Guest blog post by Kim Ward.
Having a premature baby in the NICU (neonatal intensive care unit) is hard. When you are a vegan family, there are several things that might be challenging. Here is my guide to being vegan in the NICU, based on my own experience.
Human Milk Fortifier
The first thing that is likely to come up is the issue of HMF (human milk fortifier). Premature babies need extra calories and nutrients. Usually cow milk-based HMF will be added to your pumped breastmilk to make it more nutritionally dense, since preemies can only take in a limited amount of fluids.
Prolacta is a company that makes donor breastmilk-based HMF. You can request that Prolact HMF be given to your baby instead of cow milk-based HMF. Here is their website: http://www.prolacta.com/human-milk-fortifier/. Even if the hospital has never used Prolact HMF before, you can ask to speak to your baby’s doctor or the NICU unit manager to discuss ordering it for your baby. It is very expensive compared to the cow-milk based HMF so the hospital may only be willing to order it if you offer to pay for it yourself.
In my case, I started by calling the Prolacta sales representative and asking them what I needed to do to get it for my baby. I then asked to speak to my baby’s doctor about it. He raised the issue with the unit manager, who agreed to order it if we paid for it.
Fortifying with Formula/Exclusive Breastfeeding
When your baby is closer to going home, the next step is to switch from HMF to fortifying your pumped breastmilk with formula. The hospital will recommend a cow milk-based formula specifically for premature infants, such as Neosure, which is higher in calories and nutrients than regular formula. The only truly vegan option here is to try exclusive breastfeeding or bottle feeding your pumped breastmilk. If your preemie is not taking in enough volume of breastmilk to meet their needs nutritionally, your medical team will recommend fortifying with a formula by mixing it in with the breastmilk.
If your baby is losing weight on just breastmilk, you may need to consider using soy formula. Since it is not intended for premature infants, you will need to add more of it to get the same amount of calories as you would get from a cow milk-based preterm formula. Your doctor can tell you how many teaspoons of soy formula to add to your breastmilk. You may also need to supplement with extra minerals such as sodium phosphate for bone growth. Your doctor can do a blood test to see if this is necessary.
Unfortunately, soy formula is not completely vegan because it contains vitamin D3 from animal sources. If your baby is unable to use soy formula, there are dairy-free amino acid based formulas such as PurAmino by Enfamil. However, one of the amino acids in them is made from chicken feathers, so they are not vegan either. Be aware that there are also formulas that are advertised for babies who are allergic to dairy, such as Alimentum, but these formulas are in fact made from hydrolyzed cow milk, so the milk protein has been broken down enough for babies with allergies, but cow milk is still the main ingredient.
Before resorting to fortifying with formula you can also try putting your breastmilk in the fridge until a layer of fat forms at the top. You can then skim the fat off of this bottle using a spoon and add it to another bottle of breastmilk to make a higher fat breastmilk. This will add calories to your breastmilk which may help with your preemie’s growth.
Your baby will most likely be given a multi-vitamin specifically for infants, such as Pediavit. This contains Vitamins A, C, and D. Unfortunately it contains Vitamin D3 from animal sources, so it is not vegan. You can ask to have the individual vitamins made up by a compounding pharmacist instead. A compounding pharmacist makes prescriptions from individual ingredients and can make vegan versions of many things if you ask them to find alternatives to animal products.
For us, the pharmacist at the NICU was able to work with a compounding pharmacist in the community to get vegan versions of Vitamins A, D, and C for my baby when I asked for an alternative to Pediavit. Make sure you ask what they are giving your baby, because often they will not ask for consent first when it is considered routine, such as with vitamins. In my case, I thought they were giving my baby “Pedialyte” (electrolytes, which are vegan) for a while before I realized they were actually saying “Pediavit”. Once I realized what it was I asked for a vegan alternative.
You will be asked to try lanolin nipple cream many times by many different lactation consultants. Lanolin is an animal product made from sheep. There are vegan alternatives such as Earth Mama Angel Baby nipple butter http://earthmamaangelbaby.com/products/natural-nipple-butter, or you can use coconut oil. Just politely explain that you are vegan and do not use animal products when they offer you a free sample of the lanolin cream in the hospital.
Remember that this is likely the first time any of the NICU staff have dealt with a vegan family. We were lucky enough to have a doctor who was willing to listen to our questions and work with us to come up with a plan for our baby. You will come in contact with many different professionals, including doctors, nurses, dieticians, social workers, pharmacists, and lactation consultants. Politely explain that you are an ethical vegan who does not use animal products. You may need to be firm when advocating for your baby.
Remember that if one staff member is unwilling to work with you to find alternatives, you can always ask to speak to someone else. Although nurses and dieticians will be the first to speak to you about things like HMF and fortifying with formula, it is the doctors who make the final decisions about your baby’s care (with your input). If the dietician is not listening to your concerns, raise them with your baby’s doctor. You will likely be asked about being vegan on a daily basis as you get a new nurse each day. Think of a short respectful answer that might hopefully get them thinking about their own animal use. When asked why I don’t use animal products I always just say, “because I don’t want to hurt animals.”
About the Author
Kim Ward is a new mother, on maternity leave from teaching. Her baby was born prematurely at 28 weeks, and spent 77 days in the NICU. She has been vegan for 15 years. She is passionate about animal rights and feminism. She enjoys baking and travelling.