he was unecessarily kept from me, but because he wasnt in any condition to tolerate being held or nursed. It took every bit of energy he had to keep his oxygen saturation in the 90s in a hood with 100% oxygen. As soon as he could handle it he was.put in my arms and to the breast and even encouraged to room in and co sleep before discharge. While there.are still.some nurse ratcheds and dino docs out there I believe a lot of the nicu strife is the result of poor communication. Parents hear about kangaroo care and how great it is but no one ever talks about when it is not in the baby's best interest. The nicu staff says no nursing, or no holding, doesn't explain why, parents get angry, staff gets defensive and now an adversarial relationship has begun.

MentalMom said...

I have had interesting experiences with breastfeeding IN newborn nurseries. I was nursing my jaundiced baby. I was sitting inside the.nursery at the back, behind the.nurses desk. The head of maternal child.nursing came to stop because I "might traumatize some of the younger.dads" I have her some snappy comeback about the teen dads needing to see what breasts were really for and smiled and kept on. Fast forward to next kaindiced baby, different hospital. Nursing baby in step down nursery, no Windows, nurse still.insisted in bringing over one of those folded free standing curtains. I was fully dressed with shirt modestly lifted. I don't understand why a nursing baby makes people who work with mothers and infants so uncomfortable.

Enjoy Birth said...

My first was in the NICU for 12 days. I didn't get tons of support, but luckily he was a great breastfeeder, despite the fact he wasn't even put to my breast until he was 9 days old. Looking back now I realize that was ridiculous! He was fairly healthy, just 6 weeks early.

I have a friend who is a NICU nurse. She says some nurses are very pro BF and supportive, but others are ANTI BF, like you mention. It is really sad that they can't weed out the unsupportive ones.

The Deranged Housewife said...

Kathy wrote:
One way to help reduce NICU booby traps, is for moms to know what breastfeeding should look like, so that they can better imitate it with their own babies. The book Breastfeeding With Comfort and Joy can help do that. This mom of a 28-week preemie found the book so helpful that she bought a copy for the NICU where her child had been, so that other moms could be helped by it [].

Peggy said...

This dredges up a lot of unhappy memories:

"She wants to breastfeed" --Nurse whispering to the other nurses on the other side of the curtain after I declined formula for the baby.

"Breasts shaped like yours make less milk." --Little do they know that I've since been able to make plenty of milk with just ONE boob.

"Time's up, she has to go back into the isolette." --After I had spent most of my allotted fifteen or twenty minutes for nursing trying to get my baby to latch on.

"The lactation consultant won't be in until Monday." --Said on Saturday morning.

"Look, she was starving!" --Said the neonatologist as she POURED formula down my daughter through a wide-hole nipple.

"In thirty years of nursing, I've never seen a baby with nipple confusion." --That's because they never follow up after discharge. They taught my baby to have a strong -preference- for the bottle nipple, one that nearly cost us our breastfeeding relationship. We finally got some good advice, after we got out of the hospital.

The Deranged Housewife said...

Many of these comments make me think it's more about preemies getting exhausted from attempting to nurse - I know different babies have different issues, but I think when it comes to breastfeeding, it's the NICU nurses who often have "issues." :(

Anonymous said...

I would say overall that I had a pretty good experience nursing my 29w preemie (2lb 3oz) in the NICU.

Good stuff
-really dedicated LC who probably spent close to 20hrs working with me and my baby
-doctors and nurses who had a positive attitude
-doctors, nurses, LCs, and nutritionists working as a coordinated team
-went home with a baby who was a good nurser

Bad stuff
- A NICU with an old school physical layout, which meant there was no way for parents to room in with babies
-Many breastfeeding advocates don't distinguish between full term babies and preemies and end up really freaking NICU parents out by focusing on nipple confusion and the need for babies to get all nutrition by breast. Preemies just do not have the energy to take all their feeds at the breast, but many of those babies can transition to the breast. I had assumed after reading advice for fullterm babies that I would not be able to breastfeed because my baby had gotten so many feeds by tube and bottle, but that was not the case-she always preferred the breast.

Sara said...

I'm so grateful that my mom was determined to breastfeed my sister and I (twins, born at 31 weeks). I'm sure that our lack of any long-term health issues is linked to that. She said that the hospital wasn't very helpful, but that she went to one LLL meeting before we were born, and learned more there than from anyone else. She says that without that meeting, she may not have succeeded! I've heard several women say that they were told that their milk isn't "good enough" for their preemie babies; it makes me so sad to hear that!

D said...

good article; and I agree, some staff are supportive and some are not but this makes it even harder for vulnerable mothers. How is a mother supposed to know who is coming on the next shift, the helpful nurse who will "allow" her to do KMC and support her to support her baby to learn to breastfeed or the nurse who would rather that the mother would do her visit and go home so that the nurse can do her job. After all you don't have to ask an incubator permission to touch it and an incubator won't ask you questions about the baby's care. I had my third child at 33 weeks.

Mary said...

I found that the doctors were more supportive than some of the nurses. In that case, I met with the doctors (or sat in on rounds for my baby), established exactly what I was "allowed" to do, and then had them write it all down in my baby's chart. If I was given a hard time by a particular nurse, I could just point to the chart.