Dear Cheryl,
I absolutely see your point in trying to solve breastfeeding problems
without resorting to formula or gadget use! Unfortunately. sometimes (in
our hospital) we were sabotaged by some other staff member, especially some
of our NICU nurses. As a matter of fact, today I went in to assist a mother
of a baby in the NICU--baby is tachypnic and +Group B Strep. Mom had a
C-Section because her water broke, they then tried to induce with pictocin,
she failed to progress, baby's heart rate was low. Baby in NICU--hooked up
to monitors, with I.V. antibiotics. Baby was born in pm on May 12. She was
finally "allowed" to attempt breastfeeding today! I wasn't on previous days
to see her or know of her situation. The nursing staff failed to get her
pumping right after baby was placed in NICU. The neonatologist had orders
that baby is to receive 35 cc's of breast milk or formula. Mom had pumped
10 cc's of colostrum. I helped mom latch baby on this morning, baby is
"nipple-confused", would come on and off. I then offered to stay and help
mom cup-feed to avoid bottles. The NICU nurse refused and had a red premie
nipple on the bottle. I at least argued to have them put a yellow nipple on
the bottle. I also informed the parents that they can refuse to allow their
baby to have a bottle nipple and their baby can be cup-fed as an alternative
method. (This nurse was turning red and I'm sure her blood pressure was
rising!) I gave in for that feeding, at the next feeding, baby latched and
stayed on 30 minutes! We cup-fed 10 cc's of colostrum, then followed it
with 25 cc's of formula.
As an LC, we do have a wonderful breastfeeding policy in place! Our
department in-services the nurses on cup-feeding, setting up pumps, and
basic latch-on techniques. The nursing staff is required to go, otherwise
they cannot receive their bonuses. Our lactation coordinator--head of our
department also writes up nurses that violate the breastfeeding policy.
However, we do not go against the Neonatologist orders. We often do talk to
the Neonatologist and present him with factual information and he will often
relent, or modify his orders. But, as soon as mom is pumping plenty of
breastmilk, that is all the baby gets.
As LC's in our hospital, we often discuss that there are many times we are
"fixing" a problem that didn't have to happen. Sometimes a mother's milk
supply is compromised, and that baby needs calories to be able to grow, get
strong, eat and stimulate his mother's supply.
Ideally, it would be as you say and breastfeeding would be the simple
problem to solve. I have seen a few babies be re-admitted for dehydration,
one mom recently we diagnosed with insufficient milk. There was no way of
knowing until they contactd us, by then the baby had lost well over a pound
of weight on day 5. The baby was in the peds office on day 5 and the ped
wasn't all that concerned, fortunately the parents sensed something was
wrong and brought the baby in. I worked with that mom for three days in the
hospital. We pulled out the formula, had her pumping, and taught her how to
use an SNS. She pumped out a token 5 cc's on day 10, 11, & 12, pumping 8x
day. We worked out a plan where baby got the breastmilk first, then
finished with the SNS with formula at the breast.
There have been a few incidences of delayed onset of milk production, (5
days out) that baby has been re-admitted for dehydration. Breastfeeding,---
meaning latch, frequency, and position are all fine. But, baby needs to
eat. We also have had some failure-to-thrive babies. One in particular we
worked with. Baby transferred plenty at the breast, latch on was good, all
seemed great. Baby wasn't gaining or growing. It finally ended up that the
ped ran some blood work--baby was dehydrated! Mom wasn't feeding baby often
enough! We then had the mom send formula to the day care provider and she
could breastfeed him exclusively at home. He then started to gain. This
mother wasn't complying with our instructions--we were fooled for awhile.
The pediatrician had ran all kinds of tests, including metabolic, and
genetic type testing.
These were scary instances. We had to feed the baby. No, formula isn't my
first choice, but sometimes it does save the baby's life, while we are doing
everything to preserve and protect mom's milk supply.
Connie Chiavario, CLC, IBCLC
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