Episode 75: Expert Tips Feeding Your Premature Baby in NICU
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Meg: Welcome back everybody. I’m super excited about today’s episode because today we’re going to be chatting to Tove who we have actually done an episode with before. She is a new mom to a [00:01:00] third baby. So she’s, I guess she’s not really a new mom. She’s quite seasoned. Been doing it for three years, but but now is, has had a third baby and we’ve been joined by Kath Magor Aswell, who’s a pediatric dietician who many of you know of.
Meg: She’s worked extensively with me and on obviously on her own and has a very, very busy practice. And in addition to that, she’s written, Kath, have you written four books now?
Kath: I think six. Yeah.
Meg: 6 books my word. Okay. One of which was Weaning Sense and Allergy Sense, which are the ones we wrote together. And then she’s written many other books as well.
Meg: So Kat’s a real expert and she’s really has a deep, deep passion for pre babies. And that’s what we’re gonna be talking about today. So, as you will remember from our last episode, and if you haven’t heard the last episode, please do go back and listen. It’s the episode in which Tovey and I kick off her journey with her little one.
Meg: Tove has been on our podcast before. And to e episode is actually the biggest downloaded episode we’ve ever had, which was called The Juggle is Real. Well, the juggle just got more real because,[00:02:00]
Tove: a lot more.
Meg: a lot more real. Welcome Tove I haven’t said welcome and welcome Kath. Thank you both for joining us.
Kath: Thanks Thanks. Meg
Tove: Thanks Meg.
Meg: So, Tove has a three-year-old little girl who is special needs and she’s almost four. Or just turn. Yeah, she did turn four. Tove. She’s four. Yep. And she has what was supposed to be an 18 month gap to her next one. Well, she had then had a second baby Jagger, and then it was supposed to be an 18 month gap.
Meg: And, and to that just didn’t happen because. This little baby decided to come very early. So will you just, just quickly, for those who haven’t listened to the previous episode, just fill us in on the arrival of this baby.
Tove: Sure. So, I’m gonna call her Baby G because obviously she arrived early, so I still don’t have the name for her. So we still, still crossing that bridge. But yeah, so she kind of came 33, 33 weeks and a few days. So she, she made a very early arrival. Lots of contractions. [00:03:00] She came pretty quickly.
Tove: So, it was a lot. My husband was traveling, so, and hadn’t sorted out the kids. We’d just come back from South Africa. So it was a all, all hands on deck kind of moment. Yeah, so it was definitely a, a little bit of a whirlwind, but she’s here and she’s safe and I’m alive and so those, those are really the benchmarks, right, of a successful birth at this stage.
Meg: Absolutely. And we definitely did a huge deep dive into exactly how that happened. And I’m excited to go for, for people to go and actually listen to that episode as well. And I remember, I mean, I was very, very sad because I wasn’t able to be with you for the birth, knowing that Davey wasn’t there.
Meg: I was gonna come through and be your birth partner. Because I think, Tove doesn’t have family on the island. We live on an island. And so I was gonna go in and actually hop in and be a birth partner, but baby G had plans to come a lot quicker than that. And then, She did. She certainly did.
Meg: And so she was taken immediately into the SCBU which is what they called it in the UK [00:04:00] or in South Africa, the neonatal ICU, the nicu. And when I saw you on Saturday morning Tove, she was still on breathing apparatus. I think she was on C P A P at the time. She was in an incubator. She was being fed with by a tube down her throat.
Meg: And there’d been very little contact at that point. And when we started chatting, I said to you we need to get the feeding going. How about starting a dummy? And that kicked off on Saturday. And I wonder if, because Kath’s here, if you can just take us through a little bit about what her feeding journey has been like.
Tove: Sure. I, I think without a doubt, super, super helpful. Obviously having Meg on call and having, having you on the team, because it was, the first thing I did was message Meg and say, what do I do now? I’ve a preemie baby. I’ve super prepared. I came and going done this twice. I’ve got this handled.
Tove: And then obviously she’s preemie. Now I I have nothing handled.
Meg: Yeah.
Tove: So, kind of going through, Meg bought me her book and, and kind of reading, reading a little bit, and then obviously [00:05:00] being, feeling quite anxious about the breastfeeding journey. I’ve never had issues with, with my other two breastfeeding. I’m an abundance of milk. My milk has always come in but I’ve always had my babies with me and so we’ll kind of.
Tove: All of a sudden not having this time to bond with her or hold her or connect with her. And when I do in a very controlled environment, a very sterile environment, and very noisy and not very nice from a sensory perspective. Definaitaly delayed and, affected my milk supply, at least from my side, from what I’m used to seeing. She’s progressed quite nicely, so we’re on day, going on to day four. She’s took to the booby yesterday,
Meg: So on the first, just take us back a step Tove because ’cause you have skipped out the colostrum stage. And just for moms and dads who are listening, If you can hear noise in the background, Tove obviously still in the ward, so
Tove: Sorry. Yeah.
Meg: no, it’s absolutely fine. There’s background information of doctors and consultants and, and other moms.
Meg: She’s in a general ward, so we understand that. But just take us back to [00:06:00] how did you really kick off the feeding and, and maybe Kathy, you can give input as we go along for moms who are going through that journey.
Tove: So they obviously wanted to get colostrum into her as quickly as I could. So there was a lot of hand expressing, which I don’t love ’cause I was like, oh, I’ll just pump it. And they were like, it’s not enough to pump. So, the hand expressing, so we did a lot of hand expressing and then they get a syringe and they kind of syringe off the top of your nipple.
Tove: So that’s, yeah, feels very weird because obviously that’s a wonderful way to connect or I found breastfeeding a very good way to connect with my kids. So kind of having that first feed, being me, squeezing my boob, and someone strange coming in, like pulling off all the colostrum was, was not the most amazing experience.
Tove: And I struggled to get colostrum out when I started. What I found was then, I did one set and I, I pulled a little bit and then when they let me hold her I found the colostrum [00:07:00] flowed straight afterwards. My advice, and I mean, I dunno if it’s the same for everyone and Kath you’ll probably have better insight into this, but I found after holding her my colostrum was much better.
Tove: So what I would try and do is say to them, can I come and hold her when you’re doing your caress? So when they do the nappy change or when they do the temperature or when they do something that disrupts her anyway, I would try and get in there and have like a ten five or 10 minute hold. Because my boobs would just the colostrum would just flow a little easier, and then I would go hand express and make the colostrum and they’d kind of be pushing it through her NG tube.
Meg: So, Kath, it might be useful to just for other prem moms and for Tove, just chat over a little bit around colostrum about how do we actually get it going? What, what is the best way to do it,
Kath: so colostrum is obviously really important for all babies and for some babies it’s for pre babies it’s really super, super important because their little guts are not very well developed at all. So exactly as [00:08:00] Tove was saying, when you have contact with your baby, whether it’s a picture, whether it’s a video, sometimes with Prem Births, the mom is really ill, she can’t go to her baby because her life is at risk still.
Kath: So then what I always do is encourage dads to take a video of the baby and bring it to mom so that it can just evoke some of the emotion. ’cause the emotions of that connection releases the oxytocin, which produce the letdown of colostrum in the beginning and actually allowing you to able to express that if you’re able to go to your baby and your baby’s well enough so that you can actually hold your baby during cares, which is, I really like that.
Kath: So we obviously want moms to have that connection, that touch with the baby, but the baby is very vulnerable at this stage, and so we don’t want too much fiddling in around with the baby. So it’s really great that you did it at the same time that they are working with her so that you can just calm her, keep her warm while they [00:09:00] do all their things around that.
Kath: So that was really insightful and, and good.
Meg: And, and Kath before we go on to how, the next steps, I mean, why is colostrum so important? What, what does it do with these prem babies?
Kath: Well, colostrum gonna help them maintain their blood sugar. So term babies even struggle. Newborn babies struggle to just manage their blood sugar. And colostrum is the magic food that’s got a lot of lactose in it and the sugar, and it’s going to elevate their sugar levels in their bodies.
Kath: And it’s also got some good protein and it’s got the amino acid glutamine and glutamine is what’s found abundantly in amniotic fluid and amniotic fluid is what they are at this stage. If she was still inside of Tove, would swallow and digest and that glutamine would be maturing and her little digestive tracts and building the muscles of her digestive tract and colostrum.
Kath: Full of glutamine. So it’s like a glutamine [00:10:00] wash through her little body when she gets that colostrum.
Meg: So with that in mind, the logic for me would say you want them to have colostrum for as long as possible, but obviously with normal milk coming in, it’s not gonna stay there forever. So, what would moms be expecting if they have a pre baby, how long does their colostrum stay?
Kath: So what’s very interesting with our moms who have prem babies is that the milk is slightly adjusted for prem babies, so their level when their milk comes in. So the mature milk comes in after the colostrum is actually a high level of the glutamine than your term baby milk. So that is one thing that, we can feel good about.
Kath: But the colostrum will, and there will be little bits of colostrum that can last for up to five to seven days even. But the milk will as the, as the mature milk comes in, the colostrum does get less. It doesn’t mean it just goes altogether. And sometimes what happens is that the baby’s not well enough to get all the colostrum.
Kath: And so you just keep pumping in as much colostrum as you can and [00:11:00] they’ll store it and they can actually give it for a few days longer than what you are producing. So it just depends on the baby and how well the baby is growing and tolerating the feeds. And that depends on the baby’s maturity and their gut maturity.
Meg: Very interesting. And Tove, what was your experience? Have you still got colostrum or has your milk started to come in? What was the next step for you?
Tove: Yeah, so my, milk started coming in, I would say pretty much last night. So we day four now? Kind of end of day three, but it’s still very, very yellow. So actually I was going to ask that.. Even this morning when she had a feed I used a Hakka on the other side and it was incredibly yellow compared to what I’m used to kind of seeing with my kiddos.
Tove: So I assume there’s still some colostrum in there just by virtue of the color of it, because it definitely doesn’t look like milk I’ve had before.
Kath: because remember it, it’s early and often [00:12:00] in the, towards the end of pregnancy, we start actually having colostrum from our breasts even before we deliver. So the, the colostrum little bits of it will continue. So the hormone that brings on the mature milk does kind of, Dampen the hormone that’s producing in the colostrum, so it’ll decrease as the mature milk comes in, but you will still, because of the stage of gestation that she would’ve been, you will still produce colostrum a bit longer.
Meg: Very interesting. So, I mean, I’m quite interested and, and I know moms of prem babies will be interested ’cause now when little Baby G was born and I can’t wait till she’s got a name and we can call her something, but let’s call her Baby G when Little Baby G was. Born, she was obviously being fed through a tube, and she was being given her colostrum through a tube as well.
Meg: And then
Tove: So that was interesting. It kind of differed, but generally they actually, sometimes they put it in her mouth to get [00:13:00] that actual taste going. And sometimes they would do it through the NG tube, so they kind of alternated it. And then with sugar water, I think, and is it caffeine?
Kath: Yes, they use caffeine.
Tove: Yeah, so I, I, I mean, I guess one of the things I never gotta really ask questions about but was really fascinated with was why caffeine
Meg: Mm,
Tove: just seems like such a counterintuitive Yeah.
Kath: So the caffeine is a very standard practice. It’s just to keep their hearts actually pumping and, and going like it needs to. So that’s really the main function of caffeine. The challenge is, has always been a fine line and there’s been lots of studies around how much caffeine and how long do we give it for, and everything like that.
Kath: But it, so it’s there to really just stimulate the heart and the breathing to just all work Now for the outside world, because she technically should. Still be inside. And a lot of that help should be, done for her. Now she’s having to do it on her own. So caffeine just helps her with [00:14:00] that. The caffeine though, does also increase her metabolism.
Kath: So it can be a little bit counterproductive when we are wanting her to grow and now we’re giving her caffeine to increase her metabolism. So the metabolic rate does go up a little bit with it. But you know, the, the science and the research now has been quite long and, and it’s been really good. So we know like what’s a good balance.
Kath: Between maintaining and keeping the heart rate and the breathing going, but at the same time not overstimulating the metabolism as well so that she still grows and gets enough to grow. Also just a note there, some babies will have an or gastric tube in the beginning where it goes through the mouth.
Kath: Especially the very small prem babies, but once they’re a bit older, they will change it to the nasogastric tube and I think ’cause of her age they did a nasogastric so that they were anticipating early latch. It’s really hard to latch a baby with the orogastric tube. We do do it sometimes, but they can’t actually get a closed suction [00:15:00] if we do have the orogastric tube.
Kath: So the nasogastric tube is encouraging ya to that. She’s able to then have latched latched for you. Ya.
Meg: then just obviously for everybody’s purposes or gastric is through the mouth into the tummy, and her nasogastric is through the nose, into the tummy. What was her progression? Tove from or gastric to nasogastric and also towards sucking. How did that journey actually happen?
Tove: I think we were very lucky. I tend to bake rather large humans, so although she was 33 weeks, she was 2.5 kilos, so she was a sizable baby. So she, she moved quite quickly from, the mouth to the nose, I’d say within 24 hours. So it, it moved relatively fast from, from that side.
Tove: I obviously she only really got onto the boob on what are we now? So we Monday Tuesday. We tried her on Saturday. Sunday. She kind of [00:16:00] latched.
Meg: You had done the dummy just before that can we just touch on that? Because I had gone in to see Tove, I’d said to her on the Saturday morning, have they got her with a prem dummy yet? And she said no, but was concerned because there’s quite a movement towards not using dummies often in the uk.
Meg: And I mean, Kath and I, I’ve often spoken about how important that is, to get that suck reflex going. And I mentioned that to Tove and they were quite happy to offer that dummy Tove.
Tove: Yes, it was, I think that was one of the things that I found like the most valuable about kind of having a conversation with you was just allowing me to go in and say things to them like, Is there a dummy? Can I swaddle, can I do these things that I’ve been advised from someone else and they were like, oh, well most parents don’t do that, or most parents don’t allow a bottle, or most parents don’t.
Tove: And kind of having the information to equip myself with and actually push them. It’s almost like they didn’t wanna offer it, because it wasn’t what the norm was. But the moment I asked [00:17:00] for it, they were like, it’s a great idea. Like, yes, you should do that. It’s really good for sucking. It was the same with the feeding.
Tove: They kind of said to me like, is she gonna be exclusively bottle fed? And I said to them, quite frankly, I want her to put on weight and I want her to get out of here as quickly as I can. I don’t care how she’s fed. If I need to put it in a bottle, if I need to, it down her throat like, Whatever I need to do.
Tove: I just want my child to get outta here and I want her to put on weight and I want her to be healthy. And they were like, well, that’s super helpful. If she’s struggling, then are you comfortable with us moving between the boob and the bottle and the tube and I was like whatever you want. But I think kind of going in and having myself armed with what the consequences of those decisions were and kind of prompting them to things like, can I have a dummy?
Tove: Please can you have a bottle ready if need be? Have the formula ready if need be. It was helpful ’cause they, they didn’t offer it. It wasn’t like it was something they put
Meg: Yeah. She moved onto, she moved from sucking the dummy on Saturday through to [00:18:00] latching on Sunday. Kath, can you just talk us through a little bit about what happens, how you guide moms towards that and what your advice would be? So let’s say we’re sitting with a mom who has a baby, who’s got a, or gastric or nasogastric tube.
Meg: She wants to breastfeed, even if it’s not exclusively. What’s the best standards or what, what’s the gold standard of that progression?
Kath: So, yeah, I think South Africa is definitely more open to dummies and we actually recommend it and we totally encourage it and I don’t think there’s babies in that don’t do that. And we explain it to parents that it’s actually going to help the process of feeding as opposed to hinder the process of breastfeeding and latching and everything like that. So definitely having an appropriate size soother is really important. So one that’s appropriate for your baby’s weight and their age and letting them suck. I love that they put some colostrum in the mouth because as I said, it’s got the glutamine, so it matures.
Kath: Our digestive system starts in our mouth. We actually [00:19:00] need to mature it right from our mouth down to our throats and into our stomach and into our intestine. So it’s not just the end goal, it’s from the beginning. And I love that they actually did that. And we often call that dummy dip.
Kath: So we’ll put a little bit of colostrum on the dummy, little bit of milk on the dummy and get them to suck it so that they start to. Associates in that taste with sucking and they start to make that little connection in their brains. And then yes, we’ll definitely do the, the kangaroo care, which is holding your baby like you’ve been doing during care time.
Kath: So they can smell you and feel you and then latch, and then even let them just play around in the area at your breast and do that fairly. Often. So again, that they make that connection with that smell, your skin and the breast. And then sometimes you need to help them by squeezing a little bit of milk into their mouth before their [00:20:00] suck is strong enough.
Kath: And then normally once, we find obviously breastfeeding is a little bit harder work than bottle feeding. So some babies do struggle and so that’s, I think what the, the NICU nurses were alluding to there that sometimes it does speed it up and speed up the sucking practice if the mom is open to using a bottle, and what my experience has been, and this will be very encouraging, is that it doesn’t hinder the breastfeeding at all. It all just actually helps with it. It really does. It takes the pressure off the breastfeeding, which makes the breastfeeding more pleasant and fun for mom and for baby.
Kath: And then it also allows the baby to get off the tubes that much quicker. If they’ve been struggling with the breastfeeding to get it all going. And then at night they can also practice sucking as opposed to only when mom is [00:21:00] there in the day. If you’re not able to sleep over at your particular hospital it means, if you only go for exclusive breastfeeding, then you’ll find that only the day does baby get practice to suck and then at night the baby gets fed via the tube, and so there’s no sucking practice there. What we also do in the beginning, we teach the sucking during the daytime. Once they accomplish that in the day, then they can start learning it at night because then at night they’ve already established the skill and at night they just have to practice the skill.
Meg: Excellent. So Tove, have you got any questions for Kath? I know that you probably do at this point.
Tove: Yeah, I definitely noticed so she’s, she was obviously in the incubator and the incubator’s dark and warm and, has a cover over it and it’s, it’s quite quiet. And they moved her to a hot cot yesterday. And that I found she struggled a little bit yesterday.
Tove: I couldn’t get her to do both boobs. She got really tired very quickly, like 10 minutes on and, and I think my feeling was that it’s probably, there was a lot going on from a sensory perspective. The lights were all of a sudden on, there’s no cover over her. It’s not dark. There’s noise everywhere.
Tove: There’s other babies, there’s machines. And so I found her [00:23:00] feeds were just a lot shorter and a lot less firm. And she was a lot more kind of, frazzled is not the right word, but just distracted maybe. Yesterday. This morning I had a really nice feed with her, which was great. She did like a good 30 minutes.
Tove: But, but I noticed she’s kind of struggling. I have big nipples in her mouth, obviously very small. She’s tiny. So she’s got the latching going now. She’s like, the mouth is open and she’s going in like a little shark, and she kind of gets on. And then if she gets tired, I imagine it’s also a hell of a lot of energy for someone who should have still been baking for like another five weeks, but she kind of, and then kind like lets it fall out and then, it’s like a lazy latch.
Tove: Where with my son, I’d be like, right head, put you back in. Like, come on. And kind of tickle her face to keep her awake. But she just seems very tired and so her latch is very lazy. So I can feel she’s not latching beautifully. And [00:24:00] so I’m kind of on off on, off on off and that’s obviously getting a lot of air as well, and I don’t really know how we do that because I imagine that’s a strength thing.
Tove: Is there anything I can do to help strengthen her mouth? Anything they can do? Is there a dummy?
Kath: So again, I. So I think using the dummy will obviously bring strengths to her. So whenever she’s having a feed to have her dummy at the same time if you are not there. So just to encourage them to do that and give permission for them to do that. And then also not to overwork her, it’s like. If you take it equivalent to an athlete training to run a race, who starts off now, wants to run a marathon, they’re not gonna start by running a 21 K.
Kath: They’re gonna start by running five Ks and then they’re off maybe even two Ks if they’ve never run before, and then work up to five Ks and then slowly, slowly work up if you take that person and get [00:25:00] them to run it. First on 15 K, they’ve never run before. They’ll damage so much and they will not be able to, they’ll probably take a long time to get back in the saddle of running.
Kath: And I find if we too aggressive in the beginning, it’s hard ’cause we want the baby home. We want the baby to eat. We, we want that. But if we can just. I call it slow and steady in the beginning. Then we actually get our end goal that much quicker. So what I would suggest is I wouldn’t do more than five minutes max at a feed time with her like active latching in the beginning.
Kath: If she had like this morning where you found the feed was great and she was really managing, obviously then you can continue it for as long as she. She gives you the signal but if you notice that she is really struggling or just giving you the cues that she is to tired she can’t manage it, and I also wouldn’t suggest today at this [00:26:00] early stage doing every single feed at the, the breast to latch, I would do one breast and then one ng.
Kath: You can hold her while she’s having the NG, let suck the dummy let her be close to then the next one, give her the breast again so that she has the energy for her training cause right now her breastfeeding is just training its not there for nutrition at the moment because nutrition is going through her tube, and that’s fine. You are there to train her to feed feed and take a little bit longer in the beginning, and then I promise you, you’ll reap the benefits of it because she’ll have the, and she’ll also learn a good latch because, just think about it, anything we learn when we tired, we don’t do as great a job as if we not tired.
Kath: So having her exhausted is not helpful to teach her how to
Tove: yeah.
Kath: She is not going to get it right so when she’s happy [00:27:00] and alert awake thats when she is going to be able to learn and so that’s the best moment for
Tove: to.
Tove: Her moment to the best and Okay.
Tove: Okay
Meg: so useful to understand. So, I think one of the things that I wanted to just reiterate for parents is that, you said just now suck a dummy while she’s feeding, which sounds very confusing, but what you mean is while she’s feeding through the NG tube and Yeah. And those NG tube feeds, they pace them now, just for moms’ reference, there’s not a continuous flow of milk, or nutrients down that.
Tove: Well, I thought it was really interesting yesterday because they work out how much she should have every two or three hours, and then they discounted my milk. So it was really interesting to watch. And I, as I said, I’m. I’m quite a large producer, so she latched, she had a, like a good 10, 15 minutes and then they were like, okay, but we don’t really know how much it’s, so we’re not gonna count that and we’re gonna give her the 30 mls on top of formula. And she just, she literally overflowed it, like came [00:28:00] flying out of her. I was like, Ooh. ’cause there was this tube, and they kind of, they poured in the top and they take the syringe off and you watch it go down. And she just, it was literally like a cup that was overflowing. And it just, just was like, and I was like, stop it.
Tove: Like please turn it off. Like connected. Like, what is happening here? And I was like, why aren’t you counting my milk? And they were like, well, it’s not an exact science. And I was like, yeah, but if we do the let off of the Hakka, can we not take that as like an average and just, Calm it down a bit because it like she was just filling up so much so I found that quite Um, unnerving to see just kind of watching that and being like, and they were like, well, it’s not an exact science. We’ll cut it down a little bit for the next feed. And I was like such a hectic trial and error to watch. You’re like, do we really have to trial and error this? Like, I, I mean, I know that they do, but it wasn’t, it’s not the most comforting thing to watch your, your kid see that.
Meg: Would you be doing there?
Kath: Yeah, so what we normally do is we observe the amount of [00:29:00] swallows and we count amounts of swallows, and then we work out the ml’s based on the amount of swallows, and then we estimate, so we say a good feed in 15 minutes has X amount of swallows, so that will equates to about 50% of the feed. So then we explain to the nurse that this particular baby, if they have a good feed will only need then a topup of 50% of the milk thereafter. So we assess it for each baby ’cause each baby’s different. How many swallows would equate to a good feed? So that’s quite scientific how we do it, but we’ve got the luxury of having enough of us to observe that and watch it. And not every unit has that. So if a unit doesn’t have it, that’s like the ultimate, but if a unit doesn’t have it, then what you can do is you can as Tove said, the other way would be to say, mom is managing to express in 15 minutes X amount let’s take [00:30:00] 80% of that is what the baby got in. And then we give the remaining as a top up and then observe the weight. The weight’s checked every day and see is the baby gaining what we expect the baby to gain every day? And then we can readjust our top up if we not get in the weight gain that we want to get.
Meg: Wow. Super scientific and also a little bit of kind of art to it as well. And Tove, that must feel quite difficult ’cause you don’t necessarily have a pediatric dietician on call in the unit. So you are feeling your way
Tove: no. And
Meg: in the dark a bit.
Tove: yeah, and, and I think here they don’t weigh every day, they weigh twice a week.
Kath: Oh,
Kath: okay.
Tove: they’ll only weigh twice a week. So that, that I also found a bit like, well, surely we should know, like the easiest way to know is just weigh her. They don’t like weighing every day. And the other thing they do, which I found quite unnerving in the beginning, I actually really liked it.
Tove: And that was probably like the A-type personality in me, [00:31:00] like not, not parenting moment. Probably a more me moment was when they, when she first took the boob they used the NG tube to pull out the milk in stomach to see how much got in so that they could assess it. I was like, so obviously from my side I’m like, woo, making milk. Look at me. 10 mils. They were like, this is fantastic.
Tove: 10 mils. We’ve never seen that on a first feed. And I was like, yeah, a star. But then I was also like, I’m sure this can’t be comfortable for her, that they’re pulling the milk in and out of her tube to check what’s in her stomach. So I, I found that, and they do that often. They, they check what’s in her stomach and how much of it’s looking.
Tove: Like it’s enzyme and they test it with like a, like alin stick or something. And I, I find that quite because you can almost see her now like going like it’s, it’s being pulled out of her nose and then being pushed back and it just,
Meg: Mm.
Tove: I mean, maybe it’s more because we think about it.
Kath: Yeah, so it’s quite an old way of, of practice in so that we call that aspirating. [00:32:00] That’s the technical medical term when they remove the milk from the stomach to see the stomach contents and observe the stomach contents. So I think if we, we definitely do that if we are worried about absorption and we worried about if there’s bleeding in the gut. So we worried about certain things like that and we will do it, but we wouldn’t do it repeatedly. ’cause itself can actually cause a little bit of irritation in the gut as well. And we try not to fiddle a lot around the NG space with a lot of aspirate and pulling milk out, et cetera, because it’s a very sensitive little area there.
Kath: So, but yeah, there are some places and there are some units that still do use aspiration because it’s more , like you say, exact, it’s more what they can work with tangibly. Yeah, I prefer a bit more gentle and a bit more estimated, but at the same time, we also have developed different ways of trying to be more exact with the watch [00:33:00] and the swallow, but that obviously takes a little bit more time than just taking milk out. And if you don’t have the manpower in your unit, then it would make sense why they would do it. I would hope and assume that at this point when they feel that there’s a pattern developing that has normalized that they won’t need to continue to do it.
Tove: I think it’s something I definitely am gonna flag today as something I would like to tone down, if we can and obviously Im not here and I cant control what I cant control which I think is obviously a whole nother probably segment where I need a psychologist or something to come in and talk to me about that. But that is so, relinquishing that and realizing that, you very much on her journey, her timeline and, and a bunch of doctors who are telling you how to parent And so that’s, but, and kind of letting go of that.
Tove: But I, I definitely doesn’t look great to me. As I said in the beginning, it was my A [00:34:00] type personality was like, woo-hoo, look at me, I’m making milk and I can see that I’m, ’cause you’re breastfeeding, you’re always like, am I getting them enough? Is there so it’s, be able to see it. I was like, this is magic.
Tove: You should always have this. But then, then after a while I was like, this doesn’t seem like a nice thing to be doing for her. After every feed.
Meg: Sjoe. Well, it’s been absolutely fascinating listening, and in fact, this last piece of the conversation has flagged for me a little bit of the emotional aspect of being a of a prem baby. That, you’ve really raised it to Tove that it’s really hard to relinquish control, which is what you have to do in the unit.
Meg: You’re also going to be dealing with the moving, leaving her in the hospital today because you’re being discharged and she’s not, which is a massive part of the journey and that’s gonna I can imagine it’s gonna be really hard for you.
Tove: Yeah, I don’t, I think there’s, it’s definitely, if, tie it back to feeding, it’s definitely affecting my milk like without a doubt when I’m with her like I had the Hakka on and I made like hundred ml’s this morning with my eyes closed [00:35:00] and then I did a pump in the middle of the night like five, you know that doesn’t. I think for me as well, knowing this is definitely my last baby. I made sure of that. So not kind of how I envisioned the last of my pregnancies or the last of my experiences, although I was saying to Meg, I’ve had the full spectrum now, I’ve had the special needs and the kind of standard birth and now premi just seems like a clearly needed to have it all. But it’s definitely a lot tougher than I thought it would be I was actually like, this will be great. I’ll have a week or two to settle the other kids at home without the baby, and I’ll just ease them in. And then yesterday I was like, oh, I don’t wanna leave.
Tove: I was like, gimme a day bed.
Tove: So I definitely think the reality of kind of going home without your baby. In the ward I’ve been alone and yesterday a lady came in and went and had a C-section and came out and her baby was with her and has been with her all day and I was like, she has a baby next to her I have to go to like a [00:36:00] unit with my like little syringes and like click on a door and be like, can I hold my baby? Do you mind? So I think, again, like it’s, I keep kind of trying to remind myself from a perspective base. My kid is healthy, I’m alive, I’m healthy. It was traumatic. There was a lot of stuff that went on. And that’s really what matters.
Tove: But it is tough to kind of separate, to keep, as I said, rationalizing it with yourself. And it’s definitely affecting my milk.
Meg: Yeah.
Tove: and so that kind of sits on me now when I leave and I go home. How do I get the milk? How do I keep that up? How do I keep that up? How often do I come in?
Tove: I can’t drive. I’ve had a cesarean. How do I get to the hospital? Am I gonna be here enough? Am I not gonna be here enough? And I’m here, and then there’s, they’re not doing caress and I don’t wanna disrupt her, but I do wanna hold her and I need to hold it because I need the milk, and I need the milk for her.
Tove: And so you just kind of like spiral yourself.
Meg: Mm.
Tove: like just I know I need to like just take a step back.
Meg: Yeah.
Tove: But it’s definitely plays into the whole journey in a way that I just didn’t really [00:37:00] foresee
Tove: and, and think about.
Meg: Yeah. It’s an unbelievable, a massive journey you’ve been on. Kath, before we go maybe are there a couple of words of wisdom that you can give to Tove on that transition to going home, maintaining her milk supply? How often should she come in? What should she be doing at home to maintain it?
Meg: I mean, is there, are there any little pearls of wisdom you have for that?
Kath: So, yeah, I think that, we, I dunno what the policy there, but we are very open to moms having a milk stimulant, which , helps the hormones just to increase the milk supply. And our gynea are very open and willing to prescribe it. And I think for our prem moms, especially over this transition period of going home before you establish a routine I think it’s really helpful to have that because it just helps produce.
Kath: Bit of extra milk and just gives you that support. And then the other thing is just your own nutrition. So, just having enough liquid intake, taking a shake is a really, really good idea.
Kath: So I often will prescribe a [00:38:00] shake for our moms so that they eat their breakfast, lunch, supper, have their two snacks, and then shake as well on top of it. And so you can, whatever, I don’t know what sort of shakes are available there, but a good balance check like an Ensure is really, really a good one that you can just use.
Kath: You might have
Kath: one.
Tove: that, is, is that just like a, like a protein shake? Is there
Kath: so it, it’s got protein. It’s, it’s a balance shake, so it’s got all the nutrients and it’s a complete meal in a glass, but you can have it in addition to your meals. You really want to be with your baby in the day as much as what you can be. I know you do have two other children at home, so I do appreciate that, but we really find that the speed at which the baby goes home is often determined by about the amount of time that a mom is able to spend in the unit with with her baby.[00:39:00]
Tove: Okay.
Kath: So the more time you are able to spend with your baby in the unit. The quicker you’ll find your baby grow and you able to take your baby home.
Tove: If you had to say to a mom, you can only go in once a day. Stay here and hide quietly, hide in the corner until they kick me out. But, but in theory, if mom said I can only go in once day for a period, is there like a feed that, that is like the best feed to be part of a morning feed or an evening feed? Like, is there one that outweighs the other?
Tove: Does it really just make no difference? your kids’ routine?
Kath: I find that the very busy time in the units is in the morning when the doctor’s on rounds and everything like that, and then it’s not such a nice time for you to be there because they’re so busy with your baby and the ward is busy and then it like has a lull between kind of mid-morning and mid afternoon.
Kath: And that’s often a nice time over that time to actually be [00:40:00] there with your baby and to see if you can do it over, say two feeds where you can be there for would be my, my advice. So come just before like the mid-morning feed and go just after the mid afternoon feed, if that’s a possibility.
Tove: Okay.
Meg: Wonderful advice, Kath. And you always deliver such science with so much compassion and do such incredible work with the preemies. Really a huge thank you for sharing your time, not just with Tove, but with all the moms of preemies who are listening to this episode. And then also shout out to the moms who are listening.
Meg: If you’re listening to this and you’re hanging on every word, it’s because you are living it at the moment and Tove articulated a little bit of what that feels like. And of course for many people the journey could be very different ’cause you might not have a healthy baby.
Meg: It might be really very different. So to our prem mommy’s a big shout out to you. And then, and just a big thank you to Tove. I mean to, this is a journey that certainly I know you well. You, you are fairly a type And have had, had to have your, and have [00:41:00] had to have your world upended a couple of times with, with a special needs child and now with a prem baby and you just do it with such grace.
Meg: So, yeah, really lots of care for you as well.
Kath: Yeah, absolutely.
Tove: Thanks Kath. Thanks Meg super helpful, some really awesome tips there! Im going to go and make my way and start bossing.
Meg: I have no doubt. Wonderful. Excellent. Thank you very much everybody, and see you next time.
Tove: Thanks. Bye.
Meg: Bye-Bye.
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