Breast-Feeding For Preemies

Jameca Benjamin was scared to even hold her premature baby, who weighed just under 2 pounds. The nurses were urging the teen mother to breast-feed - yet Benjamin had never known a woman who'd breast-fed a healthy baby, much less one hooked to machines in intensive care.

Breast milk is babies' perfect food. It's even more important for the most vulnerable babies, those born smaller than three-and-a-half pounds. But they're the least likely to get it, especially if they're born to low-income or black mothers.

Now specialists are targeting frightened mothers of the smallest preemies to try to change that, with strategies that range from free breast pumps to bringing breast-feeding "peer counselors" into the intensive care unit to train moms to nurse.

"This baby has all these tubes, and they're so small. It's scary," says Benjamin, who now is the first salaried ICU peer counselor at Rush University Medical Center in Chicago, part of a study to see how well the training program works. "But when the baby does well and is sucking, they're surprised, and it's a good experience."

She remembers watching her own daughter, now 4, fatten up. "It's a good feeling to say, 'I made this baby grow."'

Such programs are a big change for neonatal intensive care, brought about because of research in just the last few years proving that breast milk markedly lowers the chances of infection and a life-threatening bowel inflammation in very low birthweight babies.

At Rush, 97 percent of the smallest preemies are breast-fed for at least a while - far better than the national average for healthy babies - and 64 percent still get some breast milk once they go home.

"We emphasize to the mothers how the milk is really a medication for their babies," says Paula Meier, a Rush nursing professor who heads the hospital's lactation program and recently published its techniques in a medical journal.

The American Academy of Pediatrics recommends that babies be breast-fed exclusively for the first six months. Breast-fed babies suffer fewer illnesses such as diarrhea, earache and respiratory infections; their brains seem to develop faster; and they may be less likely to develop asthma, diabetes or get fat later in life.

The government's goal is to have half of mothers following that advice by 2010. Today, 70 percent of mothers initiate breast-feeding for the first weeks of life, but only 33 percent breast-feed for six months. Even fewer black mothers do, 22 percent.

Those figures track all babies; there are no national statistics on the tiniest preemies. Some hospitals, however, report rates than range from 20 percent to 80 percent of preemies receiving at least some breast milk, says Meier.

Undoubtedly, these mothers face more hurdles.

At first, they must pump their milk - babies so tiny can't suckle. The milk is stored and dripped into a stomach tube.

Often they're told to skip the more watery first milk from each pumping for the more fat-laden hindmilk. At Rush, Benjamin helps teach mothers to bring in milk with about 30 calories per ounce, measured by putting a few drops into a machine called the creamatocrit.

As soon as babies are taken off the ventilator, they'll get their first taste, just a drop or two, of milk while carefully cradled at mom's breast. As the babies strengthen, they'll learn to suckle and regular breast-feeding can take off, Meier says.

But the challenges are more than medical, and that's where peer counseling comes in. While often offered to mothers of full-term infants, only a handful of hospitals are experimenting with peer counselors in the neonatal ICU. Meier calls it particularly effective for low-income black women, who are most likely to have very low birthweight babies but less likely to have relatives or friends who can offer breast-feeding advice.

It can cost $1 to $2 a day to rent an electric pump; some hospitals and health departments, including the Rush Mother's Milk Club, provide free pumps for low-income women. And establishing a good milk supply means pumping every two to three hours, hard for mothers trying to hold a job.

Benjamin had her daughter, Jamia Johnson, at age 17, and says she would have opted for easier bottle-feeding had Rush nurses not declared breast milk best. Benjamin's experiences pumping while working at McDonald's and on her high school diploma encouraged Sene Garrett, a bus driver, that she could make breast-feeding work, too.

"Jameca just kept on me, ... telling me, 'Your baby needs everything from you,"' said Garrett, of Sauk Village, Ill., who learned to discreetly pump while sitting alone on her bus. Last month, she brought 5-month-old Jamari home from the hospital, a healthy 6 pounds, five more than at birth.