Have been working with a cute little girl, a little under 4 lb. and 36
weeks gestation. Mom had PIH.  Feeding orders were originally for nipple
feeds (although mom planned to breastfeed).  Yesterday I talked first
the day nurse then the night nurse (both reluctantly) to allow the baby
to breastfeed before the bottle feed.  I was told that she was required
to take 30 ml. of formula after the feeding.  Before I left, I
ascertained the time of the next feeding and instructed the mother (in
the nurse's presence) to come in at the specified time to breastfeed and
to ask her nurse to awaken her for subsequent feedings.  This she did.

This evening she willingly breastfed, but was stopped while still
actively sucking at the first breast because she had already gone over
her "time limit" and still had to take her 30 cc.  The nurse let me cup
feed it.  She reluctantly took her required 30 ml. in 15 minutes.  She
kept opening her mouth wide looking for the breast, which slowed the
progress of the cup feeding.  She obviously disliked the taste of the
milk.  When she reached the end of the required 30 ml., she was still
rooting.  I asked the nurse if she could be put to breast.  I was told,
"No, she can have more formula.  30 ml. is her minimum."  I replied that
she did not want or like the formula, but wanted to breastfeed.  I was
informed that if she breastfed, it would wear her out so that she
wouldn't take her next feeding.

I can see a reason for limiting attempts at breast, especially for a
baby who tires easily.  However, this baby was alert and eagerly
nursed.  Does this make any sense to anyone?  I know it is a widely held
belief among neonatologists and NNPs in our area that babies shouldn't
be held too much (even continuously by one parent) and that their
feeding times should be strictly limited while minimum amounts are
specified.  This means that these babies are FORCE FED (under the
euphimisms encouragement and chin support) bottles and denied access to
the breast!  I wonder how many of these children later develop serious
feeding problems.

Pumping breast milk and bottle feeding it to the baby is fine, of
course, and generally encouraged.

Time to put the soap box back under the computer.

Sandra Lang says that for some babies under 35 weeks an hour and a half
might be too long.  Any other good references on unlimited breastfeeding
for premies?

Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA