From a Mother of a Premie: Light at the End of the Tunnel

www.mybreastfeeding.com: The website of Sylvia J. Boyd, PT, LCCE, IBCLC, CLE, Lamaze certified childbirth educator and lactation consultant. Her specialty is in using her physical therapy skills to help babies latch-on & breastfeed successfully since 1967. She also enjoys teaching several Prenatal Classes in Hayward, CA.

Benjamin Aviel was born on July 5 by Cesarean section. He was 6 weeks premature and he was breech. He is my first child and my husband Danny's third. He was a very planned for and wanted child.

While in the ICU, Benjamin had a tube inserted into his nose that was a feeding tube. He was on oxygen for about 4 or 5 days after birth because he had a small perforation in his lung. It healed as the doctor said it would (they monitored it through x-rays). The feeding tube was there because a premie born 6 weeks early is most likely going to have difficulty with any kind of nipple feeding (breast or bottle) so this is the primary way to get nutrition until they are strong enough to suckle. Benjamin actually pulled the feeding tube out of his nose himself 3 times! He was in an incubator for the first week of his life to help him regulate his body temperature. He also had a slight bout of jaundice and had to have photo-therapy for about 4 days. I am learning that premies born before 37 weeks are still developing and maturing certain systems in their bodies: autonomic nervous system, respiratory system, etc., and they have difficulty regulating these on their own. They even have difficulty regulating visceral functions on their own, such as heart rate, not to mention being able to "organize" the information from the environment which our bodies take in constantly, such as visual, auditory, and olfactory stimuli. Therefore, our baby can become overstimulated and stressed if there is too much sensory information. We have learned settling techniques such as swaddling, (keeping the arms secure near the midline of their bodies so they can stabilize.) This technique mimics the sense of being in the womb and is not only comforting for baby, it helps them to gain stability so energy is not wasted trying to come back to normal and the energy can then be used to further develop their bodily systems. Also, one thing I did not realize is the importance of sleep for premies. It is during deep sleep and even light sleep that their nervous system is organizing itself and maturing. This is actually when they are getting the most "work" done and is imperative for growth and development. They say not to wake a premie up if you can help it, unless a medical intervention is necessary, or the infant needs to eat after a certain amount of time has past.

I was amazed at how much the needs of my little baby mirrored the needs of special needs children, whom I have experience working with. I have worked with kids who have autism for over 4 years. The sensory needs that children with autism and premature babies have are somewhat similar. The need to channel or focus energy on the most pressing task at any given time, such as in taking in sensory information and learning how to organize it is present in both premies and children who have autism spectrum disorder. It is good to prevent overstimulation in both populations. Additionally, many settling techniques are the same (such as being in an enclosed space or blocking out bright lighting to help with calming.) In children with autism this is part of what is referred to as a "sensory diet". These are some of the similarities I have seen and I have been able to draw upon my experiences as well as the information the medical staff has given us in order to assess what my baby needs at any given time and give the appropriate intervention.

Benjamin first got an inkling to nurse the first time I held him outside of his isolette, which was about the 3rd day after birth. His daddy said "I think he's yawning", but the yawning didn't end, it was actually his rooting reflex behaviors. He was looking for the breast! So we tried and he latched on for a few seconds. It took several days and some more strength and development in him before he was able to stay latched without tiring out or becoming distracted or overstimulated. Now he is able to latch on and nurse for up to 40 minutes. Until very recently he was not getting the minimum requirement from the breast consistently enough to keep gaining weight, so they were supplementing with bottle feeding and gavage (feeding tube) until he was able to get all nutrients solely through nipple feeding without supplementing with the tube. After he was able to do this for 48 hours, he could go home.

Practicing skin to skin contact has helped us with helping our baby to destress after a particularly difficult feeding session or to help him learn to breastfeed well. It also helped him to regulate his breathing and heart rate, not to mention contributed to the parent/child bond which is so crucial in early infanthood. We saw it as a chance to somehow compensate for the difficult clinical beginning our son had.

Regarding having a premie and wishing I knew what to expect: I guess I didn't anticipate the emotional turmoil I would go through seeing my baby hooked up to all kinds of tubes and machines and the roller coaster of emotions I would experience as he made some little progress as well as some inevitable setbacks. No one wants to see their little one receive so many medical interventions just to be able to survive. And no one likes the idea that when their infant cries in the middle of the night, it is a paid hospital staff person (as wonderfully competent and dedicated as they are!) rather than you, the parent, that comforts them. Throw in some post-partum hormones and a lack of sleep and what a wonderful emotional concoction you have!

I was also surprised at the amount of time the baby had to remain in the newborn ICU.
I always thought that if a baby's lungs were able to function, that he or she could go home. This did not turn out to be the case. There were other issues that had to be worked out before discharge.

But there is light at the end of the tunnel and as a new parent, I feel very encouraged when my child makes tiny steps of progress toward being well outside of the ICU. It foreshadows the role I am dedicated to playing for the next 18 or so years: that of cheerleader to a precious little person who needs me.

Vesteen

Danny doing the gavage feeding before Ben was able to nipple feed exclusively.

We became good at hooking and unhooking all kinds of different wires and tubes.

Biggest challenge was changing his diaper with 4 wires hooked up to his squirming little body.

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From a Mother of a Premie:

Light at the End of the Tunnel

On the Benefits of Skin to Skin:

My husband and I have found that doing skin to skin contact, or what's called "Kangaroo Care" with our premie, has sped up both my healing from a C-section birth, as well as helped to advance our son's growth and breastfeeding progress. Our son had a small perforation in his lung which healed quickly. Additionally, before he could really latch on to the breast well, through practicing skin to skin, he was able to learn my smell, my touch, and he was prompted to practice his rooting reflex, which led to a successful start in breastfeeding. We credit skin to skin with the quick recovery our 6-week-early baby has made.