Part Two of Breastfeeding offers insight into the emotional struggles moms face when learning to nurse their baby at the breast, special situations in the NICU, and transitioning to the breast at home.
Taking on Breastfeeding
It normally takes lots of practice for a fullterm mother to become adept at breastfeeding. For a
preemie mom, it can take even more practice because the baby is still learning how to coordinate sucking and swallowing, if not overcoming other barriers to nursing. While most NICU’s breastfeeding policies seem have slight differences, it is common for the mother to work 1-2x per day on feeds at the breast, once the baby is ok’d for nipple feeds. (This is usually due more to the logistics of time mom is present, more than anything else.)
Feelings
This time can be exciting and stressful. The mom is anxious for the baby to latch on readily and
nurse effectively. Some latch on immediately and learn to nurse quickly and proficiently. A great many, though, face challenges at this time. Because all babies are different and each learns
to breastfeed in their own manner and at their own speed, a mother can become easily
discouraged and frustrated if breastfeeding does not come instantaneously. Nipple confusion,
refusal to latch on, difficulty coordinating suck and swallow reflexes, or a weak suck are some of the normal preeemie complications that can contribute to difficulty in learning to breastfeeding.
This can be discouraging and disappointing to the mother who is so anxiously awaiting nursing her baby. Feelings of failure may resurface. She may blame herself for not getting it right. She may be embarrassed about asking for help with something that is assumed to come “naturally”. It is also intimidating for many mothers to try to learn breastfeeding with little or no privacy. While nurses can be quite supportive, they can also contribute to “performance anxiety” and feelings of failure with their constant “interference” with questioning before, during and after the
breastfeeding about the “success” of that session. (This "interference" is necessary, though, for the nurses to record how the baby is doing with feeding.) Moms can feel judged by their ability to get their baby nursing properly. The nurses may also add extra pressure and stress to the learning
mother by requiring her to stick to breastfeeding regulations of the NICU. Some of the normal
restrictions/regulations are supplemental feedings by bottle, limiting amount of breastfeeds, limiting time at the breast during each feed. While each NICU normally places these restrictions for valid reasons, the mother still feels a loss of control over her baby and her body. Sometimes, though, shift changes and such interrupt a breastfeeding session and this can be especially frustrating. She may feel angry at the NICU’s restrictions and feel that if she could do it “her way”, she could be more successful.
The Link to Homecoming
Since breastfeeding success is also linked to homecoming, becoming successful at
breastfeeding can place extra pressure on the mother. She feels a need to help her baby learn it quickly, so he can come home that much faster. If she is unable to successfully breastfeed or encounters many obstacles to it, she may be angry at herself. She may blame her breastfeeding abilities for prolonging the separation between her and her baby.
Choosing the bottle temporarily
When the choice comes down to learning to breastfeed successfully or speeding up homecoming by teaching the baby to nipple feeds from a bottle, it is not unusual at this point to choose learning to use a bottle as the quickest route to home. If this is chosen, there may be a sense of loss, but also a sense of relief for the mother. The burden of delaying homecoming is lifted from the mother’s shoulders and she can focus on the joy of baby’s imminent discharge. She may also be quite hopeful that once she has her baby home, she will be successful with breastfeeding - when she can learn at her own pace, without the watchful eyes of the nurses and the clock ticking away, without any rules and reg’s. The loss is normally viewed as only temporary and may not be as upsetting to the mom.
How to Help
It is important to offer support and understanding during this time of learning. Be sure the mother is receiving all the assistance she needs from nurses and lactation consultants. Help her understanding that it is normal to need help in learning to breastfeed. Most fullterm moms receive instruction, too! Reassure her that many, many preemies face challenges when they begin nursing. Be sure the nurses and doctors specifically explain about the difficulties that are
hindering breastfeeding and how most other babies overcome them. This can help relieve the blame and burden from the mother. Never blame the lack of success with breastfeeding for keeping the baby from home. Offer support to the mother if she chooses the bottle feedings temporarily. Remind her of the opportunities to nurse that await her at home. Empathize with her about how difficult and stressful it must be to try to learn such a private skill in such a non-private arena as the NICU, with a baby who has special needs.
Special Situations
Pump and Dump
Sometimes a mother will not be able to give her breastmilk to her baby because she is taking a
medication that is does not mix with breastfeeding. The milk must be “dumped” in the drain instead of fed to her baby. She may feel extra frustration at this time. She might feel rather unconnected to the baby and burdened by pumping milk to throw away. It is important to help her understand why she is continuing to express milk at this time - it is because she will be able to give the baby her milk again shortly . Reassure her that continuing to follow her schedule will help keep up her supply. Help her find a way to feel close to the baby during this time - perhaps finding a special book to read aloud to baby may help or some extra time kangarooing.
Introducing Supplemental Feeds
Sometimes, when a baby’s weight is not increasing at an expected rate, supplemental feedings may be introduced. This can be accomplished by adding MCT oil or polycose to the breastmilk to up the fat calories, by adding breastmilk fortifier to the expressed milk, or by introducing some high calorie formula to the baby’s feeds. A nutritionist explained supplementing in this way, “It is NOT that your breastmilk is deficient or lacking in any way. It is that your baby
needs an extra boost to grow at this time, because his body is requiring some extra help beyond
what breastmilk is giving him. This is no fault of the mother. It is not what she is eating or
failing to eat. It is not because her body is not making the right type of milk.. All breastmilk
varies in content, and this is through no fault of the mother.”
Even if a mother understands the supplementing is not in response to her milk quality, she can be
quite upset. It is not unsual at all for her to feel as though she is to blame, that she is failing ather responsibility of providing proper nutrition, guilty of letting her baby down. She may wonder if she will ever get anything right with this baby. These feelings can be quite intense and may not easily resolve unless someone takes the time to explain the medical reasons behind supplementing, reassuring her that she is doing her best.
Being Asked to Back Off
Occasionally, a mother may be asked to back down from her nursing attempts. This is often in
response to the baby’s medical condition. It can be hard for the mother to give up nursing sessions when she was just beginning. Again, it is extremely important that the reasons be
explained in detail to the mother. If not, she is left feeling confused and powerless. It is also important that she does not receive conflicting
viewpoints on this issue. The doctors, nurses and lactation consultants should all be in agreement
with backing off. Otherwise, feelings of doubt, confusion, loss of control and anger are likely to
surface in the mother. Be sure the mother is offered lots of comforting, encouragement and
reassurance during this break time. It helps to offer a proposed schedule of when breastfeeding
may begin again as well as other alternatives to breastfeeding, such as kangarooing.
Transitioning at Home
If a baby is ready to be discharged but is not on full feeds by breast, there will be a transitional
period after the homecoming. Many moms try immediately to go to total breastfeeds, stariting
during the rooming in period, only to meet disappointment, exhaustion and frustration. Learning to breastfeed exclusively is hard on a preemie and his mom. Often, it takes slowly increasing the number of feeds by breast over a period of days or weeks, or even months to achieve total nursing at the breast. This can cause lots of stress for the mother.
She wonders if she will ever be successful with exclusively breastfeeding. She may doubt
herself over and over. She may worry that she is not doing something correctly, but not know how to get help, since she is now away from the NICU. She may feel overwhelmed with breastfeedling which is supposedly so easy and natural to learn. She may feel like less than a perfect mother. She may begin to obsess about breastfeeding. This can cause fatigue and undue pressure, as well as depression over a loss of power and control. Feelings of unfairness may resurface, as the mother questions why she has to deal with a high/special needs baby.
It is important for her to work within her own timeline, and maintain large reserves of patience.
She will need extra encouragement for her efforts, extra praise for her perserverence , and lots of
reassurance of the possibility of a positive outcome. She will also need help with supplemental bottle feedings, and watching the baby while pumping. It is a tiresome venture, both physically and emotionally, which many moms pursue relentlessly for weeks and months. Sometimes the mother is successfull at transtitioning the baby totally to the breast and sometimes she must accept partial feedings by breast/others by bottle. For some mothers, although they try extensively, their baby may not adjust to the breast at all. This is quite common with preemie moms. It is by no means the fault of the mother.
Go to next topic Discontinuing Breastfeeding
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