Interviewed by Erika Goyer, Hand to Hold Family Support Navigator
Most of us think that because breastfeeding is nature’s way of meeting our babies’ needs that nursing should come, well… naturally. But many of us struggle to learn the carefully choreographed dance between mom and infant to make feeding successful! This is especially true if you and your baby ends up in the NICU. Being born early or with special health needs means that a baby may not quite be ready to nurse yet. And mothers may find themselves trying to establish a healthy milk supply under very challenging conditions – and possibly weeks before they expected to.
Yet NICU parents know more than anyone else how special breast milk is and the difference it makes for their children. In spite of all the barriers, mothers who have babies in the NICU actually go home nursing their infants at a higher rate than mothers who had uncomplicated births – and continue to breastfeed longer.
This month we interviewed Kay Needles-Gregorio. Kay is an International Board Certified Lactation Consultant and a NICU nurse at St. David’s Medical Center. We sat down with her to talk about how a lactation consultant can assist you and your baby as you establish your nursing routine.
What is your title and what was your program of study?
I am a registered nurse, or RN, as well as a lactation consultant, or IBCLC. I got my Bachelor of Science in Nursing. I have more than fifteen years of clinical experience, have been a certified lactation consultant for more than five, and I am currently a graduate student studying towards my Masters of Nursing in Public Health.
What sort of licensing and certification do practitioners in your field go through?
Lactation consultants are accredited through the International Board of Lactation Consultants Examiners. This credential certifies the lactation consultant is a knowledgeable and experienced member of the maternal-child health team who has specialized skills in breastfeeding management and care. IBCLCs adhere to the IBLCE Code of Professional Conduct and are required to keep their knowledge and skills current. They must recertify every five years through continuing education or re-examination.
No state currently requires licensing or certification beyond this program.
What professional associations are you a member of?
You work primarily with families in the NICU. What does a NICU-based lactation consultant do?
Simply put, lactation consultants promote and support breastfeeding and pumping. Because the staff at St. David’s Medical Center puts such a high value on our preemies receiving breast milk every mother whose baby is admitted to the NICU will get a visit from a lactation consultant. The goal is to prepare for successful nursing even if the baby is not able to go to the breast for some time.
The Lactation Team:
- Helps the mother initiate breastfeeding and/or pumping.
- Creates a plan for her baby’s feeding.
- Trouble-shoots to solve any problem the mother is having initiating her plan.
- Teaches how to position her infant at the breast in a way that suits them best.
- Develops a discharge plan for when the family goes home.
Beyond that lactation consultants also act as a resource to NICU staff to answer their questions about lactation support and as an advocate for parents within the hospital system.
What would you tell families they should expect when they meet with a lactation consultant?
They will receive a one-on-one consultation with the lactation consultant. During this time they’ll will talk about a plan to fit their family’s unique situation, because every family is different. After a plan of care is developed you will work together to learn how to use the breast pump and talk about how to safely store and handle breast milk. Each family should get an orientation to familiarize them with the NICU and show them the resources that are available for them to use. Then you’ll go over the written information you’ve been given on pumping and steps to successful lactation.
What are some of the special considerations with NICU babies when it comes to breastfeeding?
- Premature infants need breast milk more than most. Because of their early births they haven’t received all the antibodies and nutrients from their mother that they would have if they’d been full-term. Fortunately, the colostrum and breast milk of mothers of preterm infants can still deliver these vital nutrients. Its properties are unique and make the milk the best medicine available to vulnerable infants – especially when it comes to preventing infection of their immature digestive system.
- Most babies aren’t developmentally ready to nurse until they are 34-35 weeks gestation (adjusted age if they were born early). Many are unable to coordinate the suck-swallow-breathe pattern required to nurse or have problems with getting too tired to finish a feeding. For this reason pacifiers are actually encouraged in the NICU. This “non-nutritive” sucking gives them practice and helps their oral development and stamina.
- Because they need time to develop their feeding skills most premature babies will take their first breast milk by feeding tube. Even before your baby is ready to nurse take every opportunity available to hold your baby skin-to-skin, nuzzle them at the breast, and practice Kangaroo Care. Each step will bring you closer to successful nursing.
- Initially some NICU babies will have challenges at the nipple. Nipple shields can help a mother and her baby by making the nipple easier to stay latched on to and by moderating the flow of the milk. Nipple shields also may help transition a baby to the breast who has become used to the bottle.
- It will take time – sometimes much longer than you think it would – to establish your milk supply. Mothers should try not to get discouraged. A good quality breast pump can make a big difference. While you’re in the NICU you will be able to use a high-quality, hospital-grade breast pump. But you have other options as well. Qualifying families can borrow a high-quality breast pump through the WIC program. You can purchase your own. (Here’s Kay’s recommendation). Or you may be able to rent a breast pump directly from your hospital.
Watch Kay’s video - Preemie Nutrition: Increasing Your Milk Supply
How can fathers, family, and friends support the mother as she pumps and breastfeeds?
There’s a lot that can be done. Practically speaking, it’s extremely helpful to wash and maintain all the pumping equipment and storage containers. When a mother doesn’t have to wash and maintain the machinery she can focus on relaxing and pumping! But there’s more. Mothers need cheerleaders, people who can advocate for them and support them emotionally as they try to fulfill this responsibility to their infants. It can be a long journey from pumping for a fragile infant to direct breastfeeding. Moms need support every step of the way. Including healthy meals cooked by loving friends! With the support of family and a certified lactation consultant mothers can give their babies the best nutritional and developmental start possible!
For more information on breastfeeding your NICU baby:
♥ NICU to Home: A Perspective on Feeding Difficulties by Anne Boon
♥ Nourishing Your Premature Baby in the NICU by Amy Gates, RD, CSP, LD
Erika Goyer is the mother of three boys and a family support navigator with Hand to Hold.