I completed my group project for school, and presented it yesterday evening!!!! Hooray, it's done! Our group did FANTASTIC, our poster was fabulous, our presentation funny and engaging, and our written report well done. Phew! That took some TIIIIIME! In the end we did a poster on oversupply--so, not the sexual abuse topic I was considering, nor the other topic I mentioned that I can't remember now....BUT, interesting nonetheless. I can't get blogger to upload my poster, so I'll see if Brent can save it in a format where I can so you can all see. I learned a ton. I cried in frustration at one point. I was overjoyed when we were done. I would be willing to bet we had the best presentation in the class. Shazzam!
[yes, I did just say shazzam]
Hurrah! Now, only one more class and then the final exam, and I'm done! I also have a job offer out of the class--one of my classmates is going to become a Lactation Consultant and open her own private practice. She is worried about meeting the demand in our area and is looking for a partner. At first I thought she meant another LC, but then she said she would be happy to work with a breastfeeding counsellor as well, and then we sorted out that YEAH I'd love to work with her and YEAH she'd love to work with me (I'd take the simpler cases and she'd be available if I needed help, and we would let women know that I'm not an LC), so that has potential to turn into something great! Something I could totally use one of my awesome name suggestions you guys gave me for!!! It's got potential, anyways.
And I need to debrief. I've been avoiding this because it's not so nice, to think about, write about, or respond to, and y'know, it could be considered slanderous if anyone from a certain NICU read it. But I have to debrief, and it's been percolating for awhile.
I went for a clinical observation day to a NICU in our area for the breastfeeding course.
The ward I visited was a 25 bed ward, and there were 25 babies. One incubator was empty because another bed had a set of twins cobedding in it. So the ward was pretty much full, and bustling. I was SO not impressed with the fact that I was supposed to 'float around' instead of being assigned to a nurse, because when I tried to introduce myself and observe, all the nurses said a friendly "Hi!" and then ignored me. Attempts to ask questions were either obviously unwelcome or met with short answers and backs turned. One nurse shooed me away because she was "too busy." I hated it. How am I supposed to learn in that kind of situation? The breastfeeding support I saw was in the realm of sabotage and setting up for failure with poor breastfeeding practice, information, support, and promotion. One woman was trying to breastfeed her jaundiced, full term baby, but the nurse kept giving the baby bottles of formula every time the woman left the ward. Most women with premature or sick (overwhelmingly both) babies were pumping, but a bottle of formula was set at every bedside and I'm positive they were used. One formula feeding shifts the pH of a baby's bowels to a more basic environment, making it a more hospitable environment for pathological bacteria to grow [with constant breastmilk feedings the pH returns to a normal acidic environment in 3 to 4 weeks]. Premature babies are at particular risk for Necrotizing Enterocolitis, where parts of the intestines get infected and die, causing pain, illness, permanent disability, or sometimes death. Formula feeds increase the incidence and severity of NEC for premature babies. I saw quite a few incidences of formula feeding in NG tubes or bottles, and several incidences of breastmilk in NG tubes or bottles. Not one preemie was put to the breast while I was there. Not one baby was put skin to skin. And here is the worst part, which was so traumatic, and which had me crying while I was driving home. Knowing what I have learned the research shows about Kangaroo Care for premature babies, the effects of separation and stress on babies (long term health deficits) which are even more pronounced for premature babies, it was really, really hard to see these babies lying in their incubators with no visitors. While I was there, the jaundiced baby's mom visited twice to breastfeed, and looked prepared to set up camp after she herself was discharged from the maternity ward. A baby who had been in the NICU for three months had a mom visit for an hour, during which time she talked and touched him but was clearly petrified to pick him up or do any baby care (understandably so, since random things caused him to stop breathing for up to a minute at a time--but I'm positive the culture of the ward contributed to her total disempowerment and overwhelming anxiety when it comes to caring for her baby). And the twins had both mom and dad there for two hours. So that is three babies out of 25. Actually, four. That last one was a set of twins, so that's four. Twenty one babies had no visitors. Their medical needs were met, their feeds were done, their health status monitored, but they were not held, talked to, or loved on by family. My textbook says,
"Physical closeness can help reduce emotional stress for both mother and baby."
"[Dr. Nils Bergman] describes the baby's (and all other mammals') physical reaction when removed from his natural habitat [which is on the mother's body, on her chest, tummy to tummy], the "proteste-despair response," which is programmed into the baby's hindbrain to ensure survival by decreasing energy consumption and growth via lowering heart rate and body temperature and massively increasing the production of stress hormones. As part of this response, the baby also emits a "separation distress call" to alert the mother that her baby needs her. Once mother and baby are reunited, baby's heart rate and body temperature increase and stress hormones decrease.
Research has found that skin to skin contact of mother and baby reduces the production of stress hormones by 74 percent. High levels of stress hormones inhibit gut function, digestion, and growth. Dr Bergman observes that what is currently considered to be the "normal ranges" of heart rate, temperature, and stress hormones of premies in incubators reflect this "protest-despair response," and that what is truly normal needs to be redefined based on a premie's physiological norms when in skin-to-skin contact with his mother."
When I saw how few parents were physically present that day I was dumbfounded. I know parents. I know TONS of parents. They all love their babies! They all spend tons of time with their babies! They all hate separation from their babies! If their babies are sick they are hovering insomniacs. So, where are all the parents? Some parents were probably sick, caring for other children, sleeping, or any number of legitimate activities, and I was only there for five hours so that leaves a good 19 hours of day (although I doubt many parents visit at night) I wasn't there to observe. I think also that one baby had been born prematurely to a drug addicted woman and apprehended at birth, so it makes sense that she would have been alone if she had not yet been matched with a foster family. But what about the other babies? Alone in their incubators, quietly protest-despairing? As adults we know these babies are well cared for, safe, and the focus of concern for many adults, including family, nurses, doctors, interns, and students. But from a biological point of view, this baby feels that it has reached maximum danger: separation from its mother. It does not know that it is the focus of all this care, but senses danger because of separation from its natural habitat: its mother. And it is left in this state for hours upon hours upon days upon weeks, with minimal interaction with what it knows as safe.
We know from research by Nils Bergman that it is 100% possible to bring together the miracles of modern medicine that is keeping these babies alive, and the miracles of a mother's touch, which sustains and settles a baby so it can focus its energy on the overwhelming business of living and growing.
What I saw seemed overwhelmingly inhumane. It was cruel.
I don't blame the parents, or even the hospital staff, but I would allocate responsibility to the NICU subculture. Not one of the NICU nurses or doctors had any breastfeeding training, and most seemed to equate formula with breastmilk as an infant food. Not one of the incubators had a bed for a parent, and the chairs that were present were not comfortable to sit in for long periods, and definitely not possible to sleep in. The space was limited, and any breastfeeding that was done, the nurses quickly rolled over a screen for privacy, which is considerate if that is what a woman wants, but sends a subtle message that what she is doing doesn't really belong in this space, particularly if it is not something she wants. Which was the case with the woman whose baby was jaundiced: she kept rolling her eyes at me when the screen was wheeled over, and it made things really awkward for her as she obviously did not want the screen.
I have been to a great number of pediatric wards during my career as a paramedic, and ALL of them have a crib or small bed for the patient, and A BED OR PULLOUT CHAIR WHICH BECOMES A BED FOR THE PATIENT'S PARENT. Why are sick babies any less in need of the presence of a parent? Close proximity to its mother is the only safe place an infant knows. Just because their protests are in the protest-despair mode, we don't clue in to the fact that they are in distress. In the absence of the presence of its mother, AN INFANT KNOWS ITS FATHER'S VOICE AND MANNERISMS, and should be place in HIS arms, skin to skin, for safety and comfort as much as possible.
I know that this NICU performs miracles every single day, and saves the lives of these tiny babies. And I should really consider and appreciate this fact more. I should. I know it. But sometimes, saving a life is not enough. You have to do it humanely. REDUCE SUFFERING. Studies show that a breastmilk only diet, early and eventual exclusive breastfeeding, kangaroo care, and the constant presence of the infant's mother results in better outcomes for sick babies. Fewer get sick and die, fewer have setbacks, their setbacks are less severe, they go home earlier, they thrive better, their parents feel more competent to care for them, and they grow up to have healthier lives, higher IQs, and more stable mental health than their non breastmilk-only-kangaroo-cared-mother-present peers.
One plus one equals TWO! We could be so much further ahead if we put NICU interventions together with baby friendly practices. And then I wouldn't feel the NICU was so cruel and inhumane, and I wouldn't feel so sick at the thought of 21 babies in medically functional but socially and emotionally sterile environments. Not to mention all that formula. No donor milk available, just mother's milk and fortified hydrogenated cow's milk proteins.
Anyways. Maybe you all think I'm crazy, or just too sensitive. But I feel that I'm a fairly seasoned paramedic who has seen all kinds of suffering, and my radar was screeching with dissonance and empathy over what I saw in that ward. Nobody was abusing any babies or mistreating them when they moved them around, nobody was neglecting handwashing or heigine, and everybody had an attitude of bustling care for these tiny patients. There was no INTENT of cruelty, but I believe there was systematic cruelty going on regardless of intent. It sucked. And it's hanging around in my brain, and now on my blog. For you all.
Thanks for listening to me rant. It was really hard to see.