Hello Molly,
That is a very difficult situation to be in. Sometimes it is hard for
folks who do not work in a hospital to believe or understand the
barriers and frustration that LCs there have to work with. I will give
some suggestions that might help.

Ask yourself who the most bf-friendly dr/neo is. Or one of the neos
you may have the best rapport with. Ask that dr (on a good day and
maybe on a day without an active case of hyperbilirubinemia being
treated): "how comfortable would you be if we supplemented every other
feeding for babies who are low risk like full term and not DAT
(Coombs) positive?" "The reason I ask this is often I have a mom who
really wanted to bf but switched to formula once supplementation was
started." Or "whose milk supply rapidly decreased" or some such
similar scenario. You could also ask "how comfortable would you be
with supplementing 15 mls after bf?" You get the idea, you will be
slowly chipping away at the doctor's comfort and dependability on
formula in these situations. Same thing for "low" blood sugars, you
can say you know of many other units that are not treating at 40 and
also giving much smaller amts of formula like 5 mls per kg.

You can also try this same tactic when you have a mom who is really
committed to bf and really does not want to give the formula. You can
say "Mrs X is really reluctant to give any supplementation. Would you
be comfortable having her pump and supplement with ebm and rechecking
the bili in the morning? Her baby is full term and not Coombs
positive."

 Anyway, you see how I am suggesting you approach this. Once you make
some headway with one dr or a couple of cases where the baby does fine
with those changes, then you will be able to say to a 2nd dr "we've
been trying every other fdg or supplementing with half as much, and we
have had no problems." Always go from a position of respect for the
doctor, just offering a suggestion, asking how comfortable he/she
would be. Also if you have observed a bf or more, let them know that
the baby is feeding very well etc.

If you think the doctor will accept a good medical article or chapter
you can present that also. Saying something like "I've been really
trying to wrap my head around how we can be safe with these babies
with high bili but also keep them bf. So I've done quite a bit of
research in the recent medical literature. Can you take a look at this
and let me know what you think?'
Good luck and feel free to vent. Virtually all of us have had to deal
with the same things.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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