I am looking for answers to a frustrating situation at work.
A full term baby born vaginally to a primip mother breastfeed well right  
after delivery.  Than this baby became tired and not interested in feeding  for a 
good 8 hours.  I had the mom hand express her colostrum onto the  baby's lips 
and use skin to skin.  He appeared very mucousy so I told her  to continue 
with the expressing and wait.  By the night time, now 12-15  hours old, the baby 
had a dusky spell and was brought into the nursery to be  observed.  He still 
was not interested in feeding but went out to mother  for attempts.  The 
following day he had another dusky spell after spitting  up mucous and colostrum.  
He was now on an oxygen desaturation monitor and  was dropping his O2 levels. 
 The pediatrician ordered that the baby be fed  formula to see what the baby 
would do.  The first nurse who received these  orders only gave a few sips and 
the baby promptly vomited but the pediatrician  wanted the baby to breastfeed 
first and than follow with supplements of formula  each time.  The baby 
tolerated some of the supplements and vomited and  dropped his O2 stats on others.  
(I was off this day.)  The next day  the baby was sent for an Upper GI and 
the diagnosis was severe reflux.  The  mother was being discharged but her baby 
had to stay to be monitored and the  pediatrician continued the order to 
breastfeed and follow with formula.   The mom was given a pump and obtained 15 cc 
on her fist pumping.  
I asked the pediatrician (an elderly gentleman) why he was ordering the  
formula supplements.  I know he was not happy about me questioning his  orders.  
He told me he wanted to see what the baby would do with more  volume since she 
didn't have any milk yet.  I pointed out that she did but  this made him angry.
I observed this baby breastfeed beautifully and than I had the mother pump  
and her volume was increasing so I asked the staff to call and see if they  
could use the mother's expressed milk to supplement the baby.  That evening  the 
baby had a sever spell and was admitted to the Special Care Nursery.
I don't understand this thinking and I am looking to this group for any  
answers.  
Sorry for the long post.
Ann Perry, RN IBCLC
Boston, MA

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