The eating and weight-gain requirements for discharge were the trickiest, mainly due to the NICU’s asinine policy on feeding. I am a firm believer in feeding infants on demand – allowing them to eat when they are hungry, stop when they are full, and repeat as often as necessary. All babies in the NICU, however, are placed on a strict feeding schedule. Lucien was supposed to be hungry at 2:30, 5:30, 8:30, and 11:30. First of all, Lucien has no sense of what a scheduled mealtime is, or how to read clocks. He is simply hungry when he is hungry. And three hours is a very long feeding interval for a newborn. He had –and still does have – a small stomach, which means that he eats small and frequent meals.
But in the NICU he was only allowed to eat once every three hours, and at each feeding he had to consume 50 mL of breast milk. 50 mL is larger than his stomach capacity. It is an entirely unnatural system that worked contrary to his physiology and hunger cues. He would occasionally wake up before his scheduled meal time, giving hunger cues and eventually crying from hunger, and if the nurses were around there was nothing I could do about it except try to soothe him back to sleep.
(If they were not around I would surreptitiously pull him out and give him a quick snack. Not exactly the relaxed bonding experience that I had hoped early nursing to be, but it at least took the edge off his hunger. I got caught once and got a talking-to, but I kept it up anyway. The only reason they could give me was that letting him snack made it more difficult for them to keep track of his total intake, and that was not a sufficient reason for me to let my newborn son cry and scream in hunger.)
And then when he did have his scheduled meal, he and I had a time limit – 20 minutes and he had to go back into his isolette. He was not the most efficient nurser in the first days of his life (as I would have expected), so getting a full meal took a little bit more time than that. And besides, nursing is also supposed to be an enjoyable bonding experience between mother and child. One night when my least favorite nurse was on duty (we called her Nurse Ratchet.) she told me to pull him off the breast when he was still nursing. I categorically refused, so she lectured me and stood over me, watching, for however many more minutes Lucien stayed latched.
On day four I had to harass three different nurses to get his feeding tube taken out, but it was finally done! It felt like such a victory for me, and such a huge step towards getting him home.
This same day a wonderful nurse came on duty, somebody who I considered a real ally in taking care of my son and getting him home with me. She explained the hospital policy about how all babies have to nipple all feedings and meet their required minimum of milk intake for 48 hours before they are allowed to go home. She also explained that getting my expressed milk out of a fast-flow bottle nipple would be a lot easier and quicker for him, and if I wanted to be sure that he got all of his feedings maybe I should use a bottle instead of trying to breastfeed. It would have been extremely difficult for him to get his minimum in at the breast with only eight scheduled 20-minute feedings per day.
I knew she was right, but I had always sworn that no child of mine would ever get a bottle, so it hurt a bit to agree to go along with her plan. But I did, and pumped and gave him a bottle, and he ate everything that he had to. I cried because it was so far from the natural bonding experience that I wanted, because I knew full well I was disturbing his natural hunger and satiety cues, and because I felt like I was stuffing a foie gras goose instead of nourishing my baby.
He took all of his feedings, though, and we only had one hurdle left – we had to prove that he was gaining weight. His last full day in the NICU he gained 5 grams. Not surprising that he had a bit of trouble gaining weight, considering how not relaxing and not natural his feeding environment was, but it was enough to get us home. My favorite nurse was there when we were discharged. Nick and I both thanked her profusely, and she told me to go home, toss the bottle, and nurse my baby on demand from my breast. Which is exactly what I did. And lest you worry about his slight weight gain, since returning home and switching over to on-demand breastfeeding, he has been gaining an average of 1 ½ ounces per day – over 40 grams, or eight times what he was gaining with the NICU policy.
It was only six days we spent in the NICU – a very short duration for a baby of his gestational age – for which I am incredibly grateful. And though the first days after birth are very important as a bonding period, six days is still a short period of time in the grand scheme of things. As my parents encouraged me, now I can go home and nurse him on demand for the next two years if I want. And that is exactly what I intend to do.