Kate,
I think you handled this situation entirely appropriately. In my experience,
when babies become jaundiced and dehydrated they lose the ability to
breastfeed effectively...much time is spent and the baby's wt. continues to
go south.  I tell mothers that our most important priority is to feed the
baby and that the second priority is to protect the milk supply. When babies
are losing wt. and feeding poorly,  mothers are naturally worried and
exhausted.  Part of every lactation consultant's workup should be to
determine what is doable for the family and to jointly make a plan.

I feel that we live in dire fear of nipple confusion when it's not really
necessary.  If a slow flow bottle is chosen (our center likes the Haberman),
if baby is encouraged to open wide before bottle is offered and if mother is
provided a hospital grade pump to maintain supply, we've had very few
instances where infant has not been able to get back to breast if s/he was
latching at one time.  I usually have mothers breastfeed first but limit the
time...then pump and bottle feed.  If infant is too sleepy to BF then EBM by
bottle is fine.  These babies turn around in a day or two. Once they are
hydrated and gaining wt., unless there are other probs they BF well.  I saw a
month old baby who was 6 oz. below birth wt. several days ago. This infant
had a strong, coordinated suck on digital exam, had been exclusively BF and
mother produced an estimated 15 oz. per day. This infant used a flutter suck
at the breast, but with compression and massage suck corrected and he took 66
ml. It took almost an hr. though and mother would have needed  to BF 10-12
times per day to get adequate intake. Even the most commited mother would
wear out with this and I frankly did not think this underwt. baby had the
stamina. I sent this mother home with BF (no more than 30 min.) with
compression and massage, pumping after and supplement with EBM and or AIM. I
really believe that once this baby gains wt. and mother's milk supply
increases so will his stamina and  he will be able to go back to feeding
exclusively at the breast. More worrisome to me than nipple confusion is loss
of milk supply... this is sometimes not fixable. Of course we will closely
follow this mother and baby.

Whew...didn't mean for this to be so long.

Kathy Boggs, RN, IBCLC
Mountain View, CA

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