The other night I was on call in the NICU. The charge nurse called me to say that we were getting a 5 day old baby up from emergency who was lethargic all day and not feeding. I knew what was coming: a partial septic work-up – pokes, prods, monitors, IV, antibiotics, all in a tiny little person.
The baby arrived in her little cot followed by a tearful, over-exhausted woman (must be the mom) and a scraggly just-as-exhausted looking man carrying three bags and a nursing pillow (must be dad). I let them take a few minutes to settle into their new surrounding before I went into the room to introduce myself and explain what we were going to do. As I was talking, I watched the baby. She was wide awake and looking around. She was fussing and crying, much like a normal, hungry baby would. The nurse was hooking up the monitors, and the mom was telling me her story: “She was fine all night and she woke up to feed like every two hours it seemed. She drank so much formula over night and then I tried to breast feed her this morning and she didn’t seem to be interested. Since then she has been tired and we haven’t really been able to wake her and she hasn’t been interested in breastfeeding at all. I was worried, so I brought her into the emergency room. But now she seems like she is back to normal. This is the most awake she’s been all day.”
I continued to watch the baby and started my physical exam. She looked completely healthy, she had no fever, and she was rooting around the cot looking for something to eat. I decided that, likely, this baby was not septic. Maybe she just needs to eat. I asked the mom how feeding was going at home and if she was breastfeeding, bottling, or both. The mother’s eyes filled with tears as she tried not to cry: “I’ve been trying to breastfeed but the home care nurse told me that she’s not getting enough milk, so we’ve been giving her a bottle too, especially overnight.”
“Okay,” I said, “Why don’t you get her set up to breast feed for now and we’ll see how she does. Then if we need to, we can give her some formula.” The mom obliged and took down her nursing shirt and bra. I handed her her baby girl and the woman placed her at the breast.
I cringed. She had no idea what she was doing with the baby and with her breast. She was urging her baby to just take her boob and just try to eat. And, I couldn’t watch it anymore. I grabbed a pair of blue nitrile gloves from the box on the wall and approached the chair with mom and baby. “Do you mind if I help you out?”
I placed my arm around the mother’s back, much like someone had done to me back when I was a new mom to A. I grabbed her large, warm, and engorged breast in my one hand and I placed my other hand on her baby’s back and neck. I repositioned the baby into the classic “sniffing position” that I learned so long ago, and I forced the baby’s head right onto her mom’s breast. The mother watched me with thankfulness as her baby latched easily and began to suck. I recognized the characteristic long sucking draws of a baby who is nursing well. I stood hunched over the mother holding her breast and holding her baby while she relaxed and stared in awe as she realized that she was actually breastfeeding her baby, like she had always wanted to.
“Did you ever have any help with your breastfeeding before you left the hospital?” I asked quietly.
“No, I just thought she was doing okay.”
“Breastfeeding is not easy, but with a little help, there is no reason why you can’t do it successfully.”
I instructed her to place her hands where mine were. “You have to put firm support between her should blades to keep her head and neck in the right position. It’s also a good idea to support your breast with your other hand, too… like this. She took over and I left the room to chat with the nurse.
“I don’t think I want to do a septic work-up quite yet. Lets help this lady with breastfeeding her baby and see how things go in the next few hours. I think she just needs a lot of help and support with breastfeeding right now.”
When I walked back into the room, the baby was asleep on the nursing pillow as her mother stared down at her with a loving satisfaction. She looked up at me: “Thank-you Doctor. Do you really think I just need some help and then I can keep breastfeeding her?”
I took a second and slowly approached her. Sitting beside her I said, “It took me 10 days of struggle and learning how to feed my baby, but eventually I breastfed him for 14 months. It’s not always easy, but if you are determined, it will pay off.”
The mom started to cry: “Really? Are you sure?”
“Nothing is every 100% for sure, but there is never hurt in trying.”
After that, I began giving her some instructions for how to improve her breastfeeding experience. I called the nurse into the room to explain how I wanted things to go overnight:
I would like to see mom breastfeeding the baby on demand and if you could offer assistance with every feed, that would be great.
I would like mom to pump for at least 10 minutes after each feed to help increase her supply.
If baby is not getting enough milk or is not settling at the breast, please supplement with formula or pumped milk at the breast only (I then proceeded to instruct both mom and nurse on how to used a supplemental nursing system made out of a nasogastric tube and a syringe).
I would like a lactation consultant to visit mom in the morning and I would like to get her set up with the breastfeeding clinic in the community.For now the baby can stay off the monitors, but if there are anymore signs of lethargy or abnormal feeding, call me right away and we will start the septic work-up.
The nurse looked at me with surprise and the mom suddenly looked excited and energetic. I looked straight at mom and said, “This is going to be a lot of work, but if it’s what you want, we are here to help.”
“Yes, yes, it’s what I want! Thank-you.”
I left the room to call my staff and tell him about my plan. He was impressed with my assessment and my plan and agreed that we should monitor for the night and help mom get set up with the proper resources. As I got up to leave the nursing station, the nurse approached me: “I just want to say that in all my 30 years as an NICU nurse, I have never seen a resident so comfortable and confident and supportive with a mom when it comes to breast feeding. Even I learned something from you tonight. Good job.”
I never got called back for that baby. Later on in the night I passed by the mom in the hall as she went to wash her pumping supplies. I almost didn’t recognize her, but she stopped me and said, “you are so right! Everything is going so well and [baby] is really doing great. I can’t say how much I appreciate all your help. Thank-you again.”
For the first time as resident, I walked away feeling like I made a difference to someone. Finally, being a parent as a resident has paid off – I can actually say that the other night, having kids has made me a better physician.