"She breastfed all of the next day, and then was told again by another
nurse that the baby should probably be supplemented due to his size and
hungry, non-satisfied behavior."
If left alone to continue as she was, all would probably have been just
fine. It's the staff that has a "bottle-think" mentality, i.e.
"non-satisfied behavior". They think baby should feed for (fill in the
blank) minutes and sleep for 2-3 hours. After all, this is their
experience. They stuff baby full of ABM to the point of overflowing, wrap
up like a little burrito or little mummy, and baby's survival mode kicks in
to keep very still, sleep & digest this mess.
I ran into this in our Level II nursery yesterday. Nurses wanted my
pronouncement as to whether this ~8.0 lb baby "got enough". The nursery was
closing down for 2 hours for shift change, and baby was expected to leave
the staff alone during this time. Well, baby appeared satisfied, was not
rooting, but was awake & complained about being put down in her plastic
box. Staff expected her to be asleep if she was full. Baby was ~24 hours
old & peeped & pooped during that feed. Poop color was definitely changing
but not all the way yellow. All I could say is that she's satisfied for the
time being, but I can't guarantee any specific time frame. They needed
*numbers* for their charting. Baby was on antibiotics & being monitored,
but was in an open crib.
My own 3 babies were 9-10, 8-13, and 9-3. All things being normal, just
tuck baby in, plug him on & follow his lead. The needed volume of colostrum
will be there & the "white" milk will come in quickly. With #3, my "white"
milk was coming in @ approx 36 hrs.
Suggestions: Continue to encourage mom to follow her instincts to nurse by
baby's cues. Encourage her to slowly reduce the amt of milk/ABM in the SNS,
or to wean off it by using it on every other feed, then 2x day, etc. Mom
can also reposition the SNS lower on her body to reduce or eliminate the
effects of gravity on the flow through the tube.
I think most hospital staff desperately need ongoing inservices on Basic
Lactation Management, i.e. Milk Removal = Milk Replacement; Latch
Assessment, etc. So far, we have been asked to do another Skills Day on
breast pumping. This time, it's for the entire hospital, not just
Pediatrics. With the help of our BF Task Force, we intend to get into what
WE think are the Basics.
--- Phyllis Adamson, IBCLC
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