Tag Archive | breastfeeding

Preemie Christmas Parts 8 & 9

On the (eighth and) ninth day of Christmas, the NICU gave to me: nine dads kangarooing, eight moms a-pumping, seven monitors chiming, six nurses charting, five needle sticks, four brain surgeries, three minute scrubs, two blood transfusions, and a micropreemie in an isolette. 

I’ll start in order. I was super impressed with myself for thinking up day eight. The original verse is “eight maids a-milking,” and my verse is “moms a-pumping.” Lol. Anyway, pumping in the NICU is almost like a rite of passage for preemie  moms. I don’t even remember my first couple pumping sessions because I was so out of it on magnesium. My first memory of pumping contrasts sharply with what I thought my first time feeding my baby would be. I pictured me, in a hospital bed, relatively healthy and not sliced open, with my baby, as we both learned how to do this thing called breastfeeding. Mr Minion would be in charge of bringing me snacks and stuff. 

Instead, I got a hazy couple of days post-surgery, where I was confined to bed due to my epidural and magnesium. The very first time I actually remember pumping was at like three in the morning a couple days after Little Miss Minion had been born. I was on a very erratic medication schedule, since I spent pretty much every waking minute in the NICU, and my pain meds had long worn off. Looking back, this was a serious error on my part. When you are pretty much disemboweled, albeit gently, you want to remember to take your pain meds. Anyway, so I’m in agony, unable get out of bed by myself. Mr Minion and I tried to set the pump up in my bed, but the angle was wrong and I couldn’t change it because of the blinding pain. So he had to pretty much pick me up without opening my incision and help me hobble to the small couch he slept on. I was freezing and shivering aggravated both my incision and my back. I had been sitting and sleeping in pretty much one position for days now, so my back was very tight. I remember crying because I was in so much pain, and I was so tired and all I wanted to was sleep.

 The NICU had given us access to their Snappies, which are sterile milk collection tubes that hook onto any pump. They have measurements along the side, because everything that CAN be measured in the NICU IS measured. Where most books and things I had seen measured the amount of milk a baby needed in ounces, these containers measured in milliliters. I would pump and pump and pump and send off containers with five, seven, two milliliters. Mr Minion would come back from dropping them off and tell me that the nurses were so impressed with my output. He would also stop in and see Little Miss Minion during these midnight milk drops, and then report back to me with how she was doing. 

I remember being so determined to breastfeed. It was the only thing left of my “birth plan,” if you can really call it that. The nurses said she wouldn’t be big enough to even attempt it until she reached about 34-35 weeks gestational, so about a month and a half old. In the meantime, I kept pumping. Soon, she was mature enough to start getting my milk through a tube in her nose (nasogastric tube). They started her off with 2 mls every four hours. Then, they upped it to 4 mls. Then, 9mls. My milk supply stabilized and they started freezing it. Then they told us to start freezing it at home because I had an entire shelf in the freezer. One day, I was talking to one of the nurses about how afraid I was about my supply, because I still wasn’t making the amounts usually made by a full term mom. She laughed and walked me back to the freezer, where Little Miss Minion had three big tubs full of snappies. 
Kangarooing is one of the best parts of being a preemie parent. Kangaroo care is when the baby is placed on the chest of the mom or dad, skin to skin, and then lots of heated blankets are arranged over the baby to keep them warm. Kangaroo care is proven to regulate heart rate, breathing, and is the only way to really hold your micropreemie for the first few weeks. It can be a little challenging to work around tubes, wires, oxygen supports, but it’s pure bliss. It helps dads to bond, helps mom to produce more milk, and helps everyone to feel more like a regular family.  The first time Mr Minion and I each held her, it was in kangaroo care. 

Advertisements

My Check Mark

I had lots of things I hoped and expected to be able to do with Little Miss Minion. When I first found out I was pregnant, I started reading about labor and delivery, different pain management options, what to register for, how to arrange the nursery, whether to give pacifiers, whether to give formula or breastfeed, whether to give bottles right away if I would breastfeed, where she would sleep, who would come to the hospital, etc. With the exception of “have a baby,” the only other thing that didn’t get thrown out the window when LMM arrived 12 weeks early was breastfeeding. While I only successfully breastfed her twice, I exclusively pumped to provide her with milk. My goal was to make it to one year, having decided that the many health benefits and low cost (free!) made it the best choice for me. I’m very proud to say that I made it 379 days.

***disclaimer*** I don’t judge moms who can’t or don’t choose to breastfeed. It’s a ton of work and in the end FED IS BEST. This is just my own personal experience. 

Babies born early, like Little Miss Minion, often have to actively develop a sucking reflex. Once they master that, they have to learn to suck, swallow, and breathe at the same time. In the case of LMM, we used a pacifier to help her learn to suck, and then tried to get her to breastfeed (once she was about 34 weeks gestational, or 6 weeks old). Beginning at her birth, I realized that I would need to pump if I wanted to be able to try to breastfeed later, so I pumped every two hours around the clock for weeks, bringing in my milk each morning. They gave it to her via a feeding tube! Since she couldn’t drink enough to sustain her. Since I couldn’t be there all the time, they began to introduce a bottle, and she was pretty successful at that. I still tried to breastfeed, rushing to the NICU when I got off work and struggling with a lactation specialist for about a month. When it became clear that she was on the tail end of her NICU stay and oral feeds were her last real obstacle, I gave up on breastfeeding because I wanted her home.   Being the Type A person that I am, and wanting to be able to see if my supply started going down, I started tracking my pumping sessions and didn’t miss one for the entire time I pumped. I finished my last pumping session yesterday and have some interesting stats for you.

Over the course of my 379 days of pumping, I averaged 7 times a day for about 20 minutes. That’s 16 hours a week being chained to the pump, or almost 884 hours over the course of my pumping career. I pumped a total of 191,876 milliliters (and for the first couple of weeks, LMM’s daily intake hovered between 10 and 20 mls). This equates to 6,488 ounces, or 50 gallons. Buying that much formula would have cost $2,495.43, not including the fortifier she was on. I currently have a stash of about 200 ounces in the deep freezer. 

I also did some research, checking out CDC statistics on breastfeeding/exclusively pumping. Did you know that 79% of full term babies are breastfed in the two weeks after birth? For preemies, only 35% are breastfed by 40 weeks gestational. By one year, only 27% of full term babies are breastfed, compared to less than 6% of preemies. Breastfeeding a preemie is incredibly difficult, not only for the obvious reason that the baby isn’t usually big enough to try oral feeds for a couple weeks. Preemie moms often have trouble with milk production, since C sections are pretty common and the surgery depresses the ability to produce milk. In my case, I was also on blood pressure medicines for about two weeks following the surgery, due to my preeclampsia. The medicines kept me safe, but also tanked my ability to make milk.  I was one of the lucky ones who got to stop taking the medicines, and once they were out of my system, my milk production went up dramatically. 

It’s especially important for preemies to get breastmilk. Donor milk is widely used in neonatal care units because of the immune properties and the fact that NEC (an illness almost exclusive to preemies in which the intestines die) is greatly reduced in babies who receive breastmilk. Preemie moms produce more colostrum for a longer time in order to help boost the health of the baby. The full milk that comes later has more calories, more fat, more iron, and more vitamins than the milk of a full term mom. When LMM got her first blood transfusion, they remarked on how unusual it was that she had gone so long without needing one, and I wonder if it was because I was able to give her milk when so many others were unable to. Other benefits of breastmilk for preemies include lower chances of developing pneumonia, SIDS, allergies, and have also been shown to increase cognitive development and IQ.

The benefits of breast-feeding are not exclusive to the baby. Breast-feeding mothers experience lessened rates of post partum hemorrhage, diabetes, obesity, osteoporosis, and several types of cancer, including uterine, ovarian, and breast cancer. According to a 2011 NICU nurse conference, if 90% of Americans mothers breast-fed until 12 months, the economy would be saved around $13 billion.

In America, mothers who return to work face additional challenges if they choose to breast-feed. Since they won’t be able to bring their child with them to work, they will have to pump. The family medical leave act requires employers to provide pumping space and pumping time, but do a five minute Google search and you will quickly realize but not all pumping situations are the same. Although the rules state otherwise, many mothers are given the option of pumping in the bathroom or in a space that is unsuited for pumping. This time is also not required to be paid time and therefore mothers must choose between money and food for their infant. I was incredibly lucky in that my employer worked with me on providing adequate time and appropriate space to pump. 

The family medical leave act also provides for 12 weeks of unpaid leave. Most mothers that I know would be unable to afford to take 12 weeks of unpaid leave to take care of their child or to recover from a major surgery in the case of a C-section. Knowing that we were in for a long NICU stay, I returned to work after only three weeks of recovering from my emergency C-section and the trauma of LMM’s birth. With all of my extra appointments and extra testing, I had gone through about two weeks of my vacation time before she was even born. Again, I am one of the lucky ones who was able to have any paid time off. 

Exclusively pumping provides its own special challenges. When you’re only pumping, you also have to separately feed the baby. So if you have one baby and you’re pumping, it’s really like feeding two babies. I often refer to it as feeding the pump, because it is like feeding another child. In my case, I could not have done it without the help of my husband. When I was in the hospital on magnesium, and still feeling sick and recovering from my C-section, he woke me up every two hours and got me to pump. Once I was discharged, he would get up with me when I would pump overnight so I didn’t feel so alone. Once LMM came home, we took turns feeding her overnight. It took only a week or so to realize that when it was my turn to feed her, I also had to pump afterward, so my turn was taking about two hours in the middle of the night. Mr. Minion started getting up and feeding the baby while I pumped. If it hadn’t been for him, I probably would’ve quit pumping in October. 

I’m very proud of myself that I managed to pump for over a year. It was a lot of work and a huge time commitment, but I did it. Out of all of the things that I thought would happen or I thought I would do, I’m finally able to cross one off my list. Plus, I personally saved us about $2500, and who wouldn’t be happy about that?

The Home Stretch

Things are moving so fast. She’s been out of her isolette for a couple days, she’s wearing clothes, she’s keeping herself warm, she’s attempting bottles or breastfeeding for half her feeds, and she’s 4 pounds, 4.8 ounces today. The nurses are talking about discharge class and CPR for us. They have mentioned that we need to have her carseat ready soon, because she will have to pass her carseat challenge before she can go.

They are guessing around 3 weeks, at the earliest. She will have to take and finish all of her feeds by mouth for 24 hours. Her feeding tube will come out. Then they will watch her for 2 days, to make sure she can keep it up. Then she could come home.

Mr Minion and I are finishing the painting of her room tonight. We are doing the last coat on the closet doors and the main door and the windows. He put the glider together last night. We started sorting out all the gifts from the shower this morning. I’m going to get all the thank yous written and mailed this week.

And the mayhem ensues.

Big Girl

We got our window room!  It’s so nice to see the sun sometimes.

Little Miss Minion is 4 pounds! She gets to wear clothes and they turned off her bed heat, so she has to maintain her own body temperature. It’s been about a day and she’s doing great. They might switch her bed out to an open crib next time she’s due for a bed switch.

Feeding is proving to be more difficult. Taking all feeds by mouth is her ticket out, so I’m very aware of how important it is for her to learn to eat. I tried to breastfeed her again today and she just shrieked for ten minutes and then fell asleep. Granted, this was her 4th ever attempt and two of those probably don’t count because she was sleeping the whole time. One of our primary nurses (a nurse we really liked and requested to care for LMM every shift she works) will be back tomorrow so I think I will talk to her about it.

Primary nurses are important because you have the same person working with the baby several days in a row. They see patterns, likes and dislikes, little tricks. It’s more consistent. We currently have one day nurse and one night nurse who are Little Miss Minion’s primaries.

She saw the eye doctor again today. He follows up on all preemies, especially the younger ones. Her eyes look good and she’s got another follow up in 2 weeks. Preemies are at risk for ROP, a condition that can lead to blindness and is caused by prematurity. They are carefully monitored by eye doctors during their nicu stay to make sure everything looks good.

We might get a rocking chair in a couple weeks. Preemies can’t handle tons of stimuli, so when we hold her, we can’t rock her. If you are holding her, you have to be still. You have to be quiet. You can’t stroke her while holding. No humming. Just being held is a lot of stimuli and doing something else at the same time, like singing, will overwhelm her.

So excited at her progress!

Transition

The big news of today is that Little Miss Minion is officially double her birth weight! Born at 1 pound 14 ounces. Tonight she is 3 pounds 12.7 ounces!

She was moved to the stepdown unit yesterday after I posted. She’s in a temp room right now, and then we are moving tomorrow into a room with a window. It will be nice to see the sun again, and she is developmentally ready for day and night cycles now. Her eyes seem to focus on things now, like our faces. I feel like she can look at us and actually see us now.

Breastfeeding attempt number 3 was mostly a nap. She was very awake and alert when Mr Minion held her earlier, and then I tried to feed her and she fell asleep. So the new plan is to try and feed her whenever she looks awake, whether it’s time for her scheduled feeding or not.

Looking forward to the window tomorrow!

Moving on Up

Little Miss Minion is now a resident of the stepdown NICU!!! She’s in a temporary room right now and they are moving her on Monday to her permanent room with a window!

She weighs 3 pounds 11 ounces today. We tried to breastfeed again but she was trying to poop at the same time, so it didn’t really work. She’s not too great at multi tasking lol.

So excited about the move! The nurses say she could be going home in 4 to 6 weeks. So happy!

Baby Steps

They took Little Miss Minion’s nasal cannula out yesterday afternoon. The cannula was only there to help keep her lungs open. She handled it very well, even though I was watching the monitors and waiting for her to desat. They were hoping to see how she did and maybe try oral feeding later next week.

She did so awesome for the rest of the day yesterday that they said she could try practicing today. The lactation consultant got us all set up and LMM did perfectly!  I get to do it once a day until she gets used to it.

They think we might get to move to the stepdown unit soon! Baby steps will get us home in about 4-6 weeks!