In reply to Jan's response
Back in the mid 1990's we used a "sliding scale" to determine how much to supplement our preemies in the following manner:
It stated as follows:
If baby sucks and swallows:
1. Less than 5 minutes the full feeding was supplemented
2. If 5 to 10 minutes 1/2 the feeding was supplememted
3. Greater than 10 minutes - no supplement.
5 years ago, my grandson was born at 31 weeks. He was at a prominent Children's hospital in our area where they did not believe in scale weights ac/pc to determine supplement after nursing. They also did not believe in using nipple shields. He struggled to latch wasting 10-15 minutes trying to get on each feeding. My daughter was blessed with lots of milk. I had championed feedings in the NICU at a smaller hospital in the area where I worked as a lactation consultant. I always kept up with the current research and often tried new things early. Our hospital lead the way of all others in the area with success in getting babies to breast early and nursing successfully. We used shields early on and saw the amazing results of our breastfeeding preemies. We used weighing before and after nursing early on as well (both based on Paula Meier's research).
I visited my grandson one day and watched a feeding. I asked for a baby weigh scale. I had a nipple shield with me. His nurse tried to shame my daughter and me by saying "you need that (scale) to know how baby is doing?" and "don't start that shield or you will be pumping til you are done nursing." I proceded with the scale anyway. Since baby nursed for greater than 10 minutes, he was not supplemented after nursing. However, by scale weight he only got about 15 ml and needed 45 ml. You can imagine my horror when I saw how they were handling his feedings! He was slow to gain weight and took a little longer to be discharged.
When he got home, she started the shield at 5 weeks and continued until his EDC and totally weaned off the shield, off any supplement and went on to exclusively nurse for close to one year. One concern I had was as he got older, whenever he got hungry and wanted to eat he almost went "balistic" if he had to wait while she got his food ready. I always wonder if his reaction stemmed from going hungry in the NICU???
Jane Helgesen RN, IBCLC
Lactation consultant
Fairview Ridges Hospital
Burnsville, MN
Date: Sat, 25 May 2013 17:24:35 -0400
From: Jan Barger <[log in to unmask]>
Subject: Number of minutes at breast = ?? ml??
Brenda says,
<<We currently use a system in which an infant is supplemented based on
the number of minutes at the breast, and often this system fails. This seems
to cause infants to be supplemented with fortified milk too often, in my
opinion. >>
Oh Brenda, I'm dying to know how many minutes = how many ml consumed. I
can't believe anyone really truly does that. Do they count the total number
of minutes, or do they have a mom use a stopwatch so she's only counting
the minutes of nutritive sucking?
Does that mean I can figure out how many calories I consume by the number
of minutes I sit at the dinner table? Or should I just use a stopwatch and
count the number of minutes I'm actually chewing?
Is this evidence based? Whose evidence? Oh. My. Goodness!!!
Brenda, what on earth are you up against? I'm simply aghast. Is the
grant to determine if test weighing is more accurate than number of minutes at
the breast? Actually, that would be a fascinating study -- I can see it
now. Take the current standards (are they the same for every mom/baby dyad,
or does it depend on mom's milk supply and age of baby?), and do test
weights AND have moms time the number of minutes and see what you get.
Do let us know!!
Jan Barger, RN, MA, IBCLC, FILCA
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