Our hospital breastfeeding P&P reads:

6.  Newborn infants are given no food or drink other than breastmilk, unless
there is a physician order for a specific medical indication such as:
   Infants with particular nutritional requirements and restrictions in
functional capabilities due to low birth weight or early gestation.
   Infants with hyperbilirubinemia when increased breastfeeding fails to
provide adequate calories or hydration.
   Infants with potentially severe hypoglycemia or who require therapy for
hypoglycemia and who do not improve with increased breastfeeding.

I have been requested to include wording that deals with what to do if the
mom requests the baby be supplemented.  What do you think of the following.
(Do you have any better options to suggest?)

If a mother requests her infant be fed a supplement to breastfeeding, the
reasons are explored by the nurse to help solve any problems that preclude
exclusive breastfeeding:
  Assess for effective latch
  Breastfeeding offered at least 8 times in 24 hours
  Offer suggestions to treat nipple tenderness
  Discuss day/night confusion
  Plans to combine breastfeeding and bottle feeding are best delayed until
breastfeeding is well-established

Offer options to the mother to promote exclusive breastfeeding
   Provide skin-to-skin contact between mom and baby to soothe and quiet a
fussy baby
  Have family member walk and soothe baby
  Take baby to the nursery so mother can rest and bring back for
breastfeeding prn.


If the mother chooses to have supplemental feedings given to her baby:
 Amounts should be limited to 1/2 to 1 oz. of formula.
 The mother should be encouraged to breastfeed first at every feeding.
 If supplemental nighttime feedings are given in the Nursery, the baby
should be bottle fed once, and then taken out to
breastfeed for the next feeding.

Help, please......

Barb Berges BS, RN, IBCLC
Rochester, New York

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