I recently met a mother who had just delivered her baby prematurely. During her pregnancy, she planned to exclusively breastfeed, but because her baby arrived early, he wouldn’t be able to start nursing for several weeks. After the stress of her delivery and having her child admitted to the neonatal intensive care unit (NICU), she went home with a breast pump and not her baby.
This is a common problem when infants are born prematurely or with special health conditions, but at MU Health Care, we have lactation consultants and therapists trained to meet these challenges with expertise and compassion to help babies get off to a healthy start.
As both a speech language pathologist and lactation consultant, I have a dual role in the process.
As a speech language pathologist, I am trained to assess if babies are ready to feed orally and identify possible swallowing problems during breast and bottle feeding. As part of our cue-based feeding program, we meet all babies admitted to the NICU who are born at 34 weeks gestational age or less, as well as infants with special medical conditions that may affect swallowing and breathing. From the first feeding to discharge from the NICU, our team provides regular consultations as babies advance to full oral feeding and away from supplementary tube feeding.
As a lactation consultant, I encourage the first oral feeding to happen at the breast if possible. My dual training means I can evaluate the infant's feeding and swallowing at the breast and help the mom modify her technique. After the first evaluation, I meet regularly with parents to provide support and instructions at each stage. Working closely with the family, we prepare for their transition home with healthy feeding habits.
I enjoy being part of great team of skilled lactation consultants and therapists. I feel best about my work when a family feels fully supported from their admission to the NICU until they are ready to go home. It is an honor to serve families and encourage each small achievement along the way. Together, we build a feeding plan that is safe and personalized to their needs.
There are some challenges. Many times, I have to support families who are making tough decisions about changes to their feeding plans. Building an early relationship with the family and communicating clearly can help them deal with these changes. When an infant's health prevents direct breastfeeding, I work with the family to find other ways of bonding with their child through feeding.
In many cases, breastfeeding is possible with practice and some modifications. These could include position changes to help the baby breathe during feeding, pumping to manage a safe flow rate at the breast, monitoring the infant’s cues to indicate when to start and stop the feeding and the use of specialty feeding aids to help the child learn to breastfeed. While I am currently only seeing patients during their hospital stay, I help navigate outpatient referrals for families to follow up with our feeding and lactation clinics.
Early intervention and collaboration are essential to helping parents give their babies a great start. That was the case with the family I mentioned at the beginning of this article.
I helped mom establish her milk supply with pumping and regular skin-to-skin contact with her baby, and then we started working on early feeding practice. As the baby grew stronger and more stable, he was able to breastfeed more regularly with some modifications and aids. Mom and dad stayed in town so they could learn their son’s cues and provide regular care. Our team worked together to honor the parents’ wishes to breastfeed.
One of the rewards of my job is checking in on our NICU graduates. By the time this boy left the NICU, mom was transitioning off exclusive pumping and feeding her baby with a few modifications and aids. The family is now happy to be home, and the baby is thriving.