Written by Aubrey Phelps, MS RDN PPCES IFNCP CLC
The chestfeeding relationship provides such a special, unique bond – one that so many parents-to-be dream about. I’ve successfully provided chestmilk to all three of my current children, but our journeys looked quite different. When pregnant with my second, for example, I never would have imagined that she would not only never nurse, but that she wouldn’t eat orally at all. Suffice to say, most parents who plan to chestfeed their babies don’t imagine that process involving a feeding tube.
Understanding and recognizing the grief these parents are often enduring, all while trying to manage keeping their tube-fed child alive and healthy, can go a long way in promoting both their successful chestfeeding journey, as well as the health of their tube-fed child. As I often explain, any kind of professional support needs to focus on parents AND babies, to nourish the parent, and to nourish the baby. In other words, parents who are struggling, exhausted, and in need of support are unlikely to care for themselves well unless their child is safe and thriving.
The first step in supporting a chestfeeding relationship between a parent and their tube-fed child is to recognize how very different this situation looks from the experience they imagined. When I exclusively pumped for my former preemie and tubie, I remember feeling so resentful. I hated that pump. I was grateful my body was at least able to provide her with chestmilk, but loathed being attached to the plastic flanges and tubes, like a cow being milked. I sat in my chair, chained there for 15-20 minutes, 8+ times a day. Sometimes I had to choose between stopping a pumping session and potentially compromising my output or letting my small, helpless little cry a few feet away. I couldn’t bend over to get her without risking spilling the precious milk. I couldn’t hold her while I pumped for fear that she would dislodge one of the flanges or kick loose a tube. I often couldn’t even hold her while her tube fed her the hard-earned milk because I was busy trying to get the toddler set up so I could pump immediately after. Between her tube feeds and my pumping sessions, I spent nearly 8 hours a day just trying to nourish my child, for 15 months. I set alarms to wake and pump every 3 hours overnight for fear my supply would be compromised if I missed even one pumping session. I sobbed when milk was accidentally spilled or I blearily forgot to put it in the fridge after I pumped.
And while this is not every parent’s experience, having some idea of the exhaustion and sheer willpower that it takes to pump for a tube-fed child will, in my experience and opinion, build the empathy and compassion necessary to support these parents in this daunting journey. So what can a pumping parent do to try to salvage some of the experience they hoped for and imagined would come with nursing a child?
1) Ask if this is what the parent wants.
Does the parent WANT to keep pumping? Do they WANT to be the sole source of nutrition? Or are they feeling pressured to do so? The best chestfeeding relationship is one that works for everyone, but some stick with it far longer than they wanted to out of sheer guilt. And that is good for no one.
If a parent wants to continue pumping and it’s important to them to supply chestmilk alone to their child, support that! Don’t offer alternatives or suggest that formula would be “easier”, etc., even if they’re clearly exhausted. BUT, if the parent expresses a desire to stop pumping, to reduce pumping, etc., encourage them to take care of themselves. Ask how you can best support them in that and make a plan together that works for everyone.
2) Skin to skin – lots! And as often as possible.
Much of the nursing bond comes from the close, consistent contact between the parent and the nursing infant. The parent’s body will still take cues from kissing their baby, from baby’s hormones, and from the intangible, still-being-discovered silent communications that take place between a parent and their child. Skin to skin promotes the development of all that unspoken communication, and also releases oxytocin, which can help the parent with milk production and lower both their and baby’s stress.
3) Non-nutritive suckling
Even if baby isn’t fully nursing, encourage the parent to allow baby to suckle at the chest, especially after pumping (so that baby doesn’t get overwhelmed by a full chest of milk if they happen to get some out!). This can be both incredibly therapeutic for the parent and it can help their body get a better “taste” of what baby’s body needs from the milk.
4) Encourage the parent to still hold her baby during tube-feeds
Snuggle. Do skin to skin. Rock. Pat. Nuzzle. Let baby suck a pacifier while dozing off nourished and surrounded by love. This promotes wonderful comfort and bonding between the parent and the baby.
5) Wear chestmilk Jewelry
Some parents may not be interested in this, but for me, my chestmilk piece is one of the most meaningful pieces I own. It’s a constant reminder of the effort I put in and the nourishment I was able to provide my children, even if feeding them didn’t look at all like I thought it would.
In short, practitioners and lactation support specialists can do so much to help parents to bond with their tube fed baby. We start from a place of empathizing with the valid disappointment that parents feel about how their baby is receiving nutrition, and then, we work to help them to know what is good for them and how they can continue to help their baby thrive.