Interview 04

Age at interview: 32

Brief Outline: Baby 7 weeks premature, incubator and special care, 4-hourly pumping/feeding schedule, milk dried up soon after going home. Discusses mixed emotions, kangaroo care, pressure to breastfeed.

Background: At the time of interview, this 32 year old, White British woman had a 2 year old daughter whom she had breastfed for 5 weeks. A civil servant, she was married to a member of the Royal Air Force.

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Married to a member of the British armed forces, this woman and her husband were stationed overseas when her baby was born seven weeks prematurely by Caesarean Section in a German public hospital. Because her baby was early she was unable to either attend antenatal classes or read the books on childbirth and breastfeeding that she had bought. Her baby was in an incubator and tube fed at first and eventually put to the breast for limited periods, test weighed before and after each feed, and topped up with expressed breast milk or formula through a bottle. Feeding was strictly only every four hours, fitting in with hospital routine, and the baby was 'trained' by the time she came home. This mother was encouraged to practice kangaroo care, skin-to-skin contact with the baby, but had not bathed her daughter before discharge. She is full of praise for the German nursing staff and the help she received while in hospital. The baby was discharged at 5 weeks old but with little professional breastfeeding help at home her milk soon dried up and she decided to formula feed. She describes her feelings of guilt, failure, disappointment and anger but says that breastfeeding doesn't seem very important given the enormity of the situation in which the baby's medical condition is paramount. She talks about using an electric breast pump to express breast milk, which, to her dismay, was sometimes discarded if not used immediately. She also discusses the pressure that is put on women to breastfeed by some health professionals.
 

She and her husband practised kangaroo care with their premature baby. The milk that she expressed was hard to come by and she did not like to see it wasted.

So she came early and because she was early she couldn't suck, she was fed through a tube immediately so I expressed milk, and got wired up to this very ancient contraption in the German hospital which was, which was very daunting, it's very off-putting, first of all the noise if anything else and quite painful but, not a horrible pain if that makes sense just a different, very different sensation that, that you, until you do it, you just won't experience anything like it. But it actually got to be quite soothing it actually got to be quite relaxing, you know, the noise of the machine once you got used to it. And because there was a sense of, you know, wanting Amy, willing Amy to get better, being in a Premature Baby Unit, and wanting to do the best I could there was always a reason for it so you just sort of got on with it. So it was, it was quite a lengthy process I managed to get her to latch on a couple of times and I managed to breastfeed either though expressing or, or directly for only about five weeks and then the, the milk supply just stopped.

Right. And what other things were you able to do for your daughter while she was in the incubator?

We would change nappie's, change clothes, you know, clean them, I never bathed her in the hospital I don't know whether they actually did that but I was never there at the same time as that, so that was quite daunting when we came home because I'd never bathed, you know, bathed a baby before, but the health visitor was on hand to help with that so, yeah.

And what about your husband was he able to do anything for your daughter at the stage?

Yeah he, because we had, I think we just had the one car at the time so I would go off to the hospital, to the Kinder Clinic and leave him without a car but then go home in the evening, meet with him after work and then we would drive back together for a couple of hours in the evening and obviously at weekends he could be there, yeah, so.

Was he able to take her out of the incubator and hold her?

Yeah we used to do what they called kangarooing and they have the lovely chairs that you sort of, could sort of relax back on and they used to just put this little bundle, you know, on your chest and then and it was so warm it was summer and it's sort of forty degrees but they would wrap them up in all these blankets but it was skin to skin contact, it was, it was absolutely delightful, yeah.

Can you tell me any more about that kangaroo care?

We did it I think, sort of kangaroo care every day and, but not for too long, they, you know, they didn't want them out of, the sort of almost like a sterile environment I suppose for too long, I suppose they didn't want to, enough for them to, to bond with you and to get used to your smell and then back in, but it was very relaxing.

Did your daughter go to the breast during that kangaroo care?

No, never attempted to breastfeed during kangaroo care, no it was completely, completely separate probably because you, you know, did the kangaroo care in-between your four hours and you were only allowed to feed, you know, at four hourly intervals so.

So the amount of milk that you were producing became quite important to you?

It did and what I found upsetting was that because I didn't produce an awful lot, I didn't have masses and masses of milk, I had enough particularly in the early days when she was only drinking small amounts, but you would find that you, they would put a ce

She described the routines in the German hospital where she gave birth. Staff members were supportive but breastfeeding was more regimented than would be the practice in the UK.

It was a German Public Hospital that they have a sort of agreement if you like with the British Forces overseas so the majority of the nursing staff spoke English. The set up over there is second to none, you could quite happily eat your dinner off the floor it's spotless and clean. The maternity ward has a separate nursery at the end with trained breastfeeding nurses that, that run the nursery so that if you, they don't in Germany encourage the child to sleep with the mother in hospital, they go to the nursery so that mother can have a good night's sleep. And they had a special breastfeeding room, you know, to express in or to feed your babies and the nurse is constantly on hand to help to show you how to, how to feed, how to hold them, how to get them to latch on, and if you had any problems, you know, with blocked ducts or anything at all they were there twenty-four hours a day on hand to, to help you out. It was terrific, until you left, you know, you came home and you felt, you know, a bit more isolated.

So did you set up some sort of a routine in the hospital?

Yeah you do, you have to work around their shift patterns if you like and also allow for the doctors making their rounds, so there were certain time when, when nursing staff were changing over shifts that you couldn't go because they obviously have to have briefings and, and things like that, and also we were very lucky in that our girls were only in there because they were, they were simply early and thankfully there was nothing wrong with them, whereas there were other babies there with, you know, significant problems which, you know, were far more important than ours. But yeah you sort of, they, they worked on a four hourly feeding pattern so we made sure that we were always there at the four hour point to feed, either breastfeeding or with bottles and just stayed all day virtually.

So was your daughter fed between those four hours at all?

No they're very regimented in Germany and they were fed every four hours and that was it, and during the day they didn't cry for feeds in-between so I only hope that they didn't during the night as well. But I mean when, when we brought her home she, she was trained, you know, I can't think of any other way to describe it and we just carried on in exactly the same fashion and I didn't need to feed on demand, I just fed at seven o'clock in the morning, eleven o'clock in the morning, three o'clock in the afternoon, seven o'clock in the evening and, and, you know, so it went on.

And nothing at night?

Through the night as well, just on that same pattern, yeah, seven, eleven, three. Yeah.

What sort of support did you have at that time?

In Germany? I had the support whilst I was in the hospital of the, the nursing staff there and when I got back home it's a very similar set up to the UK, you have a health visitor assigned to you, I had a midwife assigned to me, but I don't know I suppose they're there if, if you want them, they were, they were very helpful, my health visitor was lovely and she would call me regularly especially when Amy was still in the Kinder Clinic, and they're very encouraging but they weren't very what I would call hands-on, you know, I can remember speaking to the health visitor and breaking down in tears and saying I'm having trouble expressing and I'm worried about breastfeeding and, and they would just say things like, 'Well it's okay'. You know, 'Just keep trying and, and it will come'. And you think well no, you know, I need you to be a just a little bit more specific than that, and in the hospital, you know, we actually had nurses t

She had doubts about her milk supply and no support for breastfeeding her premature baby at home. She was disappointed when they moved onto infant formula at five weeks.

Five weeks. When she came home I continued to try to breastfeed her at home, but it didn't, I wasn't hugely successful, and without, you know, somebody there standing over you, encouraging you, and showing you more importantly and saying, 'Yes that's correct', I don't know because I suppose at that time you're just so tired and you're overwhelmed with everything and then, and then the milk supply just started to stop because I couldn't then even express, only, you know, only get a couple of ounces, and so I thought well perhaps I could have her at the breast and she could be latched but there's nothing, nothing there. And because you can't at home have the facility to weigh them before and after you couldn't tell how much she was getting so that's when I sort of moved to formula milk through a bottle. Which was disappointing but not heartbreaking because I think you're so concerned that they have something you don't think too much about necessarily where it comes from and I think I was quite satisfied that I'd done as much as I could, and I couldn't really do, you know, you can't magic milk out of thin air so you, yeah.

That was at that stage?

Mm-hm.

How do you feel about it all now looking back?

I got, I go through different per, well I used to go through different periods, I would think that, I felt a failure in certain aspects and I felt that I'd let her down and I, and I went through a mixture of emotions, you know, disappointed, upset, angry but now when I look back especially as our daughter is older and quite happily, you know, and well developed and, you know, doesn't seem any, any the worse off for it, I think I did, I did what I could, and I'm just glad that I tried, because the other lady that I met in the Kinder Clinic didn't want to at all and wasn't, and wasn't forced to and just didn't and I, for no other reason than she didn't want to and I don't disagree with that, you know, that's personal choice but I think well I did, and I did what I could and it maybe never went how I wanted it to, but.

How did you deal with those emotions at the time as they came up?

I don't know how I dealt with it, you just, I think you just do, and I think once you have a baby in Special Care every, everything else seems to just go out of the window because you focus solely on them and everything else just becomes irrelevant. I was quite lucky being in Germany because when you've had a section in Germany you can drive straight away afterwards. So I don't think you get in the mindset of, 'Oh gosh'. You know, 'I can't drive, is it because my scar is going to pop open? Or I'm very vulnerable, or?' You, you don't feel vulnerable at all because you, you know, you can get in a car and I had to drive to the hospital to see Amy daily, and I think that just takes over anything else, I think it catches up with you later on after the event, when I look back now I think, I'm surprised how well I coped.
 

Her baby was born prematurely in Germany and she called monitoring her growth a "numbers game".

I thought while I was in the hospital because there's a lot of pressure to, to do well and to bring your baby on, they put a lot of emphasis on breastfeeding not in a pressurised way but it was made to be very important and they were keen for her to latch on, they were keen for me to breastfeed, and I, at some point I can remember thinking 'Well if I don't, if I don't learn how to do this and I don't get their latch on, and she doesn't, you know, take a, a full feed from me that, that she's not going to be able to go home' and I can remember sort of breaking down in front of the doctor one day and being very upset and saying, you know, 'What's the problem?'. And I, you know, 'You're not going to let me take her home until I can breastfeed properly'. He said, 'No, that's not the case at all'. You know, 'She goes home when she's ready to go home. We would just encourage you to breastfeed because it's better for her'.

So what criteria were used for you to be able to bring your daughter home?

They, what they're looking for I think was maintaining a certain body temperature, reaching a certain weight, I think with premature babies there's always a possibility of jaundice, they like that to have sort of come and gone it, it's going to, and that they can suck well, and that they're feeding well, irrespective of how it's coming either through a formula in a bottle or, or from the breast. So temperature was a lot, we were forever taking Amy's our daughter's temperature by putting a thermometer up her bottom [laughs], which sounds awful and sort of praying that it, would it, you know, even out and it would all be okay and she could, she could come home.

Can you just talk to me a wee bit about your daughter's weight gain?

Mm-hm.

And how you did or didn't follow that and the importance that may or may not have taken?

It had a lot of importance for us because until she'd sort of reached a certain weight we couldn't bring her home. And they were weighed weekly and I don't know, feeding became a big issue, I think this from the very onset, you know, in order to get her home she had to be certain weight and, and that didn't, you know, that didn't sort of go once you'd got home, there always seemed to be weight limits that you're working up to, you know, when they're twenty pounds they can go in a forward facing car seat and, you know, when you're driving home from Germany you and your daughter's in the car seat looking the other way and you can't turn round and see them it's. So [pause] it's, I don't know I suppose it's all you think about, one minute they're drinking four fluid ounces, then it's six fluid ounces, then it's eight and then they drop a feed, you know, and then they do lose weight after they're born anyway. So it just becomes a big numbers game whether it's the time [laughs] or the amount they're drinking, or what they weigh.