Remember those 3 things that babies have to accomplish before they can go home from the NICU? They need to be breathing on their own, without any spells. They need to be able to hold their body heat. And they need to be feeding on their own and gaining weight.
Audrey had accomplished most of the breathing requirement at Mount Sinai, arriving at the Level II with no breathing apparatus. As her brain matured, the spells slowly disappeared. And then, about 2 weeks into her Level II stay, I arrived to discover that she had been moved to a cot successfully. That was an exciting day. All that remained was feeding. But that turned out to be a huge obstacle in ways we hadn’t imagined.
When we arrived, Audrey had just started to work on NNS: non nutritive sucking. Basically, she was learning to breastfeed but wasn’t actually getting milk yet as she wasn’t strong enough. She soon started to get some milk, but not enough. That was when things got tricky. Somehow, they had to determine how much they should “top up”, using her tube. At our Level II, they used a weighing method, whereby you weighed your baby before and after every feed. It was assumed that the difference in grams was the equivalent of ml’s that your baby had taken in by self feeding. That was deducted from the “full feed” and the difference was then “dropped” into her tube. The math (hardly my strong point) was done by me.
Audrey was slow, and the feeding process took about 45 minutes (including the “top up”). She was on a four hour schedule, so four hours after the feed began she was fed again.
It was a struggle. She just didn’t seem interested. I started to suspect that she was too full from the previous feed. The doctors were saying that she simply wasn’t taking enough. They had figured out a “full feed” based on her weight. I was working with the lactation consultant (LC) on a nearly daily basis but progress was slow. I asked about moving her to “ad lib” (removing the tube feedings and seeing if she could get enough on her own) to eliminate the potential hunger issue,but encountered resistance. The LC encouraged me to be patient saying she was “such a small baby”. Of course, by this time, Audrey was over 4 lbs, more than double her initial size: hardly small to me!
Then, on January 22, I fed her and lay her down in her cot. Her feed was dropped, and I hurried off to pump, as it was still necessary and my only chance. I emerged from the pump room about 15 minutes later to discover the nurse practitioner and about 4-5 nurses crowded around her bed. For the second time in her short life, I saw my baby blue, but in this case she was an ashen grey. The nurse practitioner had “bagged” her and was administering oxygen. I rushed over and asked what happened and was told she had a spell. I stood by her, stroking her head and telling her it was okay. The nurse looking after her told the nurse practitioner that she had discovered a large amount of milk in her mouth, perhaps she had choked. And another nurse looked at me and asked, “Didn’t you burp her properly?”
Those five words hit me like a blade. Could I have done this?