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Subject:
From:
Christine Lichte <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 7 Feb 2004 18:47:05 -0500
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Hi.  This is one of those cases where "You think you know what should have
been done, but not confident enough to express yourself because you think
that maybe in this case you would be wrong".  We had a 38 week, 7 lb. 6 oz.
healthy baby boy who had a bili of 17.4 on 2nd day. Nurse said she wasn't
suprised because baby had a large bruise. Breastfeeding was slow on first
day, but mom was very patient and as usual things picked up by second day.
Baby was stooling well from birth. I watched baby at breast and heard
swallowing. I was told baby was to be started on lights (we have the Medela
bili bed).

I came in next day and was told that baby has been finger fed formula after
every breastfeed because bili went up to 20 (it is now back to 18). Baby
was wanting to be held and nurse frequently so it was hard to keep him on
the lights.  I was also told that baby was not latching well and mom's
nipples were torn up.  Went to talk with mom and she had a different story.
Yes, her nipples were sore at latch and did not look good but nursing was
not that painful.  She also said that she felt baby was breastfeeding fine
it was the nurse that was impatient with baby.  Her breasts are filling.  I
watched baby at breast.  It took some work to get him on (pacifier was
started to keep him happy in bili bed and of course the continual finger
feeding probably didn't help).  Her milk letdown and I pointed out how his
suck changed to a long draw and swallowing increased.  He was at the breast
for a good 30 minutes and breast compression really increased the
swallowing.  He accepted no formula supplement after this feed!  Mom was
very encouraged.  I assumed that the formula could be discontinued now that
her milk was increasing.

Wrong!  I came in the next day and he had been given more supplements and I
asked mom about this and she said that because he is now fussy at latch the
nurse was not patient with him and was quick to supplement. By this time
mom was tired and told the nurse to go ahead.  Bili is 16 now and baby is
being discharged with bili blanket.  Mom's breasts are full and she is
ready to go home!  She plans to work with breastfeeding at home, feeling
confident that once she can relax and not have people breathing down her
neck she will be able to focus on breastfeeding.

I know this is long, but was the formula neccesary at all?  Parents did not
want to start pacifier, but they could not hold him. Breastfeeding was just
starting to go so well until all of this happened.  If I would have known
about the supplements I would have encouraged mom to use a pump and use her
own milk.  Dad hit the nail on the head when he said, "It is weird,
everything you read and hear says that breastmilk is the perfect food for
your baby, but when things go wrong then it is not so perfect anymore and
formula becomes the food of choice."

I feel this should have been handled much differently, but I am "afraid" to
say anything.  I need some encouragement! I avoid conflict, but I need to
start speaking out.  I love the phrase, "A turtle can't move forward unless
it sticks out its neck"! I am so tired of the idea that if everything is
going well then breastfeeding is fine, but if not then you need to use
formula.  I am sure this is a common scenario for many of you.  Thank you
for listening.  Does anyone have any suggestions on how to keep baby happy
while in bili bed without using a pacifier? It seems to be a catch 22
because if baby wants to nurse frequently then this is good, but then baby
is not on the lights as long.

Christine Lichte LLL Leader, IBCLC
Warrensburg, MO

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