Sunday, October 18, 2009

Notes from the NICU

The last three weeks of my LC shadowing have been with LCs who cover the NICU. It's been very different from my previous experience with breastfeeding support; the work I observe in the NICU involves very little direct breastfeeding, more counseling on pumping, and a lot of logistics. Some recent experiences:

1) Conferring with the NICU head nurse on flu policies. This has been a constantly evolving discussion since I have started observing at the hospital. Right now the policy is that no one with flu symptoms, including the mom, is allowed to visit the NICU until they have been afebrile (without a fever) for 10 days. But moms are encouraged to continue pumping and send pumped milk for their infants with a family member or friend. The LC and the NICU head discussed what to tell flu-infected moms about pumping hygiene, how to clean the bottles once they arrive at the hospital, and where to store the milk. Interesting to see policy being worked out, and so nice to see the NICU valuing and encouraging pumping!

2) Boxing and moving left-behind milk. The overflow freezer for storing pumped milk was itself overflowing, so I helped the LC transfer some of the milk to yet another freezer. We used Enfamil boxes to store the milk - they're made to fit very similar size bottles - and joked about "redeeming" the boxes. I asked about the milk we were transferring and the LC said it belonged to a mom whose baby had died after several months in the NICU. The LCs are waiting to hear back from her about what she wants to do with the milk. The LC was crossing her fingers that the mom would be willing and able to donate it. After seeing it, I hoped so too - there were some bottles of beautiful golden colostrum, and bottles and bottles of mature milk - after moving it all I'd estimate there were over 300 ounces! What amazing dedication. I can't imagine how hard it would be for this mom to think about what to do with this milk she hoped to give to her own baby.

3) Seeing how breastfeeding/pumping can come in dead last on a list of priorities for any NICU mom. So, you've had a c-section in a hospital a hundred miles away, your baby was transferred emergently to this hospital with serious health problems, you've been trying to coordinate the care of your older children while trying to recover and hoping to be discharged ASAP, 4 days after the birth you've finally managed to get over to visit your baby, which someone had to drive you to because you're not allowed to drive, you have to understand what's happening medically with the baby and possibly make decisions with the doctors about care, and in the midst of this is this sick tiny infant who is hooked up to ten different machines who you can't hold. And then this lady comes in and asks you if you want to pump milk for your baby. Who can't even eat right now. Sometimes I think it's a miracle any mother says yes.

4) And then seeing how much pumping can mean to a NICU mom. It obviously meant a lot to the mom who pumped over 300 ounces. Sometimes, it is the only thing a mother can do for her baby. I learned last week about oral care, done to keep the baby's mouth healthy and hydrated even if they're NPO (nothing by mouth). The LC counseled a mother that even if she was just pumping drops of colostrum at the beginning, she could soak up the drops with a Q-tip and use the Q-tips for oral care. Then the baby could smell her and know that she's close by. The mom started to cry. She couldn't touch her baby, didn't know if her baby would live, but she could do this one thing.

I think I'm lucky to have this opportunity to see NICU LCs in action, although it seems unlikely that I would ever end up in that role given that I don't have a nursing degree (most of the NICU LCs are former NICU RNs). I am looking forward to getting back to some more hands-on breastfeeding support, but this has been a real window into what babies and families going through the NICU experience.


Melissa said...

I was the mom to a NICU baby who didn't make it. I have to say that the memories of the time I spent breastfeeding him when I could, and pumping for him are good ones that I will carry with me always, and something special that only I could for him, even though he was in a NICU, being cared for by nurses more than by me.

In his two months of life, I had a little over 1000 oz. of milk I ended up donating after he passed.
(He was NPO or on small feeds for a fair amount of time due to surgeries.)

It was bittersweet to need to part with all the milk -- had he lived I knew I had way more than I'd ever use anyway -- but amazing to be able to give it to a mom who was medically unable to breastfeed her daughter.

Kudos to that NICU for storing the milk, and waiting for the mom. I lost somewhere around 100-150 oz. from the PICU freezer getting cleaned out in the week between my son's passing, and when I was ready to call to inquire about it.

publichealthdoula said...

Hi Melissa,

I am so sorry for your loss. I have been reading through your blog and learning a lot. What sweet photos of your beautiful baby!

THANK YOU for donating your milk - sad that some was lost but over a 1000 ounces is amazing! As hard as it must have been to part with it, I am sure it meant the world to the mom and baby who received it. I think the NICU stores potential donor milk so long in part because they use so much donor milk and know what a precious resource it is.