In the case of a 36 week infant, I would be also thinking that the mother
was told to breastfeed *at least* every 3 hours. Here are some of the things
we do at my facility with e.g. a sleepy 36 wk baby:
STS, watch for cues, arouse and offer breast every 2-3 hrs if baby not
waking, express and spoonfeed if baby not latching and feeding. Notify
nursery nurses or LC if you are having trouble waking or feeding baby. Yes,
it is written down. And yes we spend alot of time with parents, and return
to room quite often. I have seen families bouncing a fussy baby instead of
feeding him, some saying it has not been 3 hours yet and some saying I've
just fed him so he's not hungry. We then re-visit the discussion of cues,
and unlimited, unrestricted bf.
I prefer hand expression esp. in first 24 hrs. Some moms request the pump.
If so, I recommend pump + manual expression.
Here is alot of what we see every day, and yes we are very frustrated: baby
stays skin to skin but does not wake up for 4, 5, 6 hours; conversely
parents remove the baby from STS and dress the baby and wrap and put in baby
bed, mittens on the hands are also very popular. Lots of visitors (or
not), parents tired and do not wake baby or express, mom expresses but gets
nothing out or very little, so does not express any more. Of course we
discuss that it is important to express often even if you don't get any
colostrum out yet). Parents cannot find the written info we gave them,
as tons of info and paperwork is given to them.
Now, I will move on to the early f/u visit, usually on day 3-5. Not
infrequently, and esp. in the cases we are watching due to 37 wk baby e.g.,
the parents say baby did not poop since leaving hospital, or has had very
scant pee or orange pee. Although this was a sign of trouble, which we
talked about and gave written info and the diaper photos, parents do not
report this e.g. on the day in between hospital discharge and the followup
visit. Also, if this was a mother who was advised to express regularly, she
may not be expressing at all or maybe 1-2 times per day.
All this to defend the hospital LC, most of us are knowledgeable, caring and
concerned people. One explanation is that parents and babies are in a
(possibly drugged) fog during the approx 36-48 hrs they are in the hospital.
Laurie Wheeler RN MN IBCLC
Mississippi USA
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