Reply turned post: Bottle feeding, breastfeeding, and the NICU

I vent a lot (maybe too much... trying to stay open to positive possibilities for education and cooperation) about the NICU & breastfeeding.

Because of those challenges, this post on My OB Said What caught my eye today: "You’ll get him home sooner if you just bottle feed," – NICU nurse to breastfeeding mother of a NICU baby. Many commenters chimed in to rightfully assert that the mother's breastmilk is much better than a bottle of formula, especially for a NICU baby, but I think this is not quite what the nurse meant. This was my comment:

"This is sad but true... the requirements for the NICU babies to go home is to take all feeds PO (by mouth), maintain their oxygen sats on room air, and maintain their temp. The PO feeding requirement leads to a lot of bottles because they are the easiest and fastest way to declare the baby capable of all-PO feeding. I have met very few moms able to avoid any bottles in the NICU. It basically means insisting on gavage feeding for every feed at which the mother is not present, and it is hard for the mother to be present 24/7 because the NICU is not set up for that. So it absolutely can mean that the baby stays longer. It is very frustrating because direct breastfeeding is best and least taxing for these babies."

It's a real catch-22. The way to prove the baby can do OK on all PO feeds is for the mother to breastfeed him/her around the clock. But there is often nowhere for the mother to sleep after she's discharged from the hospital herself. So to be with her baby 24 hours a day to breastfeed, she has to agree to bottle feeds to "prove" her baby can effectively take all feeds by mouth. The bottle feeds can and do cause issues with breastfeeding, but even for the most motivated mom, it can be a very difficult choice between agreeing to many bottles, and waiting extra days to take her baby home.

Recently, I saw a baby born at 32 weeks go to the NICU, have nothing but breastmilk and never have a single bottle touch her lips, and eventually go home feeding exclusively at the breast. Her mother was highly educated and motivated, had excellent family and community support, and really advocated for herself and her baby. As LCs, we were all so amazed and impressed by what they did. It was truly an accomplishment in a NICU environment... and it took bucketloads of privilege. Very few people are able to accomplish that without support from the staff, which the nurse quoted above was definitely not providing. Staff support is a huge issue. I have even heard a NICU nurse say "If they don't want to bottle feed, I just tell them 'We can put a tube down your baby's nose instead' [referring to gavage/NG tube feeding] - that changes their mind!'" A really inappropriate thing to say just to scare parents, given that this way of feeding may be necessary for certain babies who aren't able to safely do PO feeds.

In my perfect fantasy world, NICU babies who are ready to do PO feeds are moved to private or semi-private rooms that have a space for mom to sleep, so she can be with the baby 24/7 and breastfeed easily. She can stay there until the baby is ready to go home. Bottles are only given with explanation and consent, used appropriately, and stopped quickly if they begin to cause breastfeeding issues. Is this really such a crazy fantasy?

"Born Too Soon"

Watching this documentary reminds me of the great posts on Reality Rounds about avoiding the realities of prematurity. Here is a documentary that does NOT avoid them, and highlights the problems not only of early premature birth but also late-term prematurity, and the health disparities in preterm birth in this country.

It's called "Born Too Soon" and is a collaboration between March of Dimes and Kentucky Educational Television. Most of the officials interviewed are from Kentucky, and there's a focus on the rising prematurity rate in Kentucky, but it's generalizable across the country and everything that's happening there is happening around the country. I also love the doula interview, and highlighting the CenteringPregnancy model of care. I think it's an accessible, good overview of the prematurity problem (although let me just insert a little "ack!" here for the baby bottle imagery used. I am of course not a fan of coding "baby" as "bottle".)

You can watch the whole documentary here.

Breastfeeding premature babies

The video below, a news report on the benefits of breastmilk for premature babies, has been making the rounds. I forget that not everyone knows stuff like this! So let me say that while I see both sides of the breastfeeding/formula debate for healthy term infants, we need to acknowledge that breastmilk makes a much more life-and-death difference for premature babies. This semester in our breastfeeding class, we've heard about necrotizing enterocolitis (NEC) multiple times. In NICUs where all babies get breastmilk, it is virtually non-existent. Among the many other benefits of breastmilk for premature infants, this is a very clear-cut one that combats a life-threatening illness.

If you know a mother with a premature baby who for any reason can't breastfeed or pump, you should 1) Help her find a lactation consultant who can assist her and 2) Get her in touch with a milk bank so her baby can receive donated milk.


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