Thanks Jacquie,

What you wrote ties in to something that happened at work last night. I was
working with a 6 hour old baby and her mother. For some reason - no one has
told me what - we insist on the mother nursing the baby at 6 hours, though
even a few drops of expressed colostrum is enough for us to say, OK, he
ate. The baby had no interest at all in eating. He was spitting up amniotic
fluid and clealy full. His mother had type 1 diabetes and the baby's sugar
was being monitored and was fine. Mom had huge  swollen breasts and her
large flat nipples had all but disappeared. We could not get a drop of
colostrum out of her. Baby was skin to skin and sleeping away. The hours
were passing and the nurse in charge was getting upset with me that I
wasn't feeding the baby. Sugar stayed high, baby pooped twice, urinated
once, and slept on while making little bubbles from his mouth. So I asked
the pediatrician why we should be insisting on feeding this baby and he
just shrugged. Which led to a discussion of the nutritional value of
amniotic fluid. (which I am going to Google this morning) The point of the
other nurse was that we are putting the baby at risk for losing too much
weight and having to stay in the hospital either because he's 7 percent
under birth weight or because he is jaundiced and in photo therapy.

What you said about the bottle and the sucking is excellent - I will use
that to explain to parents why the baby took so much. I normally just
discuss the flow rate with them and baby's lack of choice in the matter but
what you wrote makes more sense.

As for your original question - is it ever really necessary to supplement
before 48 hours, look at
http://www.bfmed.org/Media/Files/Protocols/Protocol%203%20English%20Supplementation.pdf
I can't open it write now for some reason or I'd be happy to discuss it.
They do give reasons.

In line with what you wrote about bringing expressed colostrum. I think
that it is an excellent idea. I would like to see all the women who come
for elective c-sections to bring colostrum with them. The baby always
arrives to the nursery earlier than the mother - sometimes for many hours.
It would be great to have colostrum to feed in case the baby gets hungry
(some really do) or the magic 6 hours comes up and mom still isn't there.

The biggest problem that I saw in my shift last night though, was the
mothers themselves. I had a mother glare at me for suggesting she nurse her
baby a little longer instead of giving ABM and another who's husband
wouldn't even let me get near his wife with the baby (her request) And so
many women coming to take that free and ready bottle just because... At
least there were two of us together trying to discourage the use of ABM and
encourage the breastfeeding.

Here's to all the women and babies we do help!
All the best,
Chayn



On Wed, Oct 28, 2015 at 10:45 PM, Jacquie Nutt <[log in to unmask]> wrote:

> Thanks, Chayn, and for everyone who discussed this earlier.  When I sent in
> the comment, I meant it to be a question - "Is it EVER medically necessary
> to give a baby anything but the breast in the first 48 hours, if the mother
> is breastfeeding
> ?"  but it turned into my little rant and the question was never really
> asked.
>
> If you want to have all your enrage-glands turn on, read this incident:
>
> http://www.msn.com/en-za/news/featured/newborn-forgotten-in-incubator/ar-AAe957R
>
> However it highlights the fact that healthy full term babies are remarkably
> resilient.  It reminded me of the Mexican City earthquake in 1985 where up
> to 40 babies were pulled from the rubble of hospitals, one as late as 9
> days after the quake.  There are countless stories like this about
> earthquakes - mostly in warmer places where it was obviously possible for
> the babies to stay warm enough to survive.
>
> Last night the question became relevant again.  A pregnant woman in our
> antenatal classes wanted information on expressing colostrum antenatally,
> as she has Type 1 Diabetes and was told that as soon as the baby is born,
> he will be supplemented to bring up his sugars.  The hospital will accept
> expressed colostrum if the mother provides it.   My new question is: is
> formula supplementation "just in case" evidence-based practice if the baby
> is going to the breast well? The mother is determined to breastfeed, so why
> not let that happen??  We all know that the baby will be followed very
> closely, as he should be.  Her safety net of expressed colostrum is a
> wonderful idea.
>
> I have read Dr Newman's article and will share it with the mother.
>
> http://www.nbci.ca/?option=com_content&id=71:hypoglycaemia-of-the-newborn-low-blood-sugar&Itemid=17
>
>
> Getting back to the issue of overlarge volumes of "supplements": the more I
> read around this issue, the more I've come to believe that in the first day
> or two, the breast needs the suckling more than the baby needs food.  In a
> marvellous choreography, the steady practising in the early days gives the
> baby a rich boost of immune factors and lessons in coordination, while also
> stimulating the breasts to do their thing to produce the volumes needed
> later.
>
> The baby has a strong need to suckle, yes, so the stimulus of the bottle
> teat in his mouth will keep him suckling long after his little tummy is
> full, which leads to all sorts of misinterpretations in mothers (and some
> staff members).  Is this what causes the first damage that could lead to
> colic and reflux later?
>
> Are there other medical conditions where the breastfeeding baby *should* be
> given a supplement before Day 3, preferably human milk?
>
> Best wishes
> Jacquie Nutt IBCLC
>
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