Sounds like you have a challenging situation at your hospital. We had the same thing until recently, almost all of the babies were fed formula at night by the nurses so that mom could sleep and they could do the hearing screen. Yes, there is a lot of research out that there that this practice is very harmful and explaining at research to the nurses can help. I think we assume that you would pretty much have to be living under a rock not to know that breastmilk is healthier for the baby than formula, especially when you work in healthcare, but unfortunately that hasn't been my experience. I think even some LC's may not fully comprehend how detrimental "topping the baby off" with formula can be to the baby's future health. Many people still genuinely don't know this. Anyway, there are several issues. The estimated stomach capacity on Day 2 for the average full-term baby is 10-15 ml, but that's just the maximum capacity, that doesn't mean that the baby drinks that much colostrum. I have some good resources I'm happy to share. And if I'm wrong about any of these, please feel free correct me out there Lactnetters.  One of the first very interesting things to know is that unlike adults, the newborn's stomach does not have the ability to relax and expand like an adult's stomach can when it is overly full. I know that many LC's have wondered over the years why babies develop bottle preference and reject the breast, and one theory was that it cause too rapid gastric expansion and then the baby was no longer satisfied with the smaller volume of breastmilk because we thought that it was increasing the baby's stomach size. http://www.ncbi.nlm.nih.gov/pubmed/11641459 But it looks like no, this is not the case because the baby's stomach can't expand for the first 3 days. What the researchers found was that as the baby got larger and larger volumes, the pressure inside the baby's stomach went up and up. Likely causing the baby a lot of gastric pain, then they spit up and cry. And unfortunately when the baby is upset and crying, I see many parents misinterpret this as signs of hunger and feed another big bottle which just makes the gassiness and fussiness worse.  Instead of large volume feeds cause gastric expansion, it is likely that the baby is getting used to the fast flow of milk and easiness of feeding and will begin to prefer the bottle based on the ease of feeding. Also, it's likely that the baby is missing many feedings at the mother's breast and now as the baby's stomach size is increasing, her milk supply will not keep up with the demand. So there were only two studies that I know of that measured how much breastmilk the infant receives on day one, and I believe that the first said about 6 ml/feed and average 7 feeds, and then the other study actually found that the babies had an average of 1.5 ml/feed and 10 feeds for a total volume during the first 24 hours of only 15 ml of colostrum. The study is cited in this program by Paula Meier through Medela. I'm not promoting Medela, it's just the best program I've ever seen that really explains in detail colostrum, what it does and how formula interferes with this process. I would highly recommend it. Humans are born with more fat stores than virtually any other mammal. Many babies are born with a stomach full of amniotic fluid that needs to be digested. Many are not that hungry in the first 24 hours and prefer to do a lot of sleeping instead and cluster feeding when they do wake. Most babies eat more at night and sleep more during the day, so separating them from their mom at night is the absolute worst thing to do.  http://www.medelabreastfeedingus.com/for-professionals/Education/Programs/Detail/413 Among some things she mentions is the fact that the earlier the baby is exposed to allergens in the formula, corn, soy and milk, the more likely the baby is to have an allergic response and be allergic to the formula. The worst time to supplement the breastfed baby with a non-human milk is during the first 3 days of life when the gap junctions between the epitheleal cells that line the GI tract haven't closed yet. Lots more good stuff in this program. You should get it and show it to your staff. In my opinion, colostrum is the mechanism that nature has created to help the baby shift from parenteral nutrition (getting nutrients through the umbilical cord into their blood stream) to enteral nutrition (using their stomach and GI tract) to digest food. This should be a gentle, gradual transition and just dumping a large volume of milk into intestines that have never digested food before is a really terrible idea. Research is limited on long term effects but there is some out there and it is showing some negative effects. Here's one that shows that babies who are bottle-emptying in early infancy were more likely to be cleaning their plates as 6 year olds and were less satisfied with their meal than those that didn't empty the bottle. http://www.ncbi.nlm.nih.gov/pubmed/25183759 Here's another in which bottle-emptying behavior is associated with increased risk of childhood obesity:http://www.ncbi.nlm.nih.gov/pubmed/23755127     
Date:    Sun, 21 Jun 2015 10:44:17 +0300
From:    "fogelmans ." <[log in to unmask]>
Subject: effects of overfeeding in the hospital - and how much milk on day 2?

Dear Friends,

I have recently earned my RN and started working in a maternity ward after
12 years of working in the community.  Unfortunately, on our ward, babies
and mothers are separated from 11 pm to 5 am.  Any mother that requests to
be woken up to breastfeed her baby will be.  Unfortunately many mothers
choose to have the nurses formula feed her baby at night.  Also many babies
are "topped up" with formula during the day, again, at mother's request
because mother lacks confidence in her ability to feed her baby enough.
These babies take in what seems to me to be very large amounts of formula
or in a good case, expressed breast milk..
 I have 2 questions;
how much should a newborn be taking in on day 2? According to Nancy
Mohrbacher's Your Newborns Stomach - Day 1 - 10, a newborn should take in
5-7 ml on day one and 22-27 on day 3. What about day 2?
Also, I wonder about the effects of overfeeding babies on future
breastfeeding. There is no way that a mother can compete with the flow and
amount of these bottle feeds in the first few days. Is there any good
research on the effects of overfeeding babies during their first few days
of life?  If so, please send me links... so I can present it to the rest of
the staff.

Thank you so much,
All the best,

Chayn Nancy Fogelman IBCLC, RN, Israel


    

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