Feeling frustrated
Young mother, I did a prenatal consult/ private breastfeeding class with her.
Wound up with long labor, multiple interventions, and then C/S for failure to
progress
First 2 days in the hospital mother only gave about 1/2 oz of formula twice/
day, I kept commending her, I helped her with latch, which looked good, also by
IBCLC (latch looked good) and baby had nice jaw excursions
by second hospital day night shift nurse told her baby lost some weight and she
better give formula, this probably ruined her confidence, but I think there is
some cultural influence also by friends and family saying its okay and
desirable to give formula
by day of discharge, mom's complaining that he wants to nurse "all the time", I
notice multiple formula/ bottle feedings in the chart and as I am examining
baby in nursery (which I usually don't do, but thats where he was) baby is
crying and I tell nurse to bring him to mom, nurse reports back that mom said
to give a bottle she wanted to take a shower. So, maybe motivation is not
really there. BUT to ME mom keeps saying that she WANTS to breastfeed. And
I've multiple times discussed normal feeding patterns etc...
At 1 wk old visit pre and post BF feeds weights (on my new "baby weigh") infant
gained 50g from the breast. So I encouraged exclusive breastfeeding and gave
them handouts (in English and Spanish for the mother-in-law) about how
"Breastfed babies don't need formula" (coutesy of LA WIC and SanDiego BF
coalition website) and LLL when to start solids in Spanish (this will be
relevant later on)
next visit at 10 days baby was at or slightly above birth wt, and had gained
close to 1oz /day from the previous visit. Mom said she hadn't given any
formula since the previous visit and infant wasn't stooling. (small amount
every 2-3 days) Also mom never got engorged.
Its hard for me to say that she definitely doesn't have a supply problem, SHE
feels she does. The lack of stool still could be "constipation" or normal
pattern from the formula he had before. His wt gain really was normal BUT, mom
says she can't take it anymore (his "constant nursing and her lack of sleep)
She also says that she gets very little out (less than 1oz) when she pumps, so
she was definitely going to start giving him formula again
so...
I set mom up with a lactaid (Jack Newman style, we did it in the office and it
worked) I would rather her "supplement" that way than with a bottle, I also
suggested a change in formula to Alimentum and a glycerine suppository for the
"constipation", and for her to take fenugreek and mother's milk tea
Today in follow up, mom is giving about 12 oz of formula/ day. 3-4 times in the
bottle and only 2 times by lactaid. Infant gained >8 oz in 4 days!!! pre and
post feed weight showed 1 1/2 oz gain from the breast, and infant still
rooting. Mom reports she did notice increase in her breast size.
Mom says that glycerin supp didn't work SO... over the weekend she called a
doctor from Colombia (the country not the university) Parents are latino and
what they decided to do is reccomended by all their friends etc...
Here's what she's doing....
1. Watering down the formula (still regular similac b/c alimentum was too
expensive)
2. planning to buy the low iron formula since that is what worked with her
friends
3. Gave infant ORANGE JUICE as recommended by this Columbian doctor and IT
WORKED!!! for the constipation
When I gave her the standard lines against these practices, she is giving me
that look "I don't believe you" "I'm going to do this because it is
reccomended to me by people I know and trust and it works for them" She also
said, which is true, that I'm making her feel that she's doing everything
wrong.
I really spent a long time with her, I said that I am against these practices
but that I acknowledge she is working hard to breastfeed her baby. I
reiterated to them about long term increased illnesses in nonbreastfed babies
and again encouraged her to see an IBCLC (last week there were 2 LLL meetings
in the area that I encouraged her to go to "free" but she said that she coukd
not get there b/c of scheduling times etc...)
I feel so ineffective, its not a language barrier- they speak perfect English
and we speak perfect Spanish in our office, its a cultural barrier, not just
her particular social group but the massive formula is "good" and "free" from
WIC (she has already been and gotten some and wants a prescription to change
brands) She could ask ten other doctors and a hundred Friends and consult 20
magazines and books and they will all tell her that what she is doing is just
fine and that Dr Kotler is just a fanatic so don't listen to her
What would YOU have done and said????
Amy M. Kotler, MD FAAP
Dover Pediatrics
LLLI Breastfeeding Resource Center
Doctors Park 369 W. Blackwell St
Dover NJ 07801
ph 973 328 8300
fx 973 328 8315
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