Mandi

What an interesting question!  "Is maternal exhaustion categorized as an
acceptable medical indication for formula under the BFHI criteria?"

Mandi, I hear the dilemma, but as a BFHI Assessor, I have to tell you that
I don't think that comping a baby with a little formula so as to give a
tired mom a bit of a break would fall within the very strict BFHI
guidelines!  Sorry!  I hear your great concern for the mothers, and we
always wish we could do something to ease their fatigue/stress/distress,
don't we?  But the beauty and simplicity of the BFHI criteria are that they
are all written down very clearly and unambiguously, to do what is
compatible with the very best health of the *babies* and they are
impossible to fudge because they are checked in so many different ways
during the assessment.  Maternal need for sleep is not more important than
infant health, and even a little bit of formula for the normal, healthy,
full-term baby places that baby's health at risk.  The rational use of
formula, ie medically indicated formula, as set out in the BFHI manual,
demands that it only be used if the *baby* needs it.  Not if the mother
needs it.   This might be permitted if the baby had lost over 10% of the
birthweight, and the mother was producing inadequate breastmilk or
colostrum in spite of adequate efforts (with assistance) to do so - an
extremely unusual combination of circumstances.

For the exhausted mother who has had only nine hours sleep in 4 days, what
should be happening?  According to the BFHI criteria she should be assisted
to breastfeed (helped to latch the baby, comfortably, shown how to know
that the baby is receiving milk at the breast and being encouraged to
breastfeed whenever the baby wants and for as long as the baby
wants.  Perhaps she is also being tucked up in bed with the baby so that
she can breastfeed and sleep simultaneously.  If the baby is not latching
the mother should be shown how to express her milk and to spoonfeed it.  It
sounds like you were not lucky enough to give birth to your little one in a
baby-friendly hospital.  If you had been, the staff would have been
required to give you more help to breastfeed, rather than whipping up a
quick little formula cocktail for your baby.  More than two mothers out of
eight receiving so little help to breastfeed as you did would have "failed"
the whole hospital.

It's a tough one, I agree.  As a way to promote this startling concept for
policy and teaching, the stress needs to be on how to fulfil the needs of
the most vulnerable member of the pair - the infant.   In fact, everything
else that we struggle with day after day in trying to protect, promote and
support breastfeeding would slot into place extremely easily - whether it
was the rights of women to have their status in society elevated, the needs
of working mothers for maternity leave and lactation breaks, the right to
breastfeed in public, the needs of babies for their mothers' milk anywhere
any time, support for full implementation of the Code in hospitals and
afterwards, better education of doctors, nursing staff and other
healthworkers about breastfeeding, better research on HIV and BF - if only
an acknowledgement could be made that the paramount consideration should be
what is in the best interests of  *the baby*, first, last and always.

Pamela Morrison IBCLC
Harare, Zimbabwe
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"....guidelines as I understand it one must have medical indications for
comping a baby. Is maternal exhaustion categorized as a medical
indication? And if it is how do I make sure that this is not used as an
excuse by the staff to start handing out formula willinilli.
It is a hard one for me and I usually handle it case by case. If I feel
that a mother has reached the end of her tether and would do much better
once she had a chance to sleep for a few hours then I will consider it. I
will first try to get her to use ebm but that isn't always a possibility.
The real issue is how do I handle this from a policy and teaching
perspective. Help I need guidance. Thanks ahead of time,
Mandi Porta, RN, IBCLC"
p.s. we do have informed consent forms for formula usage.

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