While in the NICU we were introduced to the many different ways nurses get nutrients into premature babies. Baby E got the gamut, as he was a wimpy white boy and also took his sweet time figuring out just how to eat.
Gavage feeding, or feeding via naso/orogastric tubes
Tubes! A quick way to get food into your baby! Baby E had an orogastric (or oral-gastric?) tube for the first couple of days, which means they ran a tube from his mouth to his stomach and fed him with a small syringe. By the time I first met him the docs and nurses had switched him to a nose tube. Some babies in the NICU received formula this way, others breastmilk, others a combination. While the nurses had me pumping breastmilk almost immediately after delivery, I wasn’t able to get it to Baby E immediately, since he was an hour away and I had to spend the next two days in recovery. So he started on formula — and whatever other supplemental nutrients they give premature babies. Two days later A. and I brought the fruits of my labor to the hospital and Baby E got to finally have his colostrum. Through his nose, yes, but he got it!
The “gavage” feeding was a gravity feeding. We watched the nurses do it, and after a while they showed us how, so that we could complete the procedure from start to finish without assistance. Obviously you don’t want to try this at home without professional training — I’m sure I’m leaving something out, but these were the basic steps.
Step one: warm the milk.
Step two: pour desired amount of milk into a plastic graduated syringe. The syringe will not release milk unless you apply air pressure at the top/open end.
Step three: attach syringe to the end of nose tube.
Step four: apply a little light pressure with the syringe plunger to get the milk moving. Hold the syringe high enough so that gravity pushes the milk down slowly. If the milk moves too fast or the baby seems to be having trouble taking it in, lower the syringe below the level of the nose tube, enough so that the milk stops flowing.
I never saw the nurses feed Baby E through the oral tube, so I’m not sure whether or not it was different.
Needless to say, it was depressing to snuggle him close while trying to avoid bumping the plastic tube taped to his face. He pulled it out a couple of times. And it was sad to watch him take the nose feeding, though the act of receiving food didn’t seem to cause him great discomfort. He seemed so helpless and fragile and just not ready to do more than lie back and receive sustenance. After a while I finally got it through my head that if this was the way he would get strong, then we’d just have to do it this way.
Baby E took a looooong time to take a decent amount from a bottle. Even after he moved from the main NICU room to the “Feeder-Grower” floor (a nicer and quieter NICU level near the PICU or Pediatric Intensive Care Unit), he still had trouble getting more than 20-30 ccs from a bottle. We’d made equal or better headway with breastfeeding at that point. But we took it slowly. He used a low-flow nipple that required him to work harder to get the milk out. We stroked his cheeks and jaw to show him what muscles to use (though he probably thought why are they touching my face? I’m trying to EAT, goddamnit, stop touching my face!) and switched to the gavage feeding when he got exhausted by the bottle.
On the Breast, with the Shield
I had three different lactation consultants. The first was a nurse at our home hospital’s Labor & Delivery. She taught the breastfeeding class, and helped me with pumping and milk storage tips. The next two were both at the larger hospital where Baby E spent time in the NICU. They gave me lots of tips about nursing with a nipple shield, which was what Baby E needed early on. A nipple shield is a floppy silicone cover shaped like a tiny witch hat that you slap over your nipple, thus transforming it into an easily-suckable bottle top. However, it limits the amount of milk your baby is able to get from you. I can’t remember why. Probably because it’s a barrier, and blocks both the amount of suction/stimulation your baby can produce and the amount of milk that gets through. But it was an amazing tool. It got us started during a time when I didn’t think Baby E would ever latch on properly.
One of the NICU nurses was also super helpful with breastfeeding — after a successful latching on, she told me that she’d had a 34-week baby herself, and although it had been tough, she ended up breastfeeding him for 11 months. I don’t know if Baby E and I will go that long (see Devil Pred v. Imuran) but it was great encouragement right when we needed it.
Unfortunately, Baby E couldn’t get enough sustenance from the breast alone, and breastfeeding tuckered him out even more than bottling. We fell into a three-part system: I’d breastfeed, A. would give him a bottle, and then we’d gavage-feed the leftover. With three separate stages to get through, feeding Baby E seemed to take forever. But it was the only way to get the required amount of food into him, every day. We despaired of ever taking him home. We asked the doctor for timelines, for advice. His response:
“Usually it happens around 36 to 38 weeks. It’s like a switch being flipped, or a light turning on. They just figure out how to eat, and that they’re hungry.”
And one day we came in to visit and learned that Baby E was taking all of his food by bottles, and crying for them “on demand.” A few days later we took him home.
Ditching the Shield
I loved using the nipple shield. It was easy for Baby E to grab onto, and it was easy on my nipples. But overall it was a pain: I kept “losing” it like a contact lens (I’d drop it on the floor and have to spend ages feeling around for it, because clear silicone blends in nicely with every floor surface ever), it was another thing to clean, and using it meant pumping supplemental bottles or using formula in addition to the shield. I think they call this the triple-feeding procedure, or something like that. Basically, you breastfeed with the shield, feed the baby a supplemental bottle, and then pump more milk to store for future supplemental bottles. If you have a helpful spouse, they can feed the baby while you pump. It’s fucking exhausting, of course. But really the thing that got us off the shield was my clumsiness: I could not hang on to that thing, and finally, in frustration after having dropped it AGAIN for the NINETY MILLIONTH TIME, I put Baby E right on the breast. It took us about a week, but we went from triple-feeding to just the breast thereafter. It was and is awesome.
Breast is Best?
Okay, it probably is, although the actual research is still out (I refer to this article by Hanna Rosin at The Atlantic) and it’s free. But I admit, I dislike it sometimes. I don’t have a huge surge of closeness with Baby E when we’re feeding, though I do feel proud that he’s eating so well now, and that I’m providing food for him. But keeping supply up now that I’m back at work is a pain. At home, I sometimes have to choose between pumping and sitting down for a meal. At work I pump in a workroom with a DO NOT DISTURB sign on the door. I feel a bit guilty if I miss a feed. I also feel guilty that A. no longer gets to give Baby E as many bottles as he did when we were triple-feeding, which I think was a nice bonding time for them.
All of this is wah-wah, boo-hoo, big deal, I know. But I also worry about the Devil Pred somehow affecting Baby E through breastmilk, though all of the doctors have assured me it’s “safe” and that it doesn’t pass. There’s also the question of being on pred this long. I’m not getting the manic sweaty heebies yet, or throwing popcorn around. But I’d like to switch back to Imuran. Ideally, before any of the fun pred symptoms rear their head. My current plan is to wait till our next appointment, talk to the pediatrician about it, and then start the switch to formula. By then, Baby E will have four months’ worth of breast milk in him, and that might be good enough.
I realize “good enough” is probably not good enough by a lot of people’s standards, but I think I’d rather be a healthier, saner mom off the demon’s pharmaceutical with a baby drinking formula, than stay on it and hope I don’t have any of the horrible (not kid, husband, dog, or other human being-friendly) side effects I did last time, solely to keep breastfeeding. But I’m still thinking about it.
I’m so happy he’s eating without the help of a tube. Let’s leave it at that.