Pen Pal: boobing around tubing, feeding in the SCBU

Thank you so much to Laura from bubappetit. We spotted her original post on instagram and thought it would speak to many NICU and SCBU mums.

My career as a nutrionalist, is about nourishing people, physically and emotionally. Feeding my baby was a significant aspect of motherhood for me, particularly for creating a relationship with my new human. Not being able to feed my baby for the first days of life felt unbearable.

Once given the green light to start breastfeeding (when Avery’s lungs were strong enough), I was so excited. BUT establishing breastfeeding was not the ‘positive’ experience we are all promised.

Breastfeeding was always going to be tough under the best of circumstances, but learning to feed a sick baby in the hospital added so many extra layers.

Let’s start with the physical environment.

The Special Care Baby Unit (SCBU) is a step down from the Neonatal Intensive Care Unit (NICU), but has all the same bleeps, alarms and commotion. Although I had a screen, it didn’t offer much privacy and pretty much everyone on the ward could see my clumsy first attempt at feeding. Also because of COVID, I couldn’t have my husband there for support. Adding yet more stress to an already stressful situation.

I was offered no physical supports. I sat on a shitty chair with no arm rests, no footstool or support pillows. Having just given birth, my perineum and core were obliterated. I didn’t have the wherewithal at first to ask for those things, until I saw other mums using them. The staff, who were understandably more concerned with sick babies, were variable in how much they helped.

Then there’s the baby himself; he had on a heart monitor, O2 monitor, a breathing tube, NG tube and cannula for medicines and fluids. He was COVERED in these heavy wires and tubes, which pulled his head back if we weren’t careful. He pulled at his tubes, and would dislodge them. So not only was I trying to manoeuvre in order to not strangle my baby, I had to deal with tiny (and freakishly strong) hands pulling everything out. Despite asking, I was not once shown how I could lift him in and out of his cot without pulling out wires or setting off alarms. Instead this was something I learned from a mum in the expressing room.

So what about the actual breastfeeding support. Well... that started off pretty badly too.

One nurse told me “you nipple is flat, that’s why baby won’t latch.” Her solution was to cut the end of a syringe and suction my nipple, plunging my boob like a blocked toilet. It was agony. I was too shell shocked to stop her, even though i didn’t actually have a flat nipple and I know that babies latch to the areola!

On one of our other first attempts, another nurse told me “time’s up” after ten minutes. That’s barely enough time to get a decent latch. I asked for more time but was shut down and told there’s a schedule to be stuck to. Clearly distressed, I asked for specialist breastfeeding support, I was told “no.” I asked her what I could do to get breastfeeding established. She told me “come in earlier.” I had arrived at the hospital 4 hours earlier! I left the ward in tears, my husband finishing the top up feed.

After the consultant had given the green light for us to feed on demand, my instincts and intuition were constantly undermined. Staff would tell me “only feed for 20 mins in a 30 minute window” and “feed every 3 hours”. I knew this wasn’t how babies worked, I was after all well versed in responsive feeding. But when we did eventually get home I had this idea in my head that we should be on a 3 hour schedule, which my baby was having nothing to do with. Yet another stress.

Lastly, after lots of frustrating feeds, with lots of tears from both of us, I learned the unit used fast flowing teats for their top up feeds. This meant that when my baby was coming to my boob, he wasn’t getting milk as quickly as from the bottle and was getting ratty. I had wrongly assumed this was solely a supply issue. I ended up bringing some slow flow teats from home to help him transition from bottle to breast, which really helped. Sadly the nurses ‘forgot’ to use them.

Eventually I was able to get some valuable support from a feeding specialist speech and language therapist (SALT). She validated a lot of my instincts and understanding around responsive feeding, which was a huge relief after doubting and second guessing myself. She also gave me some positioning adjustments that made a world of difference.

A specialist breastfeeding nurse also reiterated the SALTs recommendations around positioning and finally lovely Abbey from @homebirth_homerton reminded me to take a step back and not worry too much about timing or length of feeds and instead focus on whether we were getting enough wet and dirty nappies.

Our breastfeeding story is still ongoing and I definitely wouldn’t say we’re there yet. I’ve been on a course of antibiotics which has caused him wind, reflux and other issues that are extremely trying. It’s also taken about a week of near constant cluster feeding to get my supply to match his demand. But we’re getting there.

There is a lot of the narrative around breastfeeding, it can be very rose tinted and romanticised so I think it’s really important to speak up and share when it’s difficult. Get support if breastfeeding is your goal and to talk to people about your experiences, particularly if they have been challenging or traumatic.

Thanks so much Laura. Laura has since shared some tips for feeding in the NICU on her instagram feed. If you would like to share your feeding story then please get in touch #mamassupportmamas #bottlesboobsortubes