Salt Lake City Based Photographer Timbra Wiist owns/operates Landslide Photography & Photographs the Journey of Motherhood (see bottom of page or sidebar for more info. . .depending on what this blog is choosing to do for the day).

Monday, July 19, 2010

9lbs @ birth and in the NICU?

Welcome to The Breastfeeding Cafe Carnival!

This post was written as part of The Breastfeeding Cafe's Carnival. For more info on the Breastfeeding Cafe, go to For more info on the Carnival or if you want to participate, contact Claire at clindstrom2 {at} gmail {dot} com. Today's post is about nursing in special circumstances. Please read the other blogs in today's carnival listed below and check back for more posts July 18th through the 31st! 
My first daughter came into this world, she was beautiful, she was perfect, we never had a problem with nursing. So many women in La Leche League meetings seemed to have stories to tell, even thrush was like an entirely foreign universe, far from my perfectly uneventful start to breastfeeding. And then baby 2 came along. I don't want to be overly dramatic, there are some REALLY difficult births out there, some very serious complications and some babies and children who are struggling with things much much more serious than we ever had to, but having your 3 day old infant sent to the NICU is any parents worst nightmare and whatever difficult thing each of us deals with, is it's own personal hell, regardless of the "degree of difficulty." And any time the boundaries of your nursing relationship are put into the hands of others, it's a "special circumstance." So. . .though I COULD talk about tandem nursing, I think I'd like to share this part of our story instead.

Our second daughter was also perfect, at birth she was nearly 9 pounds with a lovely round little head. She came fast and furious when she decided to come. She was pink, she cried. . . she nursed in the first 30 minutes and then all night long that first night if my oldest daughter wasn't awake, my newest daughter was, and vice versa. She was born at 10:04pm, we finally got our 3 year old to sleep around 2 after all the excitement, and at 4am this new one was awake. . . she nursed straight through and finally slept again around 7, so while my eldest daughter and husband enjoyed pancakes that our midwife had made, my new baby and I slept. . . and less than 12 hours after she was born, we were on our way home.

A few hours later my mom commented on how "dark" this baby was. In the evening some friends stopped by and mentioned the same thing, the following day my sister also commented on it, and our little one was pretty yellow by this point. (I'd always expected a jaundiced child, my husband was jaundiced at birth and has a syndrome that causes jaundice.) She was sleepy, very sleepy, she hadn't nursed much through the night, but perhaps she was just doing fine on reserves and allowing us both to catch up on some rest. Day 3. . .time to get our check-up. My midwife came by for this and immediately commented on my "pumpkin" baby. I think, in some ways. . . I was with her the whole time, she was jaundiced, but it was a progression I wasn't seeing and I also didn't want to admit there COULD be something more serious going on. And then we got biliruben numbers back that day that were so high 1) the lab ran them a second time sure they were contaminated and 2)our pediatrician sent us for another round of labs because in "30 years of practicing medicine he'd never heard of a number so high" and was sure it was wrong. At 11pm, after a day of worry, a couple of hours in the ER, and our labs were all back a second time. . . . we were sent to the NICU at the children's hospital, because our local hospital "couldn't treat a baby THIS SICK!"

I nursed my baby around 11pm for the following 20 hours I was not able to hold or nurse her, I fought NICU staff on pacifiers and bottles and finally began to understand and gain some perspective on how mothers who did not have the same kind of information and knowledge base regarding breastfeeding, would, in a desire to do everything that is best for their babies, just give themselves over to the mercy of the NICU staff.

As I sat in an interview with the doctor who was basically calling the shots on my daughter, she was being hooked up to oxygen and saline and having blood drawn and I was not with her. . . she was barely 72 hours old. I was told I could nurse her before she was put under bili-lights and then every 3 hours "as quickly as possible" so she'd have as much access to light exposure as possible. They had to do some labs and if her numbers were still too high, a transfusion. When I got back to the room where she was, a nurse was holding a pacifier in my crying baby's mouth, I walked in horrified and told her I didn't want my baby to have a pacifier, she shouted "I had to do something she wouldn't stop crying!" OH. . .here's a thought. . . HOLD HER?!!! COME GET ME? LET HER FATHER NEAR HER? I think my husband was in as much shock as I was and didn't know what to do, he just stood there letting the staff "get to work." I sternly told the woman "I want nothing in her mouth besides me or a finger!" And still, she stood there HOLDING the pacifier in my crying baby's mouth. . . OBVIOUSLY she didn't want it. I think I actually had to shout "Take it out NOW!" Then I said I would nurse her, she told me I wasn't allowed to. . . I almost completely lost it. I didn't want to make enemies, I didn't want to do anything that was counter-productive to my baby's well-being but I also wanted to fight for my right to do the things I KNEW would benefit my baby. I already knew she was tongue-tied and at 3 days old, I didn't need some "sucking interference" being thrown at her. The Dr. walked in and backed me saying that I could in fact, nurse her before she was put under the lights. Then they were able to lay her on her belly, since she needed oxygen and had a canula in her nose, and SURPRISE SURPRISE, this position was okay with her. . .more comforting, no crying.

This nurse didn't speak to me for the next hour or so, we just sat there in silence, her back turned to me (busy with her paperwork).

Baby girl's blood was drawn, her numbers were high, she had to have a transfusion. They set to work putting a catheter in her umbilicus, at this point I was told I could no longer nurse her, they had to work with "urgency" and created a "sterile field" on her belly (a sterile field that would land her back in the hospital with a staph infection days after her discharge from the NICU. . . but that's not a story we'll get into here). . . . but the blood for the transfusion did not come for FIVE MORE HOURS. During this time I finally told the nurse that, since I couldn't hold or nurse my baby, if she was crying during the transfusion (or while waiting on blood) a pacifier was okay, because it was just too heartbreaking to listen to her crying. (During these several hours, the nurse did pacify my baby by putting her finger in her mouth when I wasn't able to! But I knew that during the transfusion, she wouldn't have the same ability to have a free hand at all times, or may not even be in arm's reach and there may not be anyone who could get close enough to offer a pacifying finger) She encouraged my decision and said to me "I'm a member of the breastfeeding support team, and I know what the literature says, but babies don't have any trouble nursing once they've had a pacifier." WHATEVER LADY! I'm the one who gets the moms emailing me because you think like that and say things like that!!! The transfusion took quite a long time, a few hours, and then a new attending Dr. was on for the morning rounds by this point.

She too told me I could NOT nurse my baby. At every turn when I was lead to believe if things went in a certain direction, we could go back to the original plan of holding and nursing for short periods, someone on staff would step in and tell me "No. . . now we want to wait for this new sign that things are going okay." The new reason. . . because if she had a full belly and they had to do another transfusion, it could really mess up her intestines/stomach and they were leaving the catheter in for several more hours until it was determined that she definitely would not require another transfusion. . . If it was determined that another transfusion wasn't necessary, for whatever reason the Doctor wanted to give her a bottle or an NG tube to start feeding her so they could monitor how much. COMPLETELY UNNECESSARY! This made me irate, I requested another feeding method and got a line about how "WE'VE breastfed thousands of babies successfully". . . .lady have you breastfed any babies successfully AT YOUR breasts? Or is "we" a figurative term here. . . ? I aired my frustrations to a nurse, asking why they couldn't use a syringe? She'd been a nurse for several years and this was a totally new idea to her. . "Oh, yeah, that makes sense, I'm not sure why they couldn't do that, I'm sure we could" (it was more about what the nurses were willing to put up with). The resident came through to check on us and give us an update and she got QUITE an earful regarding my discontent. And I did NOT want to confront her. I did not want to be one of those crazy ladies who thinks she knows everything about breastfeeding success and management in the face of the medical world and be given some other argument she couldn't talk down. . . but I WOULD NOT sit idly by. And this woman listened and . . . .

I think I was asleep, or I just wasn't in the room, and I got a semi-nasty call from one of the nurses "Are you going to come nurse your daughter?" WHAT? They told me they were going to have to give her a bottle or an NG tube last I'd heard. . . . my words had not fallen on deaf ears!!! After 20 hours, PS: Day 3 is a HORRIBLE day for a baby to have to "not nurse" I had to use the hospital grade pump MANY times and my breasts were killing me and completely engorged, but after 20 hours of not being able to even hold my baby, I was able to nurse her for FIVE WHOLE MINUTES :)And then I became a prescription. Suddenly I was told (and almost as though I was being punished) if you aren't here every three hours to nurse her (for five whole minutes she was allowed to be out from under the lights) we will put an NG tube in her to feed her (my pumped milk). In between feedings, I still had to pump, she was receiving nutritive saline or something, so she didn't nurse much, and she was still sleepy from being jaundiced. . .

I slept on the couch in the waiting room, we asked for blankets and pillows, every day at 7am and 7pm they disappeared because this was shift change and we were required to leave the NICU for an hour at each of these times. One time, I asked for a pillow and blanket and was told "You really aren't supposed to sleep in the waiting room." Another time I used one of the chairs that pulls out into a bed, in the hallway outside of the waiting room, where it was nice and bright (not like the lovely dark waiting room) and someone (staff) actually woke me up to ask me if I'd turn the chair so it wasn't facing out into the main walkway. . . the NICU is not a super parent friendly (therefore not a very breastfeeding friendly) place!!!! I HAD TO BE THERE to nurse my baby EVERY THREE HOURS. I got calls if I slept through my alarm, of course laying down and nursing was NO OPTION. I had to sit up in a chair the ENTIRE time I nursed my baby (longer stints later as she moved to just having to lay on the bili blanket, so I could hold and nurse her on the blanket for however long I wanted), and I had to stay awake too. . . . my postpartum physical recovery SUCKED!!! My butt hurt, I had to use my peri-bottle and change pads in the public bathroom ON THE WAY to seeing/feeding my daughter, after sleeping in horrible positions and being rudely awakened.

And we were only there 3.5 days. . .it felt like a LIFETIME!!! The first 24 hours felt like a lifetime of pumping and not holding my baby and wondering if her biliruben levels would maintain their downward turn. And we had to deal with all sorts of ridiculous "checklist" items. . . things that "normal" parents don't have to watch or do or prove before they can walk out of any hospital with any newborn baby. And I sometimes wondered where the checklist for the nurses was. . . I mean seriously. . . I couldn't believe that I was educating some of them regarding breastfeeding. I had to ignore literature about co-sleeping and nod my head in understanding. I applaud ANYONE who "lives" in the NICU longer than we did. . . and anyone who leaves the NICU with their resolve still in tact over breastfeeding and actually goes on to successfully breastfeed. . . there are SO MANY OBSTACLES!!!

And don't even get me started on tandem nursing. . .that's a completely different "special circumstance" all it's own :) One that was a pretty difficult balance with a confused toddler who didn't have her baby sis at home, and a mom who had also suddenly disappeared! But today my youngest daughter turns 11 months old. She is HUGE, she is thriving, she is wonderful and still completely perfect. Her first two weeks (remember, we were sent back with a staph infection) were trying and scary and frustrating particularly with how I felt like nursing her was a "prescription" the hospital staff felt they could monitor and change at any time. But I know that I was equipped with information and determination when I went into that situation and am positive that all that I've done, I've done to be the best mother to my baby.

(Incidentally, I recently learned that the first doctor, the one who gave us the initial consult in the NICU, is now being sure that all pediatricians who come out of the U are armed with a new breastfeeding curriculum and is interested in breastfeeding advocacy, AND has been attending breastfeeding coalition meetings. . .he is a 60 something year old man!!! I applaud his interest. I hope that some determined, informed mothers throughout the years have caught his attention and piqued his interest in advocacy!)
 Here are more posts by the Breastfeeding Cafe Carnival participants! Check back because more will be added throughout the day.


bungalow said...

Wow. Your girls are going to love this story when they're older!

Years ago someone told me that the hormones surging through a new mother are the same ones that trigger a grizzly sow to kill to protect her young. Your story triggers that memory.

Terry-Lorenzo Family said...

Timbra, you've told your story so powerfully. Hearing your story has been helpful to me in understanding better the challenges moms go through when their babies are in the NICU. It doesn't make sense to me at all that these places aren't more conducive to parents being with their children. Our babies don't just need our milk; they need US to thrive and be healthy.