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Book Review: Resources for Counseling the Parents of Premature Babies

by Gwen Gotsch. Schaumburg, IL USA: LLLI, 1999

Breastfeeding Special Care Babies
by Sandra Lang. Bailliere Tindall, 1997

Breastfeeding Your Premature or Special Care Baby: A Practical Guide for Nursing the Tiny Baby
by Marsha Walker, RN, IBCLC. Lactation Associates, 1998

From: LEAVEN, Vol. 36 No. 5, October-November 2000, p. 103
Reviewed by Ann Calandro
Waxhaw, North Carolina, USA

LLL Leaders receive calls about all kinds of helping situations. One of the most poignant calls received may be from mothers seeking information about breastfeeding their hospitalized premature babies. Leaders have a wealth of information to share from the BREASTFEEDING ANSWER BOOK. However, a mother of a premature baby may be experiencing many different emotions, such as guilt, anger, fear, or helplessness, so she may need information in small increments. A written guide filled with helpful suggestions and up-to-date information, available when she has time to read and absorb the information, may be exactly what such a mother needs.

LLLI recently published a guide for mothers of premature babies: BREASTFEEDING YOUR PREMATURE BABY by Gwen Gotsch. This is an excellent resource, ideally a part of every Group Library with another copy available for sale.

BREASTFEEDING YOUR PREMATURE BABY begins with the basics of breastfeeding, describing why human milk is especially important for the development of early babies. It proceeds in an orderly way with a discussion of how breastfeeding, milk expression, and breast pumps work. There are excellent recommendations on how to safely pump and store human milk, for dealing with sore nipples, and for coping with a diminishing milk supply.

This thorough sixty-page handbook doesn't ignore the emotional side of parenting a premature baby either. It realistically addresses the normal feelings and concerns parents may experience. For example, there is a whole section about beginning breastfeeding that contains lovely black and white photos and tips on early feedings. Kangaroo (skin-to-skin) care is encouraged and illustrated. Test weighing and supplemental methods of feeding are also explained. Finally, the last chapter is full of practical advice for caring for the baby at home, including resources for the mother to help her find LLL, pump rental companies, and donor milk banks. The book is referenced as well so mothers may do further research or share the medical journal articles with a baby's health care providers.

I have already had one really exciting experience with this book. A nurse came to my office telling me about her sister who had given birth prematurely in a small rural hospital. She was seeking help with breastfeeding. I sent a copy of BREASTFEEDING YOUR PREMATURE BABY and provided information about renting a hospital grade breast pump. (This hospital did not own a breast pump, have lactation services, a nearby LLL group, or health care providers who were familiar with breastfeeding.) Several weeks later, the nurse returned to tell me that her sister read every word, shared information with her health care providers, and was now successfully breastfeeding her little boy. Never underestimate the power of a determined and informed mother, armed with an excellent reference!

Another useful resource for parents of breastfeeding premature babies, Lactation Associate's sixteen page booklet, [i]Breastfeeding Your Premature or Special Care Baby: A Practical Guide for Nursing the Tiny Baby, [/i]written by Marsha Walker, RN, IBCLC, was newly updated in 1998. This pamphlet would also be a useful guide for parents of premature babies. It explains many of the same topics as the LLLI book, but without as much detail. It includes several helpful black and white illustrations of latch on, dropper feeding, supplemental feedings, and gavage feeding. Walker encourages frequent and thorough pumping to rapidly build the early milk supply. She also recognizes that mothers go home with unique babies and varying milk supplies, so she has written feeding plans with different scenarios. For example, there is a feeding plan for a mother who has plenty of milk and whose baby is nursing well; another for a mother whose baby has received mostly bottle feedings in the hospital; and a different plan for the mother who has a low milk supply but whose baby feeds well.

Walker has included a useful list of resources at the end of the pamphlet, including information on LLL. I particularly like the lists of sources for premature baby clothing. Parents of little folks are always interested in finding some clothing that actually fits!

A third resource in the LLLI Bibliography is [i]Breastfeeding Special Care Babies[/i] by Sandra Lang. This book, published in Great Britain, is a rich source of information about premature babies and parents but is geared toward health care providers caring for tiny babies. The introduction states that "this is a book about breastfeeding in adversity!" Particularly useful are the discussions of the development of feeding ability along with helping the mother position the baby at the breast. Also well addressed are oral stimulation of the baby, teaching hand expression, breast massage, and cup feeding. There is also a discussion on nursing a baby with cleft lip/palate. This book is more detailed and has more technical information than many parents would need, although some parents may wish to learn more. It is most appropriate for those who assist the parents in the hospital - the nurse, the lactation consultant, or the physician.

Some of what Lang writes may be controversial such as that babies who are settling well at the breast, have 4-6 wet diapers a day, and are gaining weight, are getting enough milk. She does not mention stooling, which LLL and many professionals feel is most important. She also disagrees with test weighing after feeds, a tool many nurseries have found useful for assessing intake. Frequently, nurses using an electronic gram scale will discover that baby really has taken in plenty of milk and does not need a supplement after nursing. Research has shown that intake is impossible to assess without a gram scale. Even the most experienced nurses cannot tell exactly how well a baby has fed.

It is wonderful that there are now thorough and insightful books available for parents, Leaders, and health care providers to aid in assisting premature babies to achieve successful breastfeeding. More and more mothers of premature babies are getting the information and support they need so that more and more mothers and babies can go home successfully breastfeeding.

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