Breastfeeding Special Babies In Special Circumstances - Article One

Breastfeeding is even more important for babies with special needs and their parents. Breastfeeding gives you a higher level of maternal hormones, which increase your intuition and perseverance to meet the needs of your special baby. Because of its physical, psychological, and medical benefits, breastfeeding is even more important for these babies. A baby has special needs. Parents develop a style of caring for their baby and in so doing elevate their level of intuition and sensitivity toward their baby to match the level of baby's needs. Let's discuss the most common situations in which babies with needs in unique situations bring out a special kind of parenting.

The Cesarean-Birthed Baby
Following a surgical birth a breastfeeding mother has double job: healing herself and nurturing her baby. Here's how to do both:

* Ask the lactation consultant in the maternity unit to show you the side-lying position and the clutch hold for breastfeeding. These positions keep baby's weight off your incision.

* If you would rather sit up to nurse your baby, sit in a straight-backed armchair rather than in your hospital bed. This is easier on your abdominal muscles. Use pillows along your side to bring baby up to breast height and to protect your incision.

* Be sure that dad observes how the professionals help you position yourself and your baby for comfort and for correct breastfeeding technique so that he can take over this role when you go home. Ask hem to instruct dad on holding baby's lower jaw down and everting baby's lip outward, since it may be uncomfortable for you to bend over to see how baby is latching on.

* Take whatever pain medications you need to be comfortable. Pain suppresses milk production and interferes with your milk-ejection reflex. The usual medications used for post-op pain are safe, since very little goes into your milk.

* If post-operative complications prevent breastfeeding for a day or two, father or a nurse can give formula, but preferably not by bottle. Cup feeding or finger feeding with a syringe or a supplementor is better than using a bottle, which may lead to nipple confusion.

* Breastfeed your baby frequently, night and day. Studies have shown that it may take longer for a mother's milk to come in after a cesarean birth. Frequent feeding will build up your milk supply more quickly. If baby is not breastfeeding yet, you need to begin pumping your breasts as soon as possible so that your baby can benefit from your colostrum produced during this time, and so you will have an ample milk supply when baby does start breastfeeding.

* Baby should room-in with you as soon as possible. Because of post-operative sedation this is usually discouraged for cesarean mothers. It is still advised to room-in if someone can stay with you to help care for the baby.

Be patient. It takes more time, support, and perseverance to achieve a successful breastfeeding relationship following an operation. Some of the energy that would otherwise go toward breastfeeding is shared with healing your own body. Breastfeeding harmony will come, though not as easily or quickly.

The Premature Baby
These special babies have special needs for extra nutrition and comfort. Here is where the breastfeeding mother shines. The recent advances of newborn intensive care have increased the chances of taking home a healthy baby, but the same technology that is saving more babies has, by its very definition, displaced the mother. But you are an indispensable part of the medical team.

Supermilk!
A premature baby has an even greater need for mother's milk. Premature babies need more proteins and calories for catch-up growth. Researchers have discovered that the milk of mothers who deliver preterm babies is higher in proteins and calories -- a vivid testimony to how the milk of a species changes to ensure the survival of the young of that species. Supermilk for early babies -- how exciting!

While the nutritional benefits of breastfeeding are important for premature babies, the immunological benefits are even more critical. Breast milk protects these babies against bacteria and viruses that their own immune systems cannot cope with. In addition, human milk is the perfect first feeding for immature gastrointestinal tracts. Human milk offers protection against necrotizing enterocolities, a life-threatening bowel disease that affects premature babies. Your baby's neonatologist may order that baby's diet of human milk be fortified or supplemented with a commercial product. This is because in order to grow as they did in the womb, very young preemies may need larger amounts of some nutrients than mother's milk can provide. But this does not mean that mother's milk should not be used also. Human milk provides premature babies with important health and developmental benefits unavailable in commercial formulas and fortifiers.

It used to be the policy in most newborn intensive care units not to let premature babies breastfeed until after baby was able to tolerate bottle feedings. Research has shown that premature babies actually do better with breastfeeding than bottle feeding, and that the ability to breastfeed precedes the ability to bottle feed. Researchers found that a breastfeeding baby sucks and swallows in a burst-and-pause rhythm that uses less energy than the less rhythmic bottle feeding. The found that breastfeeding babies actually grew better and had fewer stop-breathing episodes and tired less during breastfeeding than with bottle feeding. Not only is breast milk superior for premature babies, so is the way it is delivered.

What Mother Can Do
To understand your important role in the care of your premature infant, let's go through the usual case of the premature baby whose breathing is stable but who is in the intensive care unit for "growing." Here are some care-by-mother steps to consider.

Practice kangaroo care.
One way that a breastfeeding mother can join the medical team is through an innovation called kangaroo care -- an affectionate nickname derived from the method's similarity to the kangaroo pouch and the easy self-feeding of the premature baby kangaroo. Research by Dr. Gene Cranston Anderson at Case Western Reserve in Cleveland has shown that preemies receiving kangaroo care gain weight faster, have fewer stop-breathing episodes, and experience a shorter hospital stay.

Using a baby sling, mother wears her diaper-clad baby skin to skin on or between her breasts The combination of mother's warm body, warm blankets, and mother's clothing keeps the premature baby toasty. Many premature babies initially react to this comfortable environment by falling asleep and sleeping more peacefully tan in their high-tech cribs. When baby awakens, the closeness to mother's breasts stimulates baby to feed as his little stomach requires -- a system called self-regulatory feeding. Live at the side of your bay's incubator and sit in a rocking chair with baby wrapped skin to skin at your breasts. Unless your baby must be attached to medical instruments, walk around while wearing your baby. Even more than rocking in the chair, the rhythm of walking helps baby breathe more regularly because, presumably, this is a pattern he had been used to in your womb. Kangaroo-cared-for babies cry less. Because it wastes oxygen and energy, excessive crying can keep premature babies from growing optimally. Breastfeeding, kangaroo care, holing and rocking, and wearing your baby lessen crying and speed growth.

Besides being good for babies, there is something in kangaroo care for mothers, too. The closeness of baby nestling on the breasts triggers the mothering and milk-producing hormones. Mothers who are invited to participate in kangaroo care are more inclined to breastfeed, produce more milk, and breastfeed longer. They develop a deeper attachment to their infants, feel more confident about their mothering skills, and feel a valuable part of the newborn intensive care team.

Newborn specialists believe that one main reason kangaroo care helps premature babies thrive is that mother acts as a breathing pacemaker for her premature infant. Preterm babies have frequent stop-breathing episodes, called apnea, which contribute to these babies' slow growth and even slower departure from the hospital. You probably never thought of yourself as a breathing machine, but picture this: Baby is snuggled comfortably against your chest, his ear over your heart. You have a rhythm in your breathing and your heart rate, and your baby senses it. The rhythm of your breathing, your heartbeat, your voice, which baby was accustomed to hearing in utero, and even the warm air flowing from your nose onto baby's scalp at each breath are translated into breathing stimuli for your baby, as if reminding the forgetful premature to breathe. Attached babies catch the rhythm of their parents.

Pump your milk.
Rent an electric breast pump and start pumping your milk as soon as possible after birth. Store this milk and begin giving your baby your milk as soon as baby is medically able to take it by whatever method works best.

Ask for help.
Seek assistance from a lactation consultant who will show you special techniques to help your premature baby latch on correctly and suck efficiently.

Avoid the bottle.
Ask the nursing staff to feed your baby with a cup, syringe, or a finger-feeding system (as discussed in my article, "Breastfeeding Helpers.") instead of with bottles and artificial nipples. Another alternative is to continue tube feeding while your baby learns to nurse at the breast. Some premature babies do not experience nipple confusion and eagerly advance from bottle to breast. Otherwise are prone to nipple confusion, so avoid the bottle stage unless medically necessary. When you take your baby home from the hospital you may need to continue to offer supplements for a week or two.

Ease baby on.
Instead of pulling your baby in very close with a rapid movement, as you would to latch a term baby onto your breast, it's better to ease the breasts into the premature baby's mouth. Use the compress-and-stuff technique. With your hand shaped like a C (thumb on top and fingers beneath the breast), cup your breast well behind the areola. Compress the breast, tease baby's mouth open wide, and gradually ease the "areola sandwich" into baby's mouth.

Forget the clock.
The concept of schedule has little meaning for term babies and none for premature. Expect your baby to suck weakly, feed slowly, tire quickly, and fall asleep frequently during the feedings. (They do this with bottle feeding, too.) Preterm babies tire more easily, need more calories for catch-up growth, and have small tummies. This is why they need small, frequent feedings. Premature babies have more bizarre sleep-and-wake cycles, so that every mother-baby pair must work out a feeding pattern that gets the most milk into the baby without tiring him out.

No More, Please, I'm Tired!
It is important not to jostle and tire premature babies, and others with medical problems, by becoming too enthusiastic and vigorous with feedings, lest babies burn more energy than they take in during feeding and consequently grow too slowly. Watch for cues (flutter-type sucking and drifting off to sleep) that baby has had enough. Ease baby off your breast, but be ready to feed again in a couple of hours, or even sooner.

The Ill or Hospitalized Baby
Breastfeeding is good medicine. Besides helping preemies thrive, the breastfeeding mother is a valuable part of the medical tem if her baby is ill, particularly if he is hospitalized. When a baby is in the hospital, it is a good practice to encourage care by parents. It seems babies get better more quickly, and parents feel involved as part of the team. The more involved they are, the better they understand the nature of the illness and the methods of treatment.

Breastfeeding is particularly valuable to infants who are hospitalized for breathing problems such as croup or bronchitis. In these conditions, the more upset baby is, the more the breathing is upset. Relaxing baby also helps relax the breathing. Here is a story of a one-year-old boy and his breastfeeding mother. Early one morning the baby awakened barking like a seal and having difficulty breathing. The baby was hospitalized for treatment of croup, but his condition worsened. The baby was in a vicious cycle--the more difficulty he had breathing, the more anxious he got, which further aggravated his breathing. The mother was told that unless the baby relaxed, his condition would deteriorate, and we would have to do a tracheotomy (surgically open his windpipe below the inflamed vocal cords so that he could breathe more air). Without taking a breath the mother volunteered, "I'll relax him" and she did! Through the opening in the baby's oxygen tent came the mother's breast, along with soothing words of encouragement and a familiar touch from someone who cared enough to give her child the very best. The baby listened, looked, and sucked. Immediately he relaxed and breathed better. The Doctor relaxed, mother relaxed, and so did the surgeon, waiting with his lifesaving instruments. The baby got the ultimate pacifier.

During and illness babies often regress to a more primitive and familiar pattern of self-comforting, such as thumb-sucking and curling up like a fetus. Being breastfed while sick lessens the anxiety of being in the hospital by helping the infant latch on to a comfortable and pleasurable pattern that he has learned to love and trust.

Breastfeeding is also valuable for the infant who has a diarrheal illness from inflamed intestine (called gastroenteritis). These infants may not tolerate commercially prepared formula, but they generally can tolerate breast milk. It has been shown that many infants with gastroenteritis continue to breastfeed without aggravating the diarrhea or getting dehydrated; whereas their formal-feeding friends with the same illness often wind up in the hospital with dehydration and need intravenous feedings. Chalk up another bonus for mother's milk. And the very act of sucking is very comforting to a baby who doesn't understand why she feels so crummy.

Breastfeeding Helps Hearts
Babies are born with heart defects (called congenital heart disease, or CHD) have one of two problems: They may have too much blood flowing to their lungs, causing overload on the heart and resulting in heart failure. Or they may not have enough blood flowing to their lungs, resulting in cyanosis (blueness); a baby with this condition is termed a "blue baby." In both of these conditions babies with CHD tire easily during feedings and grow more slowly. Years ago, breastfeeding a baby with CHD was discouraged because it was erroneously thought that breastfeeding would tire these babies out. As was discussed for premature babies, research has shown the opposite. These babies may actually use less energy and breathe more efficiently during breastfeeding than bottle feeding. Breast milk contains less salt than formula, so it is better for babies who are prone to heart failure. The same suggestions recommended for feeding premature babies apply to feeding babies with CHD; small, frequent feedings, often with a supplementer system, and large doses of patience.

There will be more articles on breastfeeding, raising baby and other related topics so be sure to keep an eye out for my articles.