Friday, 21 January 2011

Message in a Bottle

Some NICUs in this country are fabulous, and are set up to provide high level support for women who want to breastfeed their premature babies. Others, sadly, are greatly deficient in this area and fail to provide consistent, expert, informed advice to mothers. This post is about such units, so if your experience was a good one, feel free to miss out today, and join me tomorrow!

Having a premature baby is a massive shock. One minute your sat on the internet ordering maternity clothes for the third trimester, the next you are in hospital, one way or another, delivering your baby. You have missed out on getting a nice bump, having bump art and/or casting, a proper labour without the stress and the guilt, and having your baby delivered onto your chest for skin to skin, and those first attempts at breastfeeding.

All NICUs that I know of are very keen to ensure mothers express. Most have machines you can borrow. In our hospital the machines were ugly, nasty things, been in that unit for years, they were noisy and “grabby”. I hated them. So much that I shelled out £200 for a decent one, afterall, I would be breastfeeding mother long term and it would come in handy.

I felt a lot of pressure to express. It didn’t worry me, as I knew, as soon as I was told that I would be delivering at 27 weeks, that I would be required to express. In my mind I was expressing partly to feed my baby, but mostly to ensure my supply would be kept up ready for Joseph to make the transition to full breastfeeding once his suck swallow reflex had developed at around 34 weeks. 

As the time came to start breastfeeding, I felt resistance. At first I thought I was being paranoid. Only one lovely nurse helped me in those early days, and she admitted that she “wasn’t a fan” of breastfeeding, but had recently completed some training. Slowly staff began, one by one, to tell me that it may not be possible. Joseph was too small. In desperation I ordered this book. I read it, I put it on top of the incubator whenever I could, to get my point across.

I was asked to introduce bottles. I was very concerned about this, as firstly, the book advises against it (the book is actually written for staff in NICU not parents), and secondly I was very concerned about nipple confusion. I also knew that the baby’s action on the breast is different from the bottle. I was dead against it.
The pressure I was under was immense. The consultant was brought in to deal with the obstructionist, difficult mother (who moi?) and made it clear that the policy was to combine the two and it would be fine. Fine. All the other babies were managing it. I felt like screaming. The other babies were all later gestation and not IUGR. I knew for a fact that some weren’t managing both.

To my great shame, I gave in to the pressure. I wish I hadn’t. I agreed for one bottle to be given late at night, for comfort, but that was it. Of course, this opened the floodgates. I was under even more pressure. One day one of the nurses suggested I give the bottle. It was my breast milk, but it felt so wrong. I cried as Joseph sucked, and took almost all of it. It was the beginning of the end.

Soon after, my breastmilk dried up. I don’t know whether it was the psychological impact of dealing with the NICU staff, and of seeing Joseph take a bottle, rightly or wrongly I felt rejected. I don’t know whether, in the greater picture of things, it was the physical and mental trauma I had been through. The blood pressure drug , methylodopa, that I had been on for 2 weeks leading up to Joseph’s birth and four weeks after, bolsters the supply so coming off it, may have caused my milk supply to drop, in addition magnesium sulphate can, too, affect supply. Perhaps it was a combination of all of it.

One I had agreed to bottle feeding, discharge planning had been put in place. I had no idea that this would happen. If I’d known, would I have given in even sooner? I doubt it, but the thought is there.
I really got the impression that in our unit, breastfeeding mothers were a thorn in their side, they stuffed up their neat little plans. It’s alright to have them pumping whilst the milk is going down a tube, but that establishing feeding takes too much time. 

I felt there was a distinct lack of expertise with small babies. One of the NHS trust breastfeeding advisors came to visit me on the unit (on my insistence might I add) and gave me loads of advice, then asked to see Joseph, and just shook her head.

My experience is by no means unique. Breastfeeding, true breastfeeding, is not encouraged on many units. There is a lack of time on NICU units for staff to provide additional services, and on small units, they do not have the resources to hire specialist lactation staff. I wonder, too, if there is pressure from the big formula producing companies. Cow and Gate products proliferated on the ward. 

At the heart of this, are mothers and babies. We are so conditioned now, when pregnant, that breast is best. We are told all the time of the benefits, that it protects babies from infection, it’s cheap, it’s portable, it’s convenient.  For the mother of a premature baby, its the closeness we crave, the feeling that only we can suckle our young, that only we can provide what they need. We have missed out on so much.
One of my friends put it best

“(lack of support for breastfeeding)..... makes me feel so cheated. I feel like I really missed out - no bump, no labour, no breastfeeding - hard to feel like a proper mummy”

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