Dr. Amy,
What you described is a very typical scenario, seen by LCs in hospitals
every day. One can never be sure whether the nurse was pushing the formula
or the mother was asking for it. The mother will tell you the nurse made her
feel that the baby would get dehydrated etc and the nurse will tell you the
mother wanted to sleep and did not want the baby. I believe it is a little
of both. A vulnerable and not very confident mother will succumb to any
subtle message or insinuation (even in the form of a question like how many
times has he peed?) that she is not feeding the baby well. On the other
hand, even very motivated mothers will give formula if it is readily
available and if the baby is acting hungry and unsatisfied after bf. The
first thing to do is check the position/latch/swallows/etc to make sure the
baby is extracting well the available colostrum.
I generally do not ask why the baby got bottles, but just ask a general
question "how did the feedings go last evening and nite?" "how do you feel
the breastfeeding is going?" "do you have any concerns about how the baby is
feeding." These kinds of questions. Go from there. Mothers often tell me the
nurses kept the baby and did not send it out during the nite. They just
sleep I guess and don't ask for the baby. You have to give them anticipatory
guidance that they have to let the nsy know that they will do all feeds for
the baby. A small sign on the cot saying No bottles, no pacifiers helps.
Encourage this, encourage rooming in. Ask if anyone helped them with the
nite feeds, let them know to ask for help if needed. Let the nsy staff know
that it is your expectation that mothers will be encouraged to exclusively
bf, and assisted to do so. No, they won't have to MAKE the mother do it, but
the whole attitude should be to facilitate that.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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