Dear Friends:

Casey asks important questions about supplementing in the first 24 hours.

In an evidence-based world, the following would apply:

1)  Keep baby skin to skin so its temperature will be within normal range
and its blood sugar will stay high.
2)  Mother to hand express every hour or two. Feed expressed milk to baby
via spoon or syringe. Keeping baby s2s will move the milk forward in the
breast, so those golden drops of honey will come easily.
3) The breast is never empty so the mother will be able to hand express
enough newborn milk to keep her baby (and the pediatric staff) happy.
4) the baby will be likely to latch-on and feed if it is kept in the
"Breastaurant",,,,this is in addition to the hand expressing and giving
newborn milk on a spoon every hour or two.
5) Should baby need more supplement, thaw out some frozen donor milk, kept
on hand for such occasions.
6) In other situations, see the Academy of Breastfeeding Medicine's protocol
"Medical Supplementation of the Breastfed Newborn." There are unusual
circumstances that require different solutions.

Pumping in the first few days can be discouraging and difficult, because the
small volume of newborn milk and its thickness makes collection a challenge.
The mother's confidence must be nourished. Handing her a spoon will teach
without speaking. The more milk she takes out, the more milk will come.

-----------------------------------------------------------------------------------------------------------------------------------------------------------

Here is a case history that some wonderful person shared with us here on
LACTNET:

 •Baby born at 35 weeks, weighing 4#14oz.

–Spontaneous ROM labor and delivery.

•
•Baby skin to skin continuously.  No temp decline.  Mom taught self-latching
in reclined position.  Baby latches but falls asleep quickly.

•
•Mom taught to hand-express colostrum obtaining approximately 1 cc
increments.  Taught to use syringe under baby's tongue with the logic that
we use nitro and glucose tabs directly under the tongue not swallowed for
immediate access to bloodstream.

–Mom instructed to deliver every 2 hours hand-expressed colostrum under the
tongue and nurse as needed.

•
•At 48 hours, no blood sugars below 60,bili of 8, 5% weight loss.  Mom
started pumping next day after delivery.

•
•At discharge (Day 3), mom's milk in, baby's weight back to birth weight,
bili of 10, glucose WNR, breastfeeding.

•
•Mom sent home with 1) syringe and tube for supplementing at breast if
needed,
 and 2) a follow-up outpatient appointment.

•
•3 other babies born same day, similar circumstances all gone to NICU for
IVs
--------------------------------------------------------------
Rodriguez et al *J Peri Neonat Nurs  **2008; 29:1-7* about using colostrum
for mouth care in premature infants; this is standard practice at a NICU
here in my city.

Giving the baby anything other than human milk will undermine her confidence
in breastfeeding. Why should she bother to breastfeed if formula is
presented as medicine and given to her baby?

Funny how hospital staff complains about "those women" that don't breastfeed
because of cultural beliefs about the inadequacy of newborn milk; this same
hospital staff will give the baby a bottle of formula for "medical
conditions" ........the hospital staff don't believe in the adequacy of
newborn milk either!!!

warmly,
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com

             ***********************************************

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