It's been one of those days....and I'm hoping someone will be able to
answer a few questions and otherwise just allow me to vent....thank you.

As a hospital based ibclc and non-rn, I was helping a primip breastfeed
her baby Sunday morning..  Baby was just a little over 12 hours old; mom
had attempted to breastfeed several times previously with the help of
her nurse in the late evening and through the night as well as once
early morning before I came to work.  The report I received was that
baby does not root, opens mouth slightly, can open mouth wide with help
of someone pulling down on chin, but when brought to the breast, does
nothing.  So, I'm asked to go into the room, wave my magic wand......and
well, you know the rest.  (Sorry for the sarcasm.)

As you may have guessed, the baby did not root nor latch while I was
there.  He seemed a little congested and actually would breath as though
he had difficulty, breathing partly through his nose and giving puffs of
air out of his mouth.  He was also mucousy, attempting several times to
bring something up.  I tried to reassure mom that in my experience, when
babies are mucousy, they don't eat very well in the first 24 hours, but
then usually do wonderful. I also felt that with him having difficulty
breathing, he wouldn't be able to breastfeed well.  But this little guy
didn't even attempt it.   So, I started mom pumping and mom was happy to
fingerfeed colostrum at each feeding.  The first feeding I observed and
it was a struggle getting him to take the 7 ml obtained at the first
pumping by fingerfeeding; very little and strange sucking, probably took
more by having drops placed on his lips little by little. I let their
nurse know what I observed.

Next day, Monday:   Mom pumped and fingerfed through the night and last
breastfeeding attempt and fingerfeed was 7:00a.m.  Baby is still very
"blah" as one nurse described when I arrive in her room, but no longer
mucousy.  The time is 10:00 a.m. Baby has been circ'd and am told he
sucked on the nurse's finger "very well" during the procedure. At this
time baby is very sleepy and after a few minutes of gentle waking, he
wakes, but will not latch.  We try a shield.  Nothing.  I could tell mom
and dad were getting a little frustrated and worried, perhaps in part
because the day before I told them he would more than likely be
breastfeeding once his tummy felt better and here they were, seeing no
change.  I let their nurse know what I observed and she mentions that we
should let mom take a break, take her shower because she needs one, and
she would then do a bath demo being parents and baby were going home
later that day..  Fast forward 1 1/2 hours.  Moms shower done, bath demo
done.  When I enter, mom is crying and dad is pacing, wondering what
they're going to do when they go home later in the day and baby is still
not feeding well. Mom also states that she really doesn't think she can
get up in the middle of the night and pump and then fingerfeed again.
It was much too tiring.  They asked if they could try a bottle of
formula.  After I explained as well as I could that a bottle was not the
answer at this time, I did agree of course at their insistence.  Baby
would not take the bottle while I was there either.  I let their nurse
know.

Their nurse comes back to me later then and tells me she went in to help
them bottle feed and that he sucked the milk down beautifully and that
the problem was that they were not pushing the nipple into his mouth far
enough and that they think they are just going to formula feed being he
does better with it.

I talked to the baby's Ped. also and told her what I observed.  She
ordered saline drops and a cbc/diff.  While the blood was being drawn,
the nurse noted that the baby was a little shaky (this was immediately
after 20 ml of formula and 6 ml of colostrum), so while she was taking
blood she would do a blood sugar. I asked her if maybe waiting 30 min.
the results would be better.  She said she'd take it again later
depending on this first result.  It was 39.  She reports this to the
Ped.  Ped orders formula for the rest of their stay because "baby may
need a little more to get going than just the colostrum mom is pumping".

1/2 hour later after hearing this:  Mom and Dad decide to no longer
express or breastfeed and wishes to just feed formula.

"Colostrum is not enough". It had been 4 1/2 hours since last feed,
(7:00 a.m. colostrum fingerfed, then mom's shower and baby's bath demo)
he was circed and had a sponge bath...Couldn't all of the above have
contributed to the low blood sugar?  Stress/crying from the circ,
chilled at the bath, 4 1/2 hours since last fingerfeed? I'm just asking,
not judging. Or should a healthy, full term 7 lb baby not show signs of
hypoglycemia regardless of the above mentioned at this age (slightly
more than 36 hours old)?  Also, if a mom has an epidural, is there a
specific time frame when she delivers that is best as far as the least
possibility of it affecting the baby?  The epidural was given 6 hours
before delivery.

 To me the formula was a "quick fix".  With the way formula is delivered
through the type of nipples we have, I'm not surprise he
swallowed.....he would have choked had he not.  Also, because I'm not
too up on bottle feeding, is it also considered "normal" if a baby
doesn't act like he wants to eat, no rooting, mouth closed, but takes it
anyway when pushed into his mouth?  Is everything really "ok" then?
Should I learn to show parents how to bottle feed by being more
aggressive when presenting the bottle to the baby.  Because I've always
waited for baby to "take" the breast, I perhaps have assumed incorrectly
that they also "take" the bottle - but that sometimes one needs to
"give" the bottle?

I apologize for this being so long.

Warmllly, Mary, LLLL, IBCLC

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