I am having difficulty with a situation in our hospital.  Our nurses are getting much better with skin to skin, keeping mother and baby together, and supplementing with much smaller amounts than they used to and holding off a bit longer.  I am currently working on them not supplementing at all with a normal, no or low risk infant who has normal blood sugars and behaviors (just not nursing yet).  The problem is, when it gets to be any longer than 5-6 hours and an infant has not yet breastfed since birth, everyone gets nervous and will not hold off giving the supplement, including physicians.  In all of the literature I am looking at, the mantra is it is not necessary to  supplement unless medically indicated.  For our staff I need help with a definition of "medically indicated" that I can also take to the pediatricians and try to get them in agreement with.  Can anyone lead me to some literature that I can use?  I understand conditions that might require supplementation, but I am interested in the time factor and normal infants.  I dont think this is easily understood by staff because there is more than the time factor to consider.  When I ask them what is reassuring or non reassuring about the baby, the only thing they can focus on is "baby hasnt nursed in 5-6 hours".  I think fear of dehydration is their medical indication and perhaps being yelled at by the next shift or the physician.     I am currently awaiting Dr Newmans decision tree for feeding and  dehydration so that info is yet to come.  Any wisdom you can share will be greatly appreciated. Ultimately, I hope to have a guideline that answers most all of their concerns and questions. 
 
Shivering in Michigan... brrrrr.    Sue 
 

Susan Gehrman RN, IBCLC, CCE
Battle Creek Health System
300 North Ave.
Battle Creek, Michigan 49016
 
"The world may not honor your honorable intentions, but you should have them anyway"  Mother Theresa
 
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