Sunday, August 29, 2010

Breastfeeding and Kangaroo Care in a Neonatal Intensive Care Unit

I met Jessica when she came to give a talk at an ICAN meeting. Even though this birth was not local I felt her poignant story was so important I asked her if she would be willing to share it on my blog. It is full of many of the issues I have currently been writing about; changing our "plans", creating a partnership between mothers and medical staff, pairing the best of mothering with the best of science so our most vulnerable babies get the best of both worlds, and when is the moment we are reborn into the role of parent. It is of particular interest to me that although Jessica is a Certified Nurse Midwife when it came to her own child she was no different than most first time moms. It took time for her confidence in her mothering abilites to grow enough for her to step into her parental role, stand on her feet and stand up for her son and her rights.

A Nursing Story

Oliver was born under the bright lights of the operating room. At three pounds, seven ounces, he was lucky to be born in 2006. He had a statistically high chance for survival in the neonatal intensive care unit. I was told he cried when he was lifted from my belly and when his delicate little body was subjected to IVs and wires and tubes just moments after birth. The details of Oliver’s birth and my operation were finally made clear to me many months later when I reviewed the operative note. It’s all I have of his birth. But I have Oliver and I am grateful.

Magnesium sulfate kept me from holding my baby for the first 24 hours after his birth. 

(Dad stepped in providing Kangaroo Care, skin-to-skin continuous contact.)

I vaguely remember vomiting, severe headaches, and terrible abdominal pain during that first arduous day. My home birth midwife knew how badly I wanted to have a “normal” childbirth experience and my strong desire to nurse my child. Within the first couple of hours she had procured a hospital grade pump and taught my friends how to pump my breasts. They propped me up every three hours and collected my colostrum until my mother arrived and took over the duty all night (after flying across the country).

The next day I was considered stable and was wheeled to the NICU to meet my son. The NICU nurse carefully handed him to me. He was exactly what I wanted. I felt like I was meeting someone I already knew, his face so familiar yet lovelier than anything I had ever seen. I did what I had seen hundreds of new moms do when holding their babies for the first time. I put him to my breast. The nurse panicked because he was not “cleared” to take anything by mouth. But Oliver’s tiny mouth and weak suckle would have prevented him from nursing anyway at that stage. “We are just bonding,” I explained to the kind nurse. Oliver closed his eyes and breathed in the smell of his mommy. We both relaxed and I knew we would eventually get over his traumatic birth.

Oliver was born at a progressive hospital with an excellent NICU. When I knew I would be delivering him early, I was transferred via ambulance to that particular hospital because I was told it had the best NICU in the state of Connecticut. My husband and I spent hours holding him skin to skin doing “kangaroo care.” Oliver was getting stronger and my bags of breast milk were filling up the small NICU refrigerator. I was so proud of that milk. At every tube feeding the nurses would help me put Oliver to my breast to help him associate my breast with a full belly. Eventually Oliver was strong enough to move to a less intensive care unit. We decided to have him transferred to a smaller NICU closer to our house. I called the nursing manager and was told I would be supported in my desire to do kangaroo care with my child and breastfeed.

We arrived at the small NICU early in the morning on a weekend. I immediately took Oliver out of his isolette for some kangaroo time after the long ambulance ride. After an hour of skin to skin, I was told by the nursing manager to “put him back” because I was making him cold. My husband and I learned that kangaroo care at our new NICU consisted of one hour, once a day. I argued with the nurse and wanted to speak with the pediatrician. I wasn’t able to hold my baby that entire day and evening. I just sat, staring at him though the plastic of his isolette, and cried. I finally cried about everything: the loss of our birth experience, the first precious moments after birth, our special baby moon. It suddenly felt like we were in hell. That night I pumped and noticed a sharp decrease in the amount of milk I was producing. I was concerned so I called my midwife and told her what had happened. She lit a fire under me and gave me the strength to fight for my son. A friend helped me gather articles about the benefits of kangaroo care so I would be armed with information when I met with the pediatrician in the morning.

After a long meeting, the pediatrician agreed to “let” me hold Oliver for one hour, three times a day, as long as his temperature was monitored every fifteen minutes. I agreed because I wanted to show how stable his temperature would be during kangaroo care. The nursing manager stopped speaking to me but I did find compassionate support from many of the nurses. At night, the nurses would “forget” to check on us and I would end up holding him for hours. Slowly, I was able to try to nurse him again at every feeding. I was the only breastfeeding mom at that time in the NICU and the staff had never worked with a mom who was exclusively breastfeeding at discharge. My midwife came to the NICU to show the nurses how to use a supplemental nursing system and how to position a small baby correctly. With her help I was finally able to get Oliver firmly latched on during a feeding.

The last four days of Oliver’s stay at the NICU were the most difficult, but necessary to establish a breastfeeding relationship. I convinced the pediatrician to let me sleep at the hospital. The NICU nurses set up a cot for me near the unit so I could be available to nurse Oliver every few hours. By the time I put Oliver in his car seat to leave the hospital, he was 100 percent breastfeeding. It is my most important accomplishment.. I send the NICU nurses a Christmas card every year to remind them of sweet little Oliver and this annoying mom who made it her mission to breastfeed and succeeded!

Next read about a "miracle" baby and the chemical, biological, and emotional power of a mother's love.


  1. Elena sent this in via facebook:
    What an amazing Nursing Story...LOVED THAT so much!

  2. Jessica emailed to say, "I am on maternity leave now (with her second baby)and finally sat down to rewrite my breastfeeding in the NICU story for your blog. Thanks for inspiring me to finally sit down and do this!"