Premature Arrival
Yehudit Sherman
San Diego CA USA
From: NEW BEGINNINGS, Vol. 20 No. 3, May-June 2003, p. 98
My wondrous, problem-free
pregnancy went quickly downhill when my blood pressure suddenly, inexplicably
shot up at six months. By 32 weeks, my preeclampsia had progressed to
HELLP syndrome, which is a rare condition of pregnancy that can cause
liver failure. HELLP stands for Hemolysis, Elevated liver enzyme levels,
Low Platelet count. HELLP stands for Hemolysis, Elevated liver, Low
platelet. The doctors apologized for my situation being too grave for
induction and told me I needed an immediate cesarean section. I told
them that there was no need to apologize. I knew that I could not last
much longer. I was experiencing both agonizing liver pain and contractions.
Apparently my body was making a last-ditch effort to save itself and
was thus trying to expel whatever was expendable: my baby. For the only
time in our four years together I saw fear on my husband's face.
As the situation avalanched,
at each point I asked, "Will this affect my ability to breastfeed?"
While each decision needed to be made in haste, I was determined to
have the staff investigate alternatives to anything that might preclude
my ability to breastfeed. They were sufficiently knowledgeable on the
effects of each medication and procedure, and I was relieved that none
would adversely affect breastfeeding.
When my daughter emerged
she cried! Such a promising sign for a 32-week infant! But they almost
forgot to let me see her as they whisked her away to neonatal intensive
care.
Instead of dropping into
the dead sleep that I had craved, I was energized! And, I was obsessed.
"When do I need to start pumping in order to ensure that my milk
comes in?" I don't know whether anyone had the answer, but I knew
I needed to start pumping as soon as possible. My daughter was born
at 8 pm, and some time in the middle of the night I was pumping. The
result, less than one milliliter of liquid, was disappointing, but I
was assured that this was normal. My nurse rushed it over to the neonatal
intensive care unit (NICU), and we repeated this every three hours.
When she was ready for a gastronasal tube, my milk was the only thing
that my daughter was ever fed in the hospital.
To know that I was producing
milk was a great relief, but the adventure had only started. When I
was moved a few days later to a less-critical care ward, the pump available
there caused me so much pain that I couldn't imagine any mother with
ambivalence toward breastfeeding sticking with such a horrible endeavor.
I should have asked for a different pump, but I felt lucky enough to
get the only one on the unit.
If I hadn't initiated the
pumping effort, I don't know whether anyone would have come to me and
suggested that I start and maintain my milk supply. But there were La
Leche League posters in every room in the midwife and obstetrics clinics,
labor and delivery, and the antepartum and postpartum wards. "An
awake baby is a hungry baby; please call your nurse for help with breastfeeding,"
was posted in every room. A couple of weeks later, I heard one of the
NICU nurses counseling a very new, very young mother to start pumping.
I don't think that the young lady had ever thought of breastfeeding.
The NICU had a comfortable pumping/nursing room with rocking chairs
donated by grateful parents. Two lactation consultants were always on
duty, and several of the neonatal nurses also specialized in lactation.
Military medicine can have a bad reputation, but having since heard
the experiences of women who gave birth elsewhere and were discouraged
from nursing, it is clear that the naval medical center where I gave
birth is very forward-thinking in terms of breastfeeding support and
postpartum care.
A week to 10 days later,
Tikvah (which is "Hope" in English) was ready for my nipple.
We were fortunate that a nurse with patience and experience helped me
learn to nurse and to help Tikvah latch on. I sat next to her "crib"
behind a screen (made by another grateful mother) with all her wires
dangling and tangled. Although Tikvah latched on, it was hard for me
to hold and position her properly. She frequently let go and jerked
her head wildly from side to side. It was hard to watch. I was glad
that my husband, who worked at the hospital and thus came by to smile
at our daughter many times a day, was not there to see our distress.
For the next 10 to 14 days
I nursed Tikvah just twice a day and pumped the rest. As long as bottle
feedings of my pumped milk did not outnumber nursings, I thought we
would be okay. Recovering from HELLP, making two trips to the hospital
each day, spending two to four hours at each visit, and pumping every
two to three hours consumed all of the energy that I possessed. Most
of the time we had to go through 10 to 15 minutes of trying to wake
Tikvah enough to nurse, and then she would fall back asleep after just
a few minutes. To me, she seemed to be nursing fine and was content
to sleep on me. The NICU staff wanted to feed her as much as possible
to keep her gaining enough weight to go home. After all, she had been
born just under four pounds and had dropped to almost three pounds.
I found that by working with the nurses and letting them know how much
I appreciated them, they were always happy to see me and made a special
effort to work with me. Some days Tikvah nursed well. Some days she
practically didn't latch on at all. I was excited and then frustrated,
even despondent. Then suddenly one day Tikvah, no longer a critical
case, was no longer receiving the care of the most experienced nurses.
She was taking almost all of her feedings from breast or bottle. And
my feelings of gentle acceptance ended when a substitute nurse, following
a feeding, took Tikvah from me and topped her off with a bottle!
I talked to the lactation
supervisor, and she immediately wrote on Tikvah's chart that my baby
was not to receive supplementation. The next day, we were ready to leave
the hospital an hour after a small nursing when Tikvah started screaming
for the first time! We were rushed to the nursing room, and Tikvah breastfed
for twenty minutes straight. I was euphoric! This was how it was supposed
to work and how it would work at home. When she was hungry enough, Tikvah
would awaken and nurse.
The next day the hospital
staff sent Tikvah home with us. She did not meet absolutely all of their
technical requirements for release. But by this time I had learned that
the NICU staff also gauged when the parents were ready, and we were.
My husband was always enthusiastic
about my breastfeeding our daughter. When I first tried to nurse lying
down but found that I did not have enough hands to make it work, he
was so proud that he could latch Tikvah on in the middle of the night.
He was always eager to bring pillows, towels, water, pads, or whatever
else I didn't realize I would need until Tikvah was nursing away and
I couldn't get up.
Tikvah is now 21 months old. Her "premie" status is apparent
only to other parents of premature babies, her petite size the only
difference between her and full-term children. We are still nursing
several times a day.
Last updated Tuesday, October 24, 2006 by njb.
Page last edited Sun Oct 14 09:29:56 UTC 2007.
