Carol wonders, "i noticed that no one in other countries such as australia
wrote in to say that, yes, mothers there routinely let babies die or feed
them (what would it be in australia instead of dr. pepper, fosters?) horrible
stuff in bottles. somehow i think the protestations about "we don't want
babies to die" is an expression of our acculturation to use of abm and
bottles, and of that as a feeding norm. if we just ceased to think of it as
normal and acceptable, we would use our energies to think of ways to make the
change possible and support the mothers and babies in other ways."
Amen to that Carol! However, I thought of you all this weekend when I was
referred a 3 week old African baby recently discharged from the ICU in our
large teaching hospital, into a paediatric ward. The baby had very nearly died.
He had been born full-term in a hospital that was certified as baby-friendly
a couple of years ago. Mom "collapsed" shortly after delivery due to blood
loss and the baby was kept overnight in the Neonatal Unit and given to mom
the next day. However, to my horror, she told me that no-one assisted her to
breastfeed or to express her milk during her 3-day stay, or even to check if
she was producing milk. It seems as if mom and baby were discharged home on
the third day with baby exclusively "breastfed", weighing 14.7% less than he
had weighed at birth, but neither the hospital staff, nor the parents,
attached any significance to this.
Once home, things obviously went from bad to worse. The baby seemed to be
breastfeeding for hours at a time, but cried a lot. Mom's breasts became
very full and sore, so she "expressed" the milk on to a towel (!!!) (awful
technique, scrunching breast with both hands from up near the chest wall
down ..) and fed the baby "mineral water" to pacify him.
They took the baby off for his 10 day check-up, where it was found that he
weighed 30.29% less than he had weighed at birth. The paed referred them to
me at this point, but they didn't call me at this time. On the 11th day
they took him to the Casualty Dept of the large hospital because he seemed
so sick, whereupon he was admitted to the ICU where he remained on a drip
for the next 8 days before finding his way into the paediatric ward. When I
saw him 4 days after this, referred by yet *another* paed, and still 11%
below birthweight, he was still "breastfeeding" and mom had been expressing
20ml EBM every 3 hours to go down the nasogastric tube which had just been
removed. But *still* no-one had assessed the breastfeeding, so he was about
to go downhill again.
It seemed pretty fraught. The baby had that *very* alert, watchful
expression, and moved very little, and didn't cry, just moaned politely,
urine and stool output were low. He was pretty wasted, and the family were
all very caring, but obviously had no idea what to do. A breastfeeding
assessment showed that he was tongue-sucking - eureka! The breasts looked
very involuted, but mom was able to express (corrected technique) in
multiple little jets and I showed them how to finger-feed, which mom and
baby both loved straight away. I gave specific instructions about topping
up with formula - they had bought their own tin into the hospital, but
hadn't used any yet. On the way out I asked the Sister-in-Charge if there
was any particular *reason* why no-one had yet suggested that this baby
receive formula supplements???? She looked very uncomfortable and said that
"In this hospital we promote *Breastfeeding*". Aaaarrgh. Anyway, lots of
phone calls later I had "permission" to use the formula, and relayed it to
the parents.
However, when I followed up the next morning I found a miracle. Mom had
been able to more than *triple* her output by expressing every hour, as I'd
suggested, and baby had had exactly what I had recommended in terms of
volume, but it was all EBM. He was fast asleep with that "drunk", full
expression, he'd stopped moaning, and his output had increased. Mom's eyes
had that soft shiny look that tell you she's proud and happy to be able to
able to feed her baby at last. From now on? I've left lots of
recommendations, given lots of anticipatory care, and will do my best to
keep track of this baby for a while, but realize that the parents may not
keep in touch, so I just have to hope.
Sorry so long. I thought you might like to know about this baby who seemed
to fall through a crack in a system that's supposed to be perfect, but
isn't. And yes, I've reported this shocking case to our National BF
Co-ordinator.
Thanks for listening.
Pamela Morrison IBCLC, Zimbabwe
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