Supportive role boosts breastfeeding in the NICU

Luisa King and Beth Nolson pop in and out of patient rooms in Sunnybrook’s neonatal intensive care unit (NICU). Their daily visits can be as short as five minutes, a quick hello and check-in with families to see how they’re doing. Often the visits are longer, especially if a mother is having challenges pumping enough milk, or needs extra support.

As registered nurses who have worked bedside in the NICU, Luisa and Beth are also Lactation Consultants, two perspectives which bolster their current role as Breastfeeding Resource Nurses. Luisa and Beth help mothers adjust to the NICU and recognize their importance in helping their infant through the provision of breast milk. The role extends to helping educate staff, families and their support networks. There is also a focus on fostering safe, effective feeding for the infant and promoting and supporting developmental care that helps prepare the infant for feeding, starting with early Kangaroo Care.

“We help reaffirm the importance of mom and dad’s roles in their baby’s life at a challenging time, and try to boost confidence in caring for their baby,” says Luisa King. “These babies often arrive before prenatal classes and baby showers, and so many other things that happen with a full-term delivery. We reassure moms that you do have control, through things like making milk for your baby, and holding your baby. No one else can do these things.”

“We help reaffirm the importance of mom and dad’s roles in their baby’s life at a challenging time, and try to boost confidence in caring for their baby”

Luisa and Beth work closely with mothers to help create and sustain a milk supply. NICU mothers must rely on a breast pump, instead of a baby at the breast. This, and the stress of having a baby in the NICU, can make establishing and maintaining a milk supply particularly challenging.

“We get to know the mom’s wishes and what she wants, and because we have a trusting relationship with the entire neonatal team, we can help ensure reasonable expectations for feeding,” adds Beth Nolson. “Since Mom knows her baby best, she is a valuable asset to the entire neonatal team. Together we can find the appropriate strategies to help establish feeding.”

The Breastfeeding Resource Nurses create opportunities for family education related to having a premature baby. A weekly “Milk and Cookies” session sheds light on other areas of interest for neonatal families, and draws in the interdisciplinary team. Head ultrasounds, eye exams and tips for when it’s time to bring baby home are examples of topics covered by physicians, pharmacy, dietitians, nurse practitioners, physiotherapists and other members of the NICU health care team.

Discharge presents a new environment and challenges for families, whether in a step-down unit at a new hospital or at home, and the Sunnybrook team wants to see best practices continued.

Luisa and Beth work diligently to share evidence-based strategies with other hospitals. In the spring of 2015, Sunnybrook launched a Kangaroo Challenge recruiting hospitals internationally to encourage as many skin-to-skin hours as possible. For the preterm infant, skin-to-skin contact is an opportunity to foster normal brain growth and development. In the hospital, caregivers can observe better weight gain, more settled infants who display stabilized body temperature, heart rates and oxygen saturations, as well as the opportunity for deeper attachment between infant and parent. As the infant continues to grow, leaves hospital and continues their journey at home, the value of skin-to-skin becomes clear as infants and young children optimize their potential.

For Luisa and Beth, the bottom line is the health and confidence of the mothers, babies and families in the unit. “We’re both NICU nurses and lactation consultants. We have the medical background, which gives a framework for our understanding of the unique challenges in feeding a preterm baby. Our greatest joy is seeing moms, dads and babies being reconnected by skin-to-skin and being supported to meet their feeding goals,” says Luisa King.