Expressions
transition to home nursing

By: JC Diamond
Finally the moment you have waited for is here. Probably you’ve had a few days warning to get ready. It is time to bring your baby home. Not all NICUs make successfully established breastfeeding (for those mothers who *are* breastfeeding) a criteria for discharge, so many mothers come home still needing to establish this.

You should plan on spending the first few days at home doing little other than nursing and tending to the baby’s needs. Even if your baby had an extended hospital stay, you are still just bringing him home, as though he were a newborn. Much of the advice given to "new" mothers is appropriate for you to follow:  eat and drink well, and get enough rest.

Some premature babies have a difficult time nursing while you are lying down. Try a large chair with a footstool…or sit up in bed propped up with pillows under your elbow and at your side to support the baby at the breast.  It is a learning experience for the both of you to find what works and what does not.

Finally being able to feed your baby in the privacy and comfort of your own home can be both a blessing as well as a cause for worry.  Some babies will actually pick up breastfeeding quite quickly at home..where they are offered the breast at every feed instead of just the ones where the mother is there at the hospital.

Valerie writes: "Breastfeeding went well at home and still does. One of the nurses at the NICU said that Emma would pick it up quickly when she got home and was offered the breast for every feed. Within two days she had it down. "

However, some babies may not be strong enough to nurse at every feed and may need to be supplemented by either a bottle, an SNS or a cup. It is likely that you may have an elaborate schedule of pumping, feeding and supplementing that leaves you little time for anything else. Perseverance is the key.

Maureen writes: "I would nurse him with the SNS for an hour, then give him a bottle for 10 - 15 minutes. then I would pump for twenty minutes and wash all the equipment. Then I’d have 20 minutes to rest before it all started again. Those three weeks were incredibly difficult."

JoAnn adds: "Breastfeeding went very well at home. No more people wandering in and out of the nursery. The breast/bottle routine in the middle of the night was hard.  I would have rather nursed (no dishes to wash) "

Once home, there are the additional stresses of being responsible for your child’s care, and being new parents. Even though you know the hospital wont release a baby before the baby is READY to go home, there are often lingering fears and doubts.

And when a baby comes home on monitoring equipment, nursing on your own without the NICU staff there can cause concern.

Barbara writes: "It was harder than in the NICU because he had to come home on oxygen. When they took him off his meds he would desat, so in the hospital he didn’t have the tube in his nose, just near by in case he needed it. At home that thing made him madder than heck."

Concerns about adequacy of the amount of breastmilk and the quality of the breastmilk can become an issue when a baby doesn’t gain weight as fast as the doctors would like to see. Your doctor may have you come in frequently for "weigh-ins" which while helpful, can also cause a great deal of stress. You may also be asked to supplement your breastmilk with high-calorie formula or breastmilk fortifier.

Seeking out a qualified lactation consultant can help if you run into problems, but be sure that the consultant has experience with the very special problems of nursing a premature baby.  Some advice that might work for a full term baby may not be medically appropriate for a premature baby.

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