A pediatrician I know (and like) told one of my clients that her 8.5 pound
baby really only needed 15-16 ounces of milk in 24 hours and to go ahead and
let her sleep as long as she wanted and that eating only every 4-5 hours was
fine now as baby is gaining well.  Hmmm.that would be at least 3-4 ounces
less than this baby needs to continue to gain.  Also this is a baby who has
had major trouble waking for feedings and would sleep 5 hours or more at a
time if you let her.  And according to the Dr. baby's jaw looks fine.

 

So, did I contradict the Dr?  Yes - of course.  And I told mom why I was
contradicting.  This dyad struggled with milk supply and weight gain issues
initially.  Why?  Because baby had almost no peristaltic wave and no
negative pressure (suction) to speak of due to the jaw being terribly
lopsided.  Baby is finally over birth-weight (she is 2 wks old) but it took
a lot of work and small frequent feeds to do it - waking this kid every
2-2.5 hours around the clock for 48 hours to get her weight back up.  She
was over a 10% weight loss when I first saw them on day 4.  Mom had only
drops of milk and her nipples were traumatized from baby's condition.  We
got baby off the breast and onto bottle feeding and mom on a hospital grade
pump immediately.

 

I referred baby for treatment to a neuromuscular therapist who has extensive
experience with babies.  I recommended a fairly firm routine (with
flexibility) to get weight back on baby, bring in the milk supply and
protect everyone.  Baby needs at least 1 or 2 more treatments to finish the
work with her jaw - she has progressed from no negative pressure (suction)
and minimal peristaltic wave to lots of negative pressure (compensation) and
about 75% of needed peristaltic wave.  She can get milk from the breast now!
Not 100% yet, but has made wonderful progress.  However, she is still SLEEPY
and hard to wake up.  She is not waking for feeds yet.she will eat 18-20
ounces of milk in 24 hours if mom works at it and is gaining well now.  Mom
is finally making as much as baby needs - but it took her 10 full days to
get there and she needed the help of herbs to get over the hump she was
stuck at of only 16 ounces in 24 hours.

 

If mom allowed baby to sleep as Dr suggested and only fed that 15-16 ounces
per day this baby would go backwards in health and would not be gaining well
and we would have more problems.  In talking with Mom (who is an Ped. OT)
she understands why I am recommending the routine for her I am.  She
recognizes that the Dr.'s 'advice' is neither sound nor safe for her
situation.  She will be following MY recommendations.  She has already seen
what my recommendations have done for the health of her baby and her milk
supply.  Her baby had a birth trauma that resulted in a severely lopsided
jaw and some torticollis.  I referred for treatment - mom listened.  Dr saw
baby and said no big deal it will work itself out.Mom listened to me because
her education told her that I was right and Dr. was not.  Baby needs at
least one or two more treatments - mom KNOWS this, she can see it, and knows
I am right.  The suck is not 100% - baby is not able to breastfeed
exclusively - even tho Dr told her to go for it.

 

There is a lot more to this particular case - but I hope that one can see
that if I did not contradict the Dr. advice and mom were to follow this
Dr.'s advice, she and her baby would end up in trouble - again.  Mom is, of
course, welcome to listen to whoever she wants to - she chooses to follow my
suggested protocols - they make sense.  They are protecting her and the
baby.  Period.

 

I am a private practice LC - I am not going to get fired for contradicting a
Dr.  I have irritated a few Docs in my day (certainly not on purpose!) for
doing so - but honestly at this point I am not worried about it.  I have an
obligation to my client and their baby.  NOT to the Doctor's ego or title.
Call me stubborn - call me whatever you want.  I am always tactful and
appropriate in how I contradict - but I will contradict when I need to -
when the baby and/or mom needs me too.  I also send in a Dr's report to
state what I see and what I am recommending and why.  After that it is the
parent's choice in how to respond.  

 

Bottom line - I feel I am here to take care of my clients.  I am always
tactful and appropriate if and when I need to contradict.but I will
contradict.  

 

Please - no e-mails telling me how I shouldn't contradict and that I am
doing something wrong.  They won't change my mind.sometimes you have to do
what you have to do.  And as my Nurse Practioner friend tells me - Dr's need
someone who knows more about 'whatever' than they do to educate them.So I
try.

 

Warmly,

 

Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net

 


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