Our feeding journey in the NICU

So as Oscar didn't have any complications, he was simply kept in NICU to gain weight and for us to establish breastfeeding. We were put on a system called a PINC program (Premature Infant Nutrition Clinic) which meant the staff were working towards:

  • Working with infant’s primary care provider to improve growth and nutrition
  • Promoting human milk nutrition after NICU discharge
  • Optimizing mother’s milk supply
  • Assisting mothers and infants with the transition to nursing at the breast
  • Monitoring nutritional status of the infant

This also meant they were going to teach us how to feed Oscar with a tube so that we could be sent home quicker as we were able to do it ourselves. When Oscar was first in the NICU he had a tube that was in his mouth and fed through to his stomach but as he became more alert, he was moving his hands around and would pull the tube out. Within a few days of being in the NICU they moved the tube so that it went up his nose and down the back of his throat and into his stomach. (The thought of this now makes me so upset) They then used tape to keep the tube in place by taping it to his cheek. The tube had little markings on it that were increments of cm's and each baby required a different measurement. Oscars tube had to be at his nose at 17cm. (That's a really long tube to be down a tiny baby when you think about it.) This meant that the tube was further enough down that it was in the centre of his belly. Any shorter and it would have irritated his nasogastric tube (the bit between his esophagus and his stomach). 

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Next to Oscar's incubator he had a whiteboard that had timings and measurements on the board. His feeds started really frequently with tiny amounts. If Luke or I were visiting him in the NICU then we would assist in feeding him. In the NICU there were two areas in which your baby could be. The furthest end of the unit was intensive care. This is where the tiny babies start and have lots of observations and have their own section curtained off and grandparents are only allowed to visit in visiting hours. Once the baby has stabilized, they are moved further down the unit to the Nursery. This was a room with 4-6 babies in, grandparents could visit anytime and all other visitors in visiting hours. While Oscar was in the intensive care ward, he was mostly fed colostrum which was in 10ml tubes, they wouldn't let us handle the tube feeding while in intensive care but they did allow us to drip the colostrum onto his lips while they tube fed him. When he was moved to the nursery they then taught us how to feed him. 

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My milk came in on day 3 or 4. I would have to set a timer every three hours and use a breast pump. My milk had gone from taking 20 minutes of hand expressing to produce 7mls of milk to using a breastpump for 15 minutes and making 200mls of milk on each side. To me, I knew nothing different and thought that was what I was supposed to make, but the nurses were astounded. In the NICU there is a room called the Milk Room. It has huge industrial freezers and fridges, and a kitchen worktop. Every three hours I would have to go into the milk room, wash the breast pump apparatus and bottles in a bowl of hot soapy water, dry them off with paper towels, then put them in a white plastic microwave sterilizing bag that you fill with 50ml of water and put in the microwave for 8 minutes. This was a hospital essential, but in the real world you don't need to sterilize anything used with regards to breast milk as it is full of healthy bacteria anyway and doesn't run the risk of being full of germs as it is full of goodness! I would then go to the milk fridge and take out the oldest bottle of milk I had produced from the tray with my name on, fill up a jug with boiling water and go back to where Oscar was in the nursery. I then had to check the board, to see how many ml's of milk Oscar was on and measure it out using a syringe. I then had to put a cap on the syringe and let it bob around in the hot water to warm up. The rest of the milk I then had to remember to put back in the fridge. 

Next I had to change his nappy. In the hospital, they had to be extra sterile so I had to use water in a bottle, not the tap, cotton wool balls and they provided me with a nappy rash cream that had similar consistency to Vasaline but was cream in colour. 

Then I had to aspirate. I had never heard of this before but it involved taking a syringe, undoing the purple cap and taking a sample of his stomach acid. Sometimes the tube wouldn't allow the syringe to pull back which meant that the tube was against the lining of his stomach, or the tube wasn't far down enough and was trying to aspirate in his nasogastric tube. This was usually solved by either moving him so he was lying on one side and then putting him down again so the tube had wriggled around and moved position. Once the tube was co-operating, I had to pull out a ml or two of his stomach acid and place it on a testing paper, if the paper turned orange he was digesting efficiently and was ready to have more milk, if it was green in colour, it meant his stomach acid wasn't digesting and a nurse would then have to intervene. A couple of times it turned green, the nurse came over and realised the sample I had taken had been more mucus and clear in colour, than phlegmy and yellow that it needed to be to know it was stomach acid. This meant the tube just wasn't right in the thick of his stomach acid, therefore Oscar's green results were only green by mistake.

Once the test had come back O.K. The acid needed to be put back into his stomach so you simply push it back in using the syringe. I was then able to give Oscar the milk. When he was on small amounts the milk had to be pushed in using the syringe but by the time the amounts got up to around 80/100mls, they were held up with the cap off and gravity allowed the milk to feed down the tube, like a drip.

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It soon became habit but at the start it was really tough. Every six or so hours the midwives would swap shifts. Some were really, really lovely. Bothered to ask your name, came over every time it was time to feed the baby to chat to you, answer any questions, some would even say "Ok love, you change his nappy and I'll go get the milk for you from the milk room" and it felt so nice to be supported and made it a hundred times less scary that I was feeding my 5lbs 5oz baby through a tube. Others wouldn't even look up from their paperwork their whole shift. It was impossible to ask for help while I was in the middle of doing it all so that made it ten times more difficult as it's not like I could shout across to them, being in a room full of tiny sleeping babies.

My double room in the NICU - so so greatful to have had this

My double room in the NICU - so so greatful to have had this

The worst part about this whole routine, and what would have been a whole lot easier had Oscar been full term and we both went straight home - was that I was pumping and tube feeding throughout the night. I spent two days at home, in between not being weak enough to warrant staying in the postnatal ward, but there not being a bed for me in the NICU. Whilst I was at home I had to set alarms in the night and use my breast pump on both sides for 20-30 minutes. Get up, label the bottles with the time and date and put them in the fridge. As I was on such a strict schedule while in the hospital in the day times, my boobs got pretty efficient at filling up every 3 hours. So even when I was at home, which meant the midwives were feeding Oscar overnight, I still couldn't skip an alarm just to get some sleep as my supply was so high that I would wake up roughly 15 minutes before my alarm anyway with engorged, sore boobs. It was like having a big painful, puss filled spot that I was desperate to squeeze. Only they were huge, on my chest and took hooking up to a machine like a cow to relieve the pain. When my milk first came in, after a few days of hand expressing colostrum, it was around 7pm and Luke and I were at home watching TV. We then decided to go to bed as we were both physically and emotionally drained. (At this point I hadn't yet used a breast pump or been introduced to the three hour schedule, until now I had only hand expressed 7-10ml every few hours.) I then went to the toilet and as the big light was on, I looked down and my chest was enormous. I could not believe it. I shouted to Luke "Oh my god you've got to come see them they're huge!!!! They're rock hard oh my god!" To which he replied "Gross! Why the hell would I want to see that." So I was confused and replied like, "What?! Just come here!" he came in and saw my chest and his jaw dropped, "OH! Your boobs. I thought you'd done a poo and wanted me to see how big and 'rock hard' it was!!!!!" We both laughed sooooo hard and I was in so much pain as every time I laughed my c-section hurt so so much, as though I could physically feel the wound tearing back open. So we were sat trying to hold it in and not laughing at the poo-joke or my ridiculously massive tits. I couldn't stop staring at them in the mirror. My mum and Luke's mum had both warned me they'd be hard when my milk came in but never mentioned it would be this outrageous!!! I looked as though I'd booked a cheap flight to Thailand, gone down a back alley to have a boob job, and they put Butt Implants in instead. They were ridiculous!!! Considering I'd had a measly size A boobs my entire life- these were another level. The strangest thing about them was they weren't like a good boob job where the 'bulge' was in the cleavage, these were rock hard circular boobs. They were engorged right under my armpits, on top of my boobs and basically touching in my cleavage. They were hilarious. 

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They didn't bother me at first. They did feel really tight and my skin felt stretched and the whole thing was a little uncomfortable but all in all not unbearable. So I went to sleep. A few hours passed and I woke up in such pain. They had gotten even harder and my tshirt had wet patches in them where they had been leaking. I woke Luke up and told him to get the syringes. I NEEDED TO GET THIS MILK OUT!! I was so desperate and it felt so so tight. Whereas before, it had taken a lot of effort to squeeze one drop out, as soon as I went to hand express and Luke was ready with the syringe, it came pouring out, a thousand drops a second. We both couldn't believe it. The tiny syringes could no longer do the job so I just got a cereal bowl!! After squeezing both boobs into this bowl (LOL) to relieve some of the pain, I was then desperate to get some sleep. As breastfeeding was so new to me I had no idea what was in store. I went back to sleep and woke up again about 4 hours later this time with the same pain again. I didn't wake Luke this time so just sat in bed squeezing myself into this bowl before going back to sleep. I, of course, didn't have anything practical to take this milk to the baby in hospital so it just went down the sink. I then went into the hospital that morning and told the midwives that I had started producing milk by the gallon and they set me up with a breast pump.

Had Oscar come home full term, I would've been feeding him when my body woke me up from engorgement, or the baby would've cried for milk and I would've fed him, emptied my boobs and gone back to sleep. So my breastfeeding journey began with exclusively pumping for the first 8 days. Every 3 hours I would sterilise the pump, pump the milk, label and store the milk, clean the pump again. Get the old milk, measure the milk, aspirate the stomach acid, change the nappy, feed the milk, sometimes change the nappy again as newborns poo so frequently, then if it was daytime I would go back to getting on with my day, pottering around the NICU reading magazines.

My milk in the NICU Milk Fridge. The yellow colour is because the body produces exactly what the baby needs and this was super rich, fatty milk to help Oscar grow.

My milk in the NICU Milk Fridge. The yellow colour is because the body produces exactly what the baby needs and this was super rich, fatty milk to help Oscar grow.

After my milk came in we rushed to Mothercare to buy a breast pump. I then spent 3 nights at home. These involved setting alarms every 3 hours, steel siding the pump, pumping, putting it in the fridge, cleaning the pump and then going back to sleep. Then I got a bed in the NICU. It was a double bed in a nice room (for a hospital anyway) with a TV and an en suite with a toilet and shower. I slept in here for 5 nights. The first 3 nights, Oscar was down the corridor. This meant setting my alarm, pumping, feeding him and setting the next alarm for the next feed. I had so much to do in those night feeds that I remember sometimes setting my alarm for just 40 minutes time because it had taken me 2 hours and 20 minutes to pump and feed him. I was running on empty but I had no choice. I had to do every thing I was told to give him the best chance at a fighting start in life. I wanted to do it for him, there's no bigger motivator.

Getting up to pump while Luke slept peacefully

Getting up to pump while Luke slept peacefully

Luke stayed at home as he is self employed and as the baby came so unexpectedly, wasn't able to drop everything and just take two weeks off. Plus we had the two dogs at home. So Luke did the best he could to get time off whenever he could, come to see me and Oscar, bring me food and anything I needed from home and then he stayed at home to get a full nights sleep for work the next day and look after the dog. To be honest, it wouldn't have worked him staying at the hospital despite the room having a double bed as he would've been knackered and woken up every time I got up. It was better that I was in there on my own, focused and getting as much sleep to function as I could.

The first few days of being in NICU were a wirl wind. It became all about pumping and feeding. Pumping and feeding. Pumping and feeding. He was the most content baby and just slept most of the time, taking a few minutes to open his eyes and look around only to fall asleep again.

Using a double breast pump in the NICU with Oscar next to me in his incubator

Using a double breast pump in the NICU with Oscar next to me in his incubator

As I said before, some midwives were real Mumsy characters. As long as I was keeping up with pumping, it really didn't matter who fed Oscar. So some of them would say, listen sweetheart you just get up and pump and go back to sleep at the 3am feed so you can get some rest, I'll feed him for you - which meant I didn't have to leave my room. And some would say, as you've just pumped, (at say, 12pm) why don't you go and have a little lie down and I'll do this feed. Those midwives were the best. It's like they could tell when you needed a break. Some midwives didn't help in the slightest which OK I understand if I'm physically able to do it myself then I'm happy to but if not to help look after the babies what were they there for? Lend us a hand, love - I'm knackered! I remember one time saying my 'goodnights' as I went to bed in my room at NICU and asked really nicely if the midwife minded doing my 3am feed so I could get some sleep. Her shift would've been 12-6 or something so she was there anyway and had 4-6 babies under her care and two midwives on at a time, so they were fully capable. And she got all short with me and said "Yep, that's fine." I felt so awkward and guilty. 

Some Mums had babies in the NICU for months on end and had to go back to their jobs and sleep at home, visiting only when they could, so their babies were on 24/7 round the clock midwifery care and would've been tube fed by the midwives every feed! Yet she gets moody when I asked her to do one feed for me! I didn't ask again!  

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The first few days were a blur and it was pointless trying to distinguish between day and night as 24 hours a day was pumping and feeding.

To be continued...