I have been reading with interest past posts about when babies need to be 
fed, how much, etc.  Especially delaying the early feeding by 24 hrs, etc.  I 
am wondering how happy these babies were?  Are we talking babies born as I 
was under 'twilight' anesthesia or babies born without medication for pain?  I 
am wondering if these babies cried themselves to sleep in the nursery or were 
peaceful and content?  I ask this because I find it odd to say that because in 
the past babies were left hungry due to protocol that babies do not need to 
eat.  I have been at births where there are medical interventions, babies are 
sleepy and uninterested and show no desire to suckle or eat and I would 
agree there may be no urgency to force the issue with alternative to 
breastfeeding.  But, what of those babies who are screaming and rooting and 
showing signs that they need to be fed?  Would it be appropriate to deny 
them food for that 24 hours of the past becase we can?  Or is it more 
appropriat to feed them, even if it means formula because there is not an 
alternative available?  Perhaps we can work on limiting the amount of those 
early feeds to more closely mimic what would normally be available.  Very little 
is needed, this is very true, but nothing at all for a crying hungry baby is not 
the answer I would want.  What is really normal for a baby to want at  birth or 
shortly after?  Do we look at those babies who do eat well at birth and say 
that is normal?  And feed the other babies accordingly?  Do we expect babies 
to cry in hunger have it ignored as a welcome to the planet?  When do the 
needs of the baby and the emotional impact of being left to cry in hunger 
outweigh the risk of the formula?  Do we really know enough to say that it is 
fine for a baby to go 24 hours without any noursihment if that baby is not 
content with our choice?

While I completely agree that the marketing of formula is obscene and I detest 
it's pervasive acceptance as normal and equivalent to mother's own milk, I 
wish we could find a place to accept that a hungry baby has the right to be 
fed even if that means formula.  While formula is less than optimal, it beats 
the heck out of hungry.  I agree it should be used sparingly and only as 
needed...like any other medical intervention.  Perhaps that would appease 
me...present formula as a medical intervention.  No one thinks a mother is 
somehow 'less than' if her child needs medical care or regular medications, 
etc.  Instead we feel bad for her, bad for her baby and the struggles they 
face and support them as they develop ways to provide this necessary care 
for their child.  Formula use should be like that....what is needed if normal is 
working, but not something you are made to feel horrible about needed.  It's 
the idea that bottle feeding is just fine, formula is just as good, etc. that 
irritates those of us who want to protect brastfeeding.  And, I understand 
that.  But there needs to be that middle ground.  That place we walk with 
mothers who have no alternatives but to provide a pharmaceutical 
replacement for what they cannot produce.  

Now, how do explain that formula is not the evil incarnate the mother believes 
it to be....and that it is what she will have to feed her babies because her 
breasts did not develop.  How to explain that the same way she needed 'help 
with her fertility' she will need help with feeding her babies?  How to explain 
that it is not the nurses fault the formula was given and they were definitly 
NOT wrong.  The babies were indeed screaming and rooting and all the skin to 
skin and sucking was not getting them food.  Yes, it is sad, yes, we are so 
sorry that this is what was needed, but babies need to eat. Mom had a 
cesarean, she was in pain, babies were put to breast within less than an hour 
after birth, were skin to skin in recovery and attempted to suck on the 
inverted nipples on skin over muscle.  Not so much as a drop of colustrum to 
be found on hand expressing (and I am very good at hand expressing) and 
babies were screaming.  Ideally we would have used a feeding tube at the 
breast, but mom was so uncomfortable she did not want to continue having 
the babies on her.  They had been skin to skin for over an hour each and she 
was exhausted as were they.  The nurses were awesome, respectful and 
gentle, but hearing the babies scream was hurting me, it had to be hurting the 
mother.  

If I believed that formula was poisonous and would do irrepabable damage and 
no baby should ever receive formula, how could I possibly comfort mothers 
who will not have alternatives?  My goodness, unless milk banks start popping 
up on every corner, I see it is either breastfeed, pump, or use artificial baby 
milk options we have.  Casual milk donation? Sure an option for some, but 
most mothers would not be comfortable with that choice.  It certainly is not 
readily available anyway.    So, for me, I see that babies have a right to be 
breastfed.  They have a right to the normal way of being fed...skin to skin, 
mouth to breast, sucking and one with their mothers.  I think all babies 
deserve breastmilk to come with that effort, but I accept that it is not always 
possible.  So, if I can protect the breastfeeding, but cannot promise the milk 
to go with it, I am able to work.  I am able to tell mothers that the process is 
equally important.  That it is sad and unfair their breasts are not able to 
produce sufficient milk, but indeed they can be breastfeeding mothers.

If I have to pick one part of my work that breaks my heart the most....it is 
babies who want to breastfeed, mothers who want to breastfeed, and breasts 
that are not going to make the milk that should go along with the process.  I 
cannot add to that pain for the mothers by pointing out the shortcomings of 
artificial milk or what their babis have lost -- they are painfully aware of that 
reality.  

I have had my trio of milk supply issues this month.  I should be done for 
awhile.  I hope.  Milk supply issues are the hardest for me...the body defying 
the mind's desire....just so unfair.

Take care,
Pam MazzellaDiBosco, IBCLC, RLC

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