Mary, so sorry you had this terrible interaction.  Either the pediatrician
knows something that you don't about the situation, or there is a big ego
problem here on his part. It sounds like you have worked so diligently with
this family.   I think sometimes the mother will share info with the MD
that they will not share with the LC in order to not disappoint you.  And
sometimes they share with the LC what they won't share with the MD out of
unwillingness to offend.   How was the baby's weight at discharge?  Wets
and stools?  Maybe mom gave more formula feeds than she is willing to share
with you, but she told the MD?  All just postulating.
I think the most important thing for you to do in this situation is to make
your honest recommendations to the family with the information that you
have, and then document everything. If the MD knows something that you
don't, your documentation will reflect the info that you have and be a
formal and legal representation of the advice you gave.  Will you have
follow up with the family post discharge?

Hope this is an infrequent or isolated problem.

Liz Dedman, MD, FAAP, IBCLC
Growing Healthy Children
Louisville, KY





On Wed, Mar 7, 2012 at 1:12 AM, mary westra <[log in to unmask]> wrote:

> Hi,
> I am needing to get some support and tips from fellow lactnetters.  I
> wrote about a day ago with questions pertaining to pumping and hand
> expression and whether to do both or just hand expression on day one for a
> non latching baby.  I want to thank everyone for the responses and
> resources that were provided to me.  Now I'd like to share a little about
> the case and with the interchange that I had with the pediatrician.  I am
> going to make a long story as short as possible.  The baby was jaw
> clenching, very little rooting with a bite reflex when any attempt at
> latching.  I did an oral assessment while finger feeding droplets of
> colostrum at hour of life 20.  There was little tongue movement.  Until
> that time, she had not fed and I was called into see baby and mother.  Baby
> was full term with no significant history other being suctioned after
> vaginal birth.  Mother was a primipara. Skin to skin maintained almost
> continuously. I worked with mother and baby for next 12 hours with no
> success.  Spoonfuls (or "puddles") of colostrum were fed from a plastic
> spoon. Total estimated intake about 12 ml.  By 10 p.m. (no lactation
> coverage at night) baby was over 30 hours old and vacillating between
> crying and agitated when trying to latch or deep sleep. Parents, nursing
> staff and myself worked a plan where mother would hand express or pump if
> unable to latch .  We also discussed using formula if unable to express any
> colostrum.  When I saw the mother the next morning she had given 2 feedings
> four hours apart of 10 ml of formula.  The pediatrician had been to see the
> baby and examined the baby for discharge.  He told the mother that the baby
> had been fed too much and that was why she was sleepy.  He told her not to
> feed the baby and that when she was hungry enough, the baby would latch on.
>  I then phoned the pediatrician, who I did not know, because I was
> concerned.  I relayed the above history to him, telling him my concerns
> about the baby not latching .  He then said "I don't believe you".  In
> retrospect I am not sure what he meant by that.  Did he think that I am
> such a great IBCLC that I can get all babies latched?  I don't think so.
>  However, I was taken aback by his remarks and I asked him to come in and
> latch the baby himself and he said he would!  Unfortunately, he did not
> keep his word.  I ended up telling the parents my advice which was against
> his.  But it was one that I felt safe with.  Basically, I think it is the
> advice that most of my peers would agree with.  Feed the baby (which
> includes judicious use of formula if needed)  and establish milk supply and
> follow up with lactation consultant and pediatrician.
> In over ten years of being an IBCLC working primarily with newborns in the
> hospital, this was a new experience.  I am usually trying to talk everyone
> out of supplemental feedings.  I have never had to tell parents that I felt
> uncomfortable with the pediatrician's advice to not feed the baby.
>  Something that really worried me was the father asking me how many days
> did I think a newborn could survive without eating.
> I'd like any advice from others as to how they have handled situations
> like this one and thanks for listening!
>
> Mary Westra, RN, IBCLC
>
>             ***********************************************
>
> Archives: http://community.lsoft.com/archives/LACTNET.html
> To reach list owners: [log in to unmask]
> Mail all list management commands to: [log in to unmask]
> COMMANDS:
> 1. To temporarily stop your subscription write in the body of an email:
> set lactnet nomail
> 2. To start it again: set lactnet mail
> 3. To unsubscribe: unsubscribe lactnet
> 4. To get a comprehensive list of rules and directions: get lactnet welcome
>

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome