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Premature Babies in Our Chinese Hospital

The hospital I work at is the largest in the county. All mothers from surrounding towns and villages are encouraged to have their babies in this hospital. Having said this, very high risk pregnancies and babies are referred to the main hospitals in the nearby city, Taiyuan. During my breastfeeding rounds, I have seen several premature babies. Most of these premature babies have been born between 34 and 36 weeks gestation. As soon as they have trouble maintaining their temperature, the baby is put into an incubator. Good thing is: the incubator is next to the mother… a huge advantage to the separation that happens in many of our Western countries. However, the incubator is still a true barrier. (Grand)parents are afraid to take the baby out of the incubator, afraid that the baby will get cold. The baby gets the bottle whilst in the incubator, no one holds the baby, no skin-to-skin contact, no breastfeeding. After a couple of days they might start pumping with a cheap hand pump. I have explained to the staff on the ward the importance of starting early pumping to bring in a good milk supply. I have offered the use of a double electric pump for mothers staying at the hospital. The hospital staff is apprehensive, so are the (grand)parents. Once the baby comes out of the incubator and mother’s milk has come in, they put the baby to the breast. No weight controls. No measures to determine if the baby is getting what he needs. Little to no follow-up after mother and baby are discharged from the hospital.

One day I see a mother of a 30 week old baby, weighing 1500 grams. Premature rupture of membranes caused this mother to deliver prematurely. I’m surprised that such a small baby is in our hospital. But he looks good. He’s not on oxygen, no nasogastric tube, just a tiny little baby in an incubator next to mother’s bed!!! After the stress since her membranes ruptured, the mother is now relieved that the baby is doing so well. And he is, really! On the second day after birth, mom started expressing milk with a small hand pump (one where you have to press a balloon to cause suction). She is now pumping 5-6 times a day and she tells me that she is pumping quite a bit (although she doesn’t know how much exactly). I have tried introducing feeding logs, but haven’t been successful yet. Anyway, mother pumps enough to provide the baby with all the milk he needs. That is good! I look at her breasts, they do feel a bit engorged and I wonder if this simple pump empties her breast sufficiently. I decide to talk to the doctor in charge later…

The baby hasn’t been to the breast yet, neither has the baby been out of the incubator. When I explain about the benefits of skin-to-skin for these premature babies and when I encourage her to hold the baby close to her breasts and let him smell, lick and suckle a little, I feel a lot of resistance. The mother responds with great surprise, almost shocked “The baby is too small and weak to take out of the incubator. His immunity is too low. No, we can’t take him out of the incubator.” I feel that I’m not going to get far with this young mother. All I can do is give advice. Today is one of those days where I wonder how much use my visits to the hospital are. Is anything ever going to change?

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