In a message dated 9/12/2006 12:01:46 AM Eastern Standard Time,
[log in to unmask] writes:
A mom who REALLY wants to succeed with breastfeeding this time (her first
baby received breast milk from a bottle for MONTHS due to refusing to
breastfeed) had a baby with problems with respirations, (2.5 weeks early???)
on CPAP, etc. She has requested that the nurses not use bottles - tube
feeding when she is not there to breastfeed (night feeding). However, they
won't release the baby to mom until she can take in all her calories orally
- so the nurses are pushing her to accept the use of bottles "so you can
take her home"
I'm sure she'll agree to the bottles - in the hopes things can be "fixed"
once she gets home. I can't really blame her! Mom has been told the baby
must be kept on a q 3 hour feeding schedule with feedings that should last
no more than 15 minutes.
We are told to consider oral feeding with a bottle as "normal" feeding - and
breastfeeding as "extra" and "more difficult" and "exhausting for the baby."
What is a mother to do?
Jeanette Panchula, BSW, RN, PHN, IBCLC
Jeanette's post brings up some very interesting points and I have not seen
really any comments back regarding her questions.
I had some discussions with nurses at a Level II nursery I work at. The
nurses still use the red premie nipples because they feel a firmer, slower
nipple would be too difficult for these babies to obtain the intake they need.
They know that babies tend to desaturate their oxygen levels when bottle
feeding but take this as the "norm" and feel babies will eventually work through
this. They also feel that with babies on monitors and mostly fed by the staff
Vs the mother, they can keep a better eye on handling the desaturation drops
in oxygen.
I have sited Wolf and Glass's work that preemies should not have a faster
pace and that some babies out of desperation basically hold their breath when
feeding and then make up with bursts of rapid breathing. I have not made any
inroads in this discussion.
Another issue in these nurseries is the need to have babies fed larger
amounts and therefore less frequently. There are many a premie babies who gets
moved to every 4 hour feeds. I am also dealing with most of the babies getting
calories added to their mother's breast milk to speed up the weight gains.
This means limiting how often the babies can breastfeed.
I have pointed out that 4 hour feeds is not a norm for babies and have been
trying to encourage breastfeeding ad lib when babies are looking to suck.
Almost all the babies in our Level II nursery that are preemies end up with
reflux.
Last night I had a debate with a nurse who told a mother of a 34 weeker,
who's NG tube was just pulled that bottle feeding would be easier and if the
mother tried to breastfeed the baby would get too exhausted and than the NG tube
would have to be replaced. I pulled the nurse aside and informed her that
if the baby was truly ready for oral feeds that breastfeeding would be good for
the baby and not too taxing. I also pointed out that this should be the
mother's decision.
I am looking for comments, sites to articles and help to how to approach the
issues I have observed. Especially, can people respond to the need for
preemies to take larger volumes and less frequent feeds Vs smaller volumes more
frequently.
Thanks,
Ann Perry, RN IBCLC
Boston, MA
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