Babies & newborns Sunnybrook Magazine – Fall 2016

Improving outcomes for NICU babies through breastfeeding peer support

Alexis Danford (above) with her daughter Reylene, who was born at the NICU 15 weeks early. (Photography by Tim Fraser)

Alexis Danford was only 25 weeks pregnant when she went into labour. Born at Sunnybrook almost 15 weeks early and weighing less than two pounds, her daughter Reylene faced a range of serious health problems, including life-threatening breathing, heart, brain and eye issues.

Fortunately for the new mom and baby, the Neonatal Intensive Care Unit (NICU) at Sunnybrook’s Women & Babies Program was running an initiative that brings in breastfeeding peer counsellors to help and encourage families like hers. Breast milk is especially critical in the care of premature infants, as it promotes healing, growth and development and decreases the risk of life-threatening infections and conditions. Yet, mothers of preterm and critically ill infants face unique barriers and challenges to breast-feeding.

The NICU Peer Counsellor Program aims to increase the percentage of premature infants who are exclusively breastfed on the day of discharge. The program is part of a study through Sunnybrook’s Breastfeeding Centre of Excellence: it opened last year as the first of its kind in Canada. The program’s goal is to promote the exclusivity and infants, with a particular focus on “micro-premature” (born before 26 weeks) infants. The study found that bringing peer counsellors – moms who are themselves graduates of the NICU – into the unit increases breastfeeding rates in new moms who are having trouble breastfeeding.

“Having a peer counsellor to help support me with my breastfeeding experience was integral to achieving my feeding goals,” says Alexis, 25. “I had to pump every two hours for the first three months of Rey’s life. I was getting my supply up for when we were ready to start trying at the breast. During this time I was often exhausted and sometimes felt overwhelmed, but my counsellor would make a point to recognize my efforts and motivated me to keep going. I’m grateful to have had such strong support.

Alexis Danford with healthy, happy Reylene

“I’m grateful to have had such strong support,” says Alexis Danford (above), of having a peer counsellor during her daughter Reylene’s time in the NICU. (Photography by Tim Fraser)

“Three days after my daughter was born, still in shock and terrified, I met Ophelia Kwakye in Sunnybrook’s NICU Family Room. She introduced herself to me immediately and invited me to join her and the rest of the NICU moms for the weekly Mom Lunch,” adds Alexis, a freelance multimedia producer from Barrie, Ont. “From that day forward, she made every effort to encourage, support and help me in any way possible. She was someone who truly understood what we were going through and assured us that there was a beautiful and joyful end in sight.”

Kwakye gave birth to her own son 15 weeks early. He stayed at Sunnybrook for almost four months, battling infections and pneumonia, and requiring three blood transfusions. Kwakye credits NICU Parent Support Specialist Kate Robson with getting her through the trying time.

It was Robson who later approached Kwakye to see if she would be interested in becoming a peer counsellor herself. It’s a part-time job for Kwakye, who now spends her days working with moms in the NICU.

“I go in the unit, room to room, and talk to moms about how to pump every two to three hours and how to maintain your milk supply,” says Kwakye. “I also encourage them about what happens around here and how to take care of themselves. I ask them about what they’re doing and share how they can do better.”

“We truly are blessed and grateful for all that the entire amazing team in the Sunnybrook NICU did for our family.”

– Alexis Danford

When it comes to preterm babies, and micropreemies especially, breastfeeding is truly life-saving, says Jo Watson, chair of the Breastfeeding Centre of Excellence and operations director of the Women & Babies Program.

Breast milk promotes healing, growth and development, and decreases the risk of life-threatening necrotizing enterocolitis (a condition that affects the intestines), infections and time spent in hospital. It also improves motor outcomes, cognitive skills and neurobehavioural development.

“When a baby is born premature, the composition of the milk actually changes from the characteristics that a full-term baby would receive,” says Watson. “It’s higher in fat, because what that baby needs is a higher fat content to support the final growth of the brain that would have happened in the uterus. Breastfeeding also reduces the risk of sudden infant death syndrome, and premature babies are at higher risk for it.”

Watson developed the program after seeing similar initiatives elsewhere with successful outcomes. “The opportunity came up to apply for funding through the Government of Ontario and the support of the Best Start Resource Centre at Health Nexus to have an improvement project specifically focused on supporting breastfeeding in populations that had lower breastfeeding rates,” explains Watson. “I knew this model had worked in other centres, so we thought that we would introduce peer counsellors into the NICU and see if we could improve breastfeeding outcomes.”

Mothers of complex or critically ill pre-term infants encounter  a variety of unique breastfeeding barriers and challenges that can make it difficult to initiate and sustain breastfeeding. Many have to pump their milk up to 10 times a day for many weeks before the baby can be at the breast, Watson says. “Not only are you pumping around the clock, but you also have a sick baby in an intensive care unit. A lot of women have to travel a long way to get here and get home. They may have other kids at home. There are all kinds of challenges. It’s hard to maintain that routine for weeks and weeks,” she says.

According to Watson, the national average for babies receiving only breast milk on the day of discharge from an NICU is 40 per cent. “Our rate was already at 70 per cent, so we were doing really well in comparison with the rest of the country, but we thought we could do better, and we knew there were still opportunities,” she says.

Ophelia Kwakye, peer counsellor in the NICU

Former NICU mom Ophelia Kwakye is now a peer counsellor, advising new moms on breastfeeding their preemies. (Photography by Doug Nicholson)

While rates for breastfeeding exclusivity at Sunnybrook for 2013 indicated that preterm infants are less likely to be exclusively breastfed at discharge than their full-term counterparts (68.3 and 76 per cent, respectively), thanks to the peer counselling program at Sunnybrook, that rate has increased to 75 per cent.

“I fiercely believe that Ophelia was an integral part of not just surviving the NICU, but [also] flourishing in it,” says Alexis. “The empathy, insight and information she was able to provide as a graduate mother herself were intrinsic and incomparable.”

Now almost five months old, Reylene is doing phenomenally well, says her mother – thanks, she adds, to Sunnybrook’s Peer Counsellor Program and the centre’s exemplary practices.

“Considering we had prepared for the worst, to now be home with a beautiful, healthy baby girl is both astonishing and humbling,” says Alexis. “We truly are blessed and grateful for all that the entire amazing team in the Sunnybrook NICU did for our family.”

About the author

Catalina Margulis