Wednesday, September 1, 2010

The Catch-22 of Breastfeeding Micropreemies

I've wanted to write this post for a very long time. It's hard though. That's my only excuse for not having done so already...

I'm really not a "breastfeeding nazi". At most, I am an advocate for being fully educated and surrounding yourself with supportive people. Because I have now had such a successful breastfeeding relationship, it is something I hope for other moms and babies. But I do not feel it is my place to be judgmental or critical if it just doesn't work out for some reason.

That is my attitude with full-term babies and late-term preemies.

But here's my dirty little secret...

I DO judge moms of very premature babies who do not try (hard) to breastfeed or pump for their babies. It makes me angry and it makes my heart hurt for those tiny little miracles fighting so very hard and not being given their very best weapon against all the trials they will face.

Why the dichotomy?

Well, here's the thing. Full-term babies (and later-term preemies) receive a lot of wonderful antibodies from mama throughout that third trimester. Do they completely make up for not being breastfed? Nope. No question- they do not. But they are SOMETHING. They provide those babies with very real and important protection and defenses as they come out into this big ol' world. Micropreemies are born before the third trimester even begins. Scary, isn't it? You can't bank on a micropreemie having received antibodies in utero. The only way to pass them on? Breast milk.

But there's more. One of the more common issues to plague these extremely premature infants (and one that many nurses told me is a great fear) is necrotizing enterocolitis or NEC. NEC is an acute inflammatory disease in the intestines of infants. Necrosis or death of intestinal tissue may follow. The treatment? Most often, surgery. Portions of the bowel and/or intestines are removed and the babies are fitted with colostomy bags. The end of the world? No. But it doesn't end there... doctors and nurses must continue to monitor these babies closely. There is always the fear that they "didn't get it all" and it can continue to spread...

NEC kills babies. It's that simple. It is a dangerous, scary condition where the intestinal tract begins to die. In order to grow, these babies need to eat. In order to eat, they need to be able to digest. It's that simple.

I am not a medical professional and I wasn't able to pin down exact numbers. What I do know from my own conversations with the NICU team and from the research I've done is this:

NEC is over ten times more common in formula-fed infants as it is in breastfed infants.

Ten times.

We all know that breast milk is easier for babies to digest. This is especially true for the tiniest of babies. Their systems are simply taxed a little too much by formula. Formula companies have yet to produce a formula that is truly gentle enough for a micropreemie tummy. They add calories, yes, but that doesn't make it easier to digest. I would bet they're working on it. And I truly hope they are someday successful in making a better formulation for those oh-so-fragile bellies. But the breast milk from the preemie's mom? Consider this- moms of preemies produce breast milk that is different from that of full-term moms. I find that so amazing... not only was my milk easier for my baby girl to digest than formula, it was also easier for her than that of a full-term mommy would have been.

There you go- that's my hard-nosed stance and, if I'm going to be real and authentic, I cannot apologize for it.

But here's the Catch-22...

These very premature infants often arrive so very early because something went awry with mom's health. Oftentimes, the mother is very, very sick and breastfeeding can be an incredible challenge. Women who have healthy, full-term babies and minimal complications with childbirth will often talk about how incredibly draining, frustrating, and downright hard it was to breastfeed. Now imagine adding in seizures, dangerously high blood pressure, organ failure, multiple transfusions, high doses of medication, and- let's not forget- the terror, stress, and devastation of having given birth three or more months early. Is it any wonder providing breast milk doesn't happen often enough for these very premature little ones?

I waver on this issue. Constantly. Every couple of months, someone asks me to pray for a micropreemie or very premature baby who is undergoing surgery for NEC. I do, of course. But I find myself wondering (did his mommy try to breastfeed?) and judging (why not???). I'm not proud of this. But it's the truth.

I'm trying to learn to balance those two sides of me- the side that fiercely advocates for the tiniest of babies and, thus, believes that their mommies owe it to them to try to breastfeed... and the side that realizes many of these mommies are still fighting to live themselves. They're not negligent mamas... they just have more on their plate than is humanly possible.

Where do you weigh in on the issue?

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