Thursday, July 13, 2006

Some people will do anything to get breastmilk.

That was the comment from one of our attending neonatologists when he spotted me feeding breastmilk to a baby whose mom had opted not to breastfeed. He's right. If there are no contraindications, I'll do anything within reason to persuade the moms of my babies to provide at least a little breastmilk. The gambit that had him shaking his head was rather more unusual than most.

My biggest ploy is promising the moms that they don't have to keep it up if they don't like it. I do as much educating as possible, but I won't put on the guilt thumbscrews. NICU moms feel guilty enough that their baby was born prematurely, or sick, or with congenital anomalies. Very few of them should feel guilty, and the moms who should generally don't.

We've known for years that breastmilk is the best food for nearly all of our babies. There are a few contraindications: certain medications, many illegal drugs, HIV, and some rare metabolic disorders. Aside from those cases, we know that breastmilk has many advantages. There is evidence that breastmilk helps to promote brain development. It helps to decrease the risk of infection. It has other benefits as well. The neonatologist at Tales from the Womb presents some of the ways in which breastmilk helps to prevent a devastating disease called Necrotizing Enterocolitis. In very simple terms, part of the intestine dies. Often the diseased part can be removed and the baby will survive, but sometimes they end up with short gut syndrome (sometimes called short bowel syndrome). This can make absorbing enough nutrients very difficult. Sometimes they die.

Back to my story. It was a simple one. The mom had opted not to breastfeed. She didn't explain why, but she simply was not interested. She didn't want to hear any more about the benefits to the baby and she didn't want to discuss it -- until the baby was about 3 days old. Her breasts began to fill with milk, even though she wasn't pumping and she wasn't nursing her baby (he was too small). She was in extreme pain and came to me for advice on what to do about the engorgement. I gave her some basic instructions in managing engorgement, then added, "If you like, I can suggest something that will relieve your pain right now."

I explained that it would prolong lactation and she might need to repeat the treatment, but that it would provide immediate relief. I had her interest immediately. She didn't care that she'd continue to produce milk a little longer my way and she didn't care that she would require several repeat treatments. The equipment was just down the hall and she could use it whenever she came to visit her baby.

The magic treatment? A breast pump. I got her a pump kit and showed her how to use the pump. I explained that if she wanted to eventually be able to stop pumping, she needed to pump enough to be comfortable, but not enough to stimulate increased production.

It took her nearly 2 weeks to stop lactating. She pumped twice a day at first and less frequently as her supply declined, but we did have colostrum to feed her baby and, since he was small, several breastmilk feedings each day for a time.

Honestly I'd hoped she would find that it wasn't too burdensome to continue, but sometimes you've got to take what you can get.


Kelly said...

I agree with the Attending's comment! Yet, that's the most clever "anything" I've ever heard of! Kudos to you for getting the job done in a round-about way!

Anonymous said...

Awesome! Good for you (and your little patient). Keep up the good and clever work.

Sarabeth said...

You've got a pat on the back from me.

Judy said...

It was a win-win situation. Mom was more comfortable and baby got breastmilk. It's not a method I get to use often, but I'd do it again in a heartbeat.

neonataldoc said...

Good for you. I agree, anything for even a little breast milk.