PREMATURITY AND PRENATAL SURGERY
Since many babies who undergo prenatal surgery will be born prematurely, mothers who have elected for this procedure should receive guidance on how to prepare for breastfeeding a preterm infant. Many neonatal intensive care units are encouraging kangaroo care and the benefits of skin-to-skin contact will help the baby with the process of learning to breastfeed and increase the mother’s milk supply. Premature infants frequently have difficulty latching and sucking because they lack the fat pads in their cheeks that help fill the space in a full-term baby’s mouth. A nipple shield may help make it easier for the preterm baby to latch onto the nipple and stay latched on. Breast compressions can help increase the milk flow during feeding if the baby’s suck is weak (Weisinger, West, Pitman, 350).
The mother of a spina bifida baby will be exclusively pumping anywhere from a few days to a couple of weeks to bring in and maintain her milk supply since her baby will not be able to feed at the breast shortly before the initial surgery and during recovery. To keep an adequate milk supply, the mother should pump at least 8-12 times a day, with at least one expression at night. Since pumping is not baby driven, short pumping sessions in addition to regular 8-12 expressions will help drive milk production up in a fashion similar to a newborn’s frequent feedings. Exclusive pumping takes a great deal of dedication, but with frequent expressions a mother can maintain an abundant milk supply (Weisinger, West and Pitman, 341). The milk that the mother expresses during this time will be given to her baby in the NICU (often through a gavage tube) and set her supply for future breastfeeding after the baby is released from the hospital. Milk pumped at home should be taken to the hospital in sterile containers and stored in a cooler with ice packs in transit.
Most high level NICU’s will have high quality breast pumps that mothers can use at the hospital or rent and take home. Hand pumps can be used at home as well, and can be convenient for nighttime pumping. The importance of pumping as stimulation to signal the breasts to produce an abundant milk supply can not be underestimated by the mother. Galactagogues like teas and supplements may be helpful in increasing milk supply, however they are not a substitute for regular, frequent pumping and may even be unnecessary for many women (Weisinger, West and Pitman, 355). After the baby is released from the hospital, the mother may still need to pump temporarily to keep her supply if the baby needs additional surgeries for tethered cord or a shunt revision.
Hospital staff may be tempted to look at breastfeeding as something that would be ideal, but is not a high priority considering the serious nature of the baby’s condition. However, for a mother and baby undergoing the stress of surgery and a multi-week NICU stay, breastfeeding offers many other unique benefits. A baby who is receiving breast milk, either pumped or from the breast, is less likely to contract common hospital borne infections like necrotizing enterocolitis. Babies who are put to the breast for skin-to-skin contact during breastfeeding experience endorphins that help strengthen bonding with the mother. This is especially important since the baby and mother will have more separation than a mother and baby would under normal circumstances. The endorphins released during breastfeeding from the skin-to-skin contact with the mother can help with a faster recovery from the trauma of surgery. Breastmilk is far more digestible for an infant and has a complete nutrient content, which eliminates problems like constipation that can accompany iron supplementation (Weisinger, West, Pitman, 345).
Encouraging the mother of a spina bifida baby to breastfeed has the added benefit of helping to reframe the experience of having a special needs child. Family, friends and even some healthcare professionals often focus on how the child’s diagnosis sets her apart from other children. Breastfeeding the baby with spina bifida focuses the parents on the ways in which their baby is like any other baby, with similar physical and emotional needs. With some adaptations their child can do many things that other children are able to, starting with breastfeeding.
The needs of breastfeeding spina bifida babies and their mothers are varied. The different methods of delivery along with the unique challenges of prenatal or postnatal surgery and hydrocephalus can make breastfeeding seem daunting or even impossible. However, with adequate care, most babies with spina bifida will be able to breastfeed. Supporting mothers in breastfeeding during the postpartum period will help establish breastfeeding patterns that will allow the baby with spina bifida to keep breastfeeding as long as he and the mother wish to. Like any other baby, infants with spina bifida have bodies that are prepared to breastfeed and receive breastmilk, not artificial feeding substitutes. Nurses, lactation consultants, doulas and other breastfeeding help can help mothers and spina bifida babies with the breastfeeding process so that they can experience the same benefits that breastfeeding offers any other mother and baby.