Nancy Wight said;
>>I am concerned that a lactation consultant convinced parents not to follow a
physician's feeding plan, without discussing it with the physician. A growth
retarded infant may or may not be able to take all feedings directly at the
breast.<<
I'm not sure if you are responding to MY post exactly but since you don't
specify and since I did use the word CONVINCE several times I will respond.
my paragraph as written;
>>My most recent case is a growth retarded, 37 wkr. discharged at about 3 wks
of ages whose mom was told by all of the LCs at this large Boston hospital's
NICU to continue with the pumping and bottle fdng 30cal "formula +milk"
(right Barbara?) regime, that putting the baby to breast was too risky and
tiring. Now this baby may in fact have a "syndrome" not picked up by genetic
testing but has gained terrifically (14 oz/2wks!). I had to spend an
inordinate amt. of time convincing these well meaning parents that it was
perfectly appropriate to try this healthy appearing, alert baby at the
breast. They were convinced that the baby would receive just as much benefit
from the br. milk via the bottle as it would via the breast and they were IN
AWE (and not in a good way) of my suggestions that perhaps the breast could
be offered as a comfort when the baby was fussy (he is often!) or that
perhaps the benefits from the MECHANISM of br. feeding might be hugely
underestimated and could greatly benefit them all! Interestingly when I did
convince Mom to give it a try after his normal bottle fdng., he latched on
with minimal assist and continued to feed despite the fact that he had
refused to take ANOTHER DROP out of the bottle! Now obviously this baby took
MORE than he would have if just given the bottle and more quickly and easily,
how is this risky or tiring? I left them with what I hoped was a glimmer
that this was now possible but after speaking with Dad today, the pedi. told
them to hold the brfdng. to 1xday! <<
I'm hoping that including the above will make it clear that I didn't try to
convince these parents to ignore the pedi's advice. My visit took place the
day after discharge and the parents were working with the advice given to
them by the hospital LCs/nurses.
They visited with their pedi, for the first time, a few days after I saw them
and frankly I'm upset that the pedi didn't follow MY feeding plan (such as it
was!) without discussing it with ME first!
Notice I said upset, not surprised, as this happens all the time!
I was not suggesting that these parents abandon the 30cal concoction for
brfdng. on the first day home. What I am suggesting based on my experience
with babies, NICU and otherwise and my assessment of this particular baby is
that there is no reason for this baby not to be breastfeeding more often with
a plan in place to carefully monitor his acceptance of it. This baby may or
may not need the extra cals, minerals etc provided by the bottle fds, that
remains to be seen, but delaying/restricting or perhaps obstructing entirely
(long term) the breastfdng also has implications that shouldn't be casually
dismissed.
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts
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