We are NICU nurses. What an incredible job with a plethora of mixed emotions depending on the situation.
We think ABC’s first, and rightly so … Airway, Breathing, Circulation. As important as the ABC’s sound and most definitely are, I’d like to talk about how important it is for us, as nurses, to advocate for breastfeeding or pumping, or a combination of the two. This is important for both mother and baby.
I, like most NICU nurses, sometimes dreaded receiving a report and hearing, “This mom will be here to breastfeed for the first time at 8:00 am.” It had nothing to do with not wanting to help a mom breastfeed, but it was the time I assumed it was going to take.
I honestly enjoyed helping a mother breastfeed her baby. At the same time, though, I had “tasks” I had to complete. Whatever emergency or change arose during my 12-hour shift, I needed to be prepared to efficiently take on that task without a multitude of other tasks and/or charting left behind. I had a baby on a ventilator who required fluid changes, but now I have a mom who needs help breastfeeding. It’s going to have to wait, right?
I’ve been there. I understand, I promise.
My hope here is to not discourage you or tell you that you are not doing enough, but to encourage you and remind you about doing what you can to help provide the very best medicine to a baby – their mother’s own milk. Not only that, but providing much needed encouragement and “medicine” to a mother – the feeling that she is adequate and she is doing what she can to provide for her baby.
A mother’s preconceived notions
It’s the norm for a mom to have a preconceived idea about how breastfeeding will go. She dreams about the beautiful, healthy baby she will place skin-to-skin. She assumes that nature will follow course, and the infant will breastfeed, then become sleepy and satisfied afterwards. This will help her feel a sense of accomplishment, knowing she’s provided something only she can provide. Her preconceived idea could be based on a number of things, such as a movie she has seen or a friend’s experience.
A full-term baby who has struggles with breastfeeding is difficult enough. A NICU baby who has been whisked away while the mother is left with a breast pump is traumatic.
This crushed “dream” can carry over into her entire view of how satisfied she is with her experience. Yes, the dreaded “patient satisfaction” scores come into play.
Our attitudes and the amount of support given to the parents can have a positive or negative impact on a mother’s overall view of the hospital, and ultimately her decision to breastfeed in the NICU. It can also have a great impact on her confidence in her ability to breastfeed her preterm/sick infant.¹
With that said, if I can make a difference in a handful of nurses and how they view breastfeeding or pumping, I will feel successful.
As I’ve said a multitude of times, I would never view breastfeeding and/or human milk (HM) the way I used to. There are so many incredible differences HM can make in the life of not only an infant, but their mother as well (see a blog I recently wrote, How Human Milk Can Reduce the Devastating Impact of NEC).
HM reduces the incidence of late-onset sepsis, chronic lung disease, retinopathy of prematurity, and is associated with decreased lengths of stay. The natural immunity a mother’s milk can provide makes a substantial difference in the life of her child. Improved myelination of neurons via docosahexaenoic acid and improved mother-infant bonding via oxytocin are critical.²
Research has shown that mothers who are able to provide developmentally appropriate interactions with their premature/sick infants had a significantly higher rate of breastfeeding at 8 weeks after birth. The separation of parents from their baby in the NICU, combined with parental mental health issues such as depression, post-traumatic stress disorder, anxiety, and other stress-related conditions can adversely affect the parent–baby relationship, resulting in adverse outcomes for the baby’s social and emotional development, and behavioral and cognitive functioning. This separation may also put the preterm baby, especially the very low birth weight baby, at risk for abuse following hospital discharge.³
A study done by Maastrup et all identified that 95% of preterm infants who were discharged exclusively breastfeeding received their first oral feed directly at the breast.² Even if the mother is unable to provide the first oral feed at breast, if she breastfeeds several times a day, there is a greater likelihood she will still be providing some breast milk at discharge. Helping to facilitate the first oral feed at breast may be important to the overall long-term infant outcomes.
We can make a difference
So, now, as a NICU nurse, I hope you can see that the daunting task of helping a mother breastfeed for the first time and/or advocating for and supporting her through her difficult journey with a premature/sick infant can make a huge difference in the life of a mother-infant dyad.
The National Association of Neonatal Nurses (NANN) encourages all neonatal nurses to provide mothers of critically ill newborns with the education, support, and encouragement needed to provide human milk for their infant.⁴
Many studies have looked at how our caregiving influences patient outcomes. More research needs to be done about the influence of the environment on the nurses, which inevitably impacts patient outcomes. We need to explore NICU staff experiences, their struggle working in difficult conditions, job pressure, and strategies that could help overcome these challenging situations.¹
Let’s start by focusing on a few things that are easy to quickly discuss at the bedside. These will help engage mom and make her feel you are there to support her breastfeeding journey.
- Ensure she starts pumping with a hospital-grade (multi-user) double electric breast pump with Initiation Technology™ within 1-3 hours after delivery.
- Ensure she has been given the option of renting a hospital-grade (multi-user) double electric breast pump.
- Ensure she understands she needs to be pumping at least every 3 hours.
- Offer her the opportunity to pump at her baby’s bedside.
- Allow mom to provide oral care with her colostrum as she is able.
- Ask what her goals for breastfeeding/pumping are.
- Ask her if she would like her baby to be put to breast when it is time for the very first oral feeding. Explain to her the importance of this. If so, make sure this is passed along in report.
- Encourage her.
I know there were shifts I spent a great amount of time helping a mother breastfeed. That time included a lot of encouragement. No, I wasn’t bagging a baby, I wasn’t changing arterial line fluids, and I wasn’t calculating a dopamine drip.
But I like to believe I was still making a difference in the long-term outcome of a baby, and the perspective a mom had of herself about her ability to care for her very fragile infant that she may feel she has failed in the first place.
- Shattnawi, K. (2017). Healthcare Professionals’ Attitudes and Practices in Supporting and Promoting the Breastfeeding of Preterm Infants in NICUs. Advances in Neonatal Care (2017), 17(5):390-399.
- Casavant, S., McGrath, J., Burke, G., & Briere, C. (2015). Caregiving Factors Affecting Breastfeeding Duration Within a Neonatal Intensive Care Unit. Advances in Neonatal Care, 15(6):421-428
- Craig, J., Glick, C., Phillips, R., Hall, S., Smith, J., & Brown, J. (2015). Recommendations for Involving Family in the Developmental Care of the NICU baby. Journal of Perinatology, 35, S5-S8. doi:10.1038/jp.2015.142
- “Position Statement on The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit #3065.” National Association of Neonatal Nurses. (2015) http://nann.org/uploads/About/PositionPDFS/1.4.3_Use%20%20of%20Human%20Milk%20and%20Breastfeeding%20in%20the%20NICU.pdf