I know, I know...
Protocols are difficult if not impossible to create with breastfeeding moms
and babies due to all the alternative observations that need to be done.
Is it a mother problem? A baby problem? a combination problem?
However, I have been finding that as more and more "lactation specialists"
are being added to hospital staff, more and more "interventions" are being
done.
PLEASE do not consider this a "complaint" about any one person or position.
It is because I've done so many positions that I know how many times and
how many ways I have also erred.... And want, as I tell my La Leche League
moms, to help them avoid the mistakes I made. Just because it took me SIX
WEEKS to figure out that my baby and I would be happier in bed together
rather than in separate bedrooms does not mean everyone should go through
it to learn it!
Now - back to the subject at hand:
People now know there are such things as IVs, tube feeding, cup feeding,
SNS, nipple shields, skin to skin, kangaroo care, pumping, suck training,
bottle feeding etc, etc.
However, I have been in contact with two moms this week whose babies, in
the period of 2 days in the hospital, DID ALL OF THE ABOVE!!! In one case
the baby had low glucose (31) in the other the baby refused to breastfeed
during the hospitalization. Needless to say, the poor mothers are now
suffering from "fragile baby syndrome" - (my baby is a very sick baby) and
in one case the mom has decided she can't cope - she's going to bottle feed
her milk. (At least that was her decision on Friday, instead o giving her
MORE advice, I just agreed with her that she was going to do this and hope
on Monday I can give her additional options once she has had some peace.)
Hospitals in our area have lately been overwhelmed by too many births, too
many moms wanting to breastfeed, and insufficient staffing for the support
these moms need. Births have a great deal of interventions, so the babies
are not the "wide awake and ready to go" type of kids. But given that this
is the case, we need to develop some lists of interventions - in the order
from least invasive up, and a time frame for each, so that when an MD says
"this baby has to eat" the nurse can honestly say she is starting the
process and will continue through it until the baby is stable.
My suggestions for a start:
1. baby is skin to skin x ??? hours with blankets over both
2. if baby still not attempting to latch on after xxx hours, teach mother
how to hand express into a spoon
3. offer colostrum or colostrum and glucose water in a spoon/dropper to
baby's lips .... wait xxx time continuing kangaroo care
4. continue hand expression and offering colostrum q xxx time
5. 24 hours and no effort by baby to breastfeed:
What now? what then?
Doctors will insist in feeding the baby, especially as discharge here is 24
- 48 hours. How to feed the baby?
I'm finding people wanting to use the SNS when babies aren't latched on
well - what good does the sns do then? Baby still not breastfeeding. If
the SNS is at the nipple, the baby will get the idea that no matter how
he/she sucks, the food will come.
Cup feeding? Babies who are too sleepy/uncoordinated don't seem to do well
Finger feeding? I know others feel very negative about putting something
formed into the baby's mouth, but we're now to the point where the MD will
insist baby WILL be fed - it's just a question of how.
Tube feeding? Exposing the baby's mouth to a negative stimulus.
Bottle feeding with a special nipple (which one???)
I know I've given more questions than answers. That's what Lactnet is for,
isn't it???
Jeanette Panchula, BSW, RN, IBCLC
Vacaville, CA
mailto:[log in to unmask]
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