Booby Traps Series: Booby Traps in the NICU

This is the 37th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

For several months I’ve been writing about Booby Traps found in the hospital for healthy, full term babies.  But as we all know not all babies are born at term.

For babies born early, the importance of breastfeeding and breastmilk really can’t be overstated.  Premature babies who do not receive human milk are at significantly higher risk of infections, sepsis, meningitis, digestive problems, and necrotizing enterocolitis (NEC).  NEC is a life-threatening condition in which part of the baby’s intestine dies, and exclusively formula fed babies are 6 to 10 times more likely contract it than babies who receive breastmilk.  All of these conditions can be life threatening to a preterm baby.  Research has even found associations between breastfeeding and long term health and developmental outcomes for people born preterm.

In spite of this, parents and babies who spend time in the Neonatal Intensive Care Unit (NICU) often encounter a specific set of Booby Traps which undermine breastfeeding.  I’ve listed several below, and I hope you’ll feel free to share others you have found when your babies have been in the NICU.

Not being informed of the importance of breastfeeding for a preterm baby.  Given the evidence cited above, it seems unimaginable that healthcare providers wouldn’t inform a mother how breastfeeding and breastmilk could alter the life course of her infant.  Unfortunately, this is sometimes the case.  In Breastfeeding Answers Made Simple, Nancy Mohrbacher writes, “Where breastfeeding is not the cultural norm many healthcare providers hesitate to ask mothers to provide expressed milk for fear of putting pressure on them during a crisis or making them feel ‘guilty.'”  She cites a study in which mothers of preemies who were encouraged to breastfeed stated that they didn’t feel coerced or pressured.  One mother who was not informed of the importance of breastfeeding at the hospital from which she transferred stated, “I think they must have a fake license, I can’t imagine doctors and nurses do not tell mothers that there is a difference when a baby is fed their mother’s milk.”  Several studies show that when mothers who had not intended to breastfeed learn of the importance of breastfeeding and breastmilk, they overwhelmingly choose to provide milk for their preterm babies, and later report being glad that they did.

Emphasis on breastmilk, but not breastfeeding.  A common lament of nursing moms in the NICU is that health care providers were, “really supportive of breastmilk, but not very supportive of breastfeeding.”  Mothers may hear that breastmilk is important, but get poor help establishing breastfeeding with their preterm baby – a process which is often very challenging and often requires long term, skilled assistance and support.

This doesn’t have to be the case.  In Breastfeeding Answers Made Simple, Nancy Mohrbacher describes the difference between Sweden and the U.S. regarding breastfeeding in the NICU.  In Sweden, “where breastfeeding is the norm, many NICUs consider parents their preterm baby’s primary caregivers and encourage them to be active in all aspects of their baby’s care.  They also promote early breastfeeding as a developmental skill to be facilitated.  As a result, many preterm babies are exclusively breastfeeding at much earlier gestational ages than they are in the U.S.”

In contrast, Mohrbacher writes, mothers in the U.S. “are seen primarily as providers of milk because it is widely believed that preterm babies are incapable of breastfeeding effectively.  The goal is for the babies to gain enough weight to be discharged as soon as possible, and to accomplish this, bottle-feeding is often suggested.  In some U.S. NICUs, expressed milk is valued as a ‘medicine’ for the baby and others efforts to express milk are a priority.  In the U.S., exclusive breastfeeding of preterm babies before discharge is unusual.”

Lack of access to lactation support. The breastfeeding support needs of babies in the NICU are far greater than of the typical healthy, full term infants.  Lactation consultants have a key role to play in helping mothers establish both breastfeeding and milk supply and encouraging mothers to provide milk for their babies (a function demonstrated to be wildly successful).  But mothers often find that there are no or few lactation consultants to be found there.  This, despite research showing that “among mothers of infants admitted to the NICU, breastfeeding rates among mothers who delivered at hospitals with an IBCLC were nearly 50% compared with 36.9% among mothers who delivered at hospitals without an IBCLC.”

Poor help establishing milk supply.  Establishing a milk supply sufficient to meet a preterm baby’s needs can be very challenging, especially when the only form of stimulation comes from a breastpump.  Mothers deserve expert help in this area, but many report receiving little help.  This is a key support role lactation consultants can play, but as noted above, they aren’t always available.

Lack of access to donor milk.  Donor milk is a lifeline to preterm babies whose mothers can’t provide them enough of their own milk.  Roughly one in ten preterm babies will contract a life-threatening case of NEC (see above), and UNICEF estimates that “donor milk reduces the risk of NEC (described above) by about 79%.  Donor milk also reduces the risk of late onset sepsis, another life threatening condition.  The good news is that more and more hospitals are making the use of donor milk the standard of care for certain babies (often under 30 weeks gestation and weighing under 1500 grams).  This means that parents at these hospitals (unless they refuse) have access to safe, life-saving human milk at the hospital’s expense.  The bad news is that for too many parents, donor milk is either not used in their NICU, or if it is, they can’t get their insurance companies to cover for it.  This, despite the fact that a typical baby’s use of donor milk totals a few thousand dollars and case of surgical NEC can cost up to $350,000.  At $3-4 an ounce, donor milk is out of financial reach for just about all families.  Neonatologists who understand the value of donor milk may try valiantly to obtain insurance coverage for it, but they are often unsuccessful.  I have hope that this will change in the coming years, but for families unable to obtain donor milk now, that’s obviously of little comfort.

Poor “post discharge” support. Most parents can’t wait for the day that their baby is “sprung” from the NICU.  But once home, many find that they’re treated, as far as breastfeeding goes, like any other new mom, when they require a lot more assistance.  One lactation consultant I know tells me that much of her practice is devoted to desperate parents of NICU graduates who are still struggling with breastfeeding.  Better follow up and coordination with community resources is needed for these families.

There are most certainly other barriers for moms of babies in the NICU, including lack of private space to pump or breastfeed, lukewarm support for skin-to-skin, and poor coordination between hospitals and providers.

There are also examples of hospitals making remarkable strides in supporting breastfeeding in the NICU, and I hope to profile one soon.  In the meantime, we’d love to hear about your experiences with Booby Traps in the hospital.

Was your baby in the NICU?  Did you experience any of these Booby Traps?  Are there others which we’ve missed?

Image credit:  Wikimedia Commons

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48 Comments | Last revised on 04/11/2012

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