Well, Jacquie, do I ever feel your pain.

For some reason all the pediatricians working in Norwegian hospitals have
got it into their heads that formula supplementation is the answer to every
problem, especially imaginary problems like 'diet-controlled gestational
diabetes' (can someone please explain that one to me?). This is a new
development, starting in mid-2014.

Cold baby? Heel stick and supplement just to be on the safe side. Baby
under 2700 grams at birth? Supplement within half an hour of birth and oh,
wait to check blood sugar until an hour later (no joke, that is our new
procedure and anyone who disregards it is liable to be reprimanded). Baby
over 4500 grams at birth? Check blood sugar within an hour and give a
little formula just in case. Baby between 35 weeks and 37 weeks gestation
at birth? Formula feed within first hour, check blood sugar three to six
times in first 24 hours and supplement with 10 ml of formula three-hourly
for the first TWO TO THREE DAYS. Mother had gestational diabetes, with our
without need for insulin? Give 10 ml formula within twenty minutes of birth
and wait one hour to check blood sugar. No choice, no alternatives, baby
must be given formula or the employee's head is on the chopping block.  The
pedis are against checking blood sugar before giving formula out of concern
for the pain involved. There is no concern for what is happening to
breastfeeding, or to babies' guts, or to the attachment process as mothers
and babies are disturbed for the sake of weighing a baby immediately after
birth in order to determine whether they are outside the magic limits of
2700-4500 grams. It makes me SICK.

Baby's temp 2 hr after birth 36 degrees C or less? Check blood sugar and
feed formula if pedi says to, regardless of the blood sugar level.
Pediatrician are more ofteh in the room during the birth, not a normal
scenario but one which is becoming distressingly commonplace in my hospital
as we manufacture diagnoses to stick onto pregnant women so their risk
category goes from normal to high and we can monitor them more intensively
and disturb them more completely while they try their best to just have
their babies. If the pedi thinks the birth looked 'hard' the baby is likely
to be separated from mother for 'observation' and supplemented as of course
its blood sugar will be lower than if it were left where it belonged.

Mothers are given no choice, no advance info on what is going to happen to
their baby and the breastfeeding if they fall into any of these risk
categories, despite most of them being known before the baby is born.

I've been working in this field since pre-Baby-Friendly days when
rooming-in was not the norm and skin-to-skin had never been mentioned. It
was easier back then to help a mother to exclusively breastfeed from birth
because the doctors largely ignored everything that happened after the
five-minute Apgar score. I am not joking, things are bad and getting worse.
About 40% of babies on my ward have now received formula before they go
home and most of those get it before they even get to lick their mother's
breast. Meanwhile, we laugh condescendingly at 'immigrants' who request
formula because 'I don't have milk in my breasts yet.' We don't laugh at
pediatricians who don't think there is milk in breasts, we jump when they
say jump and we sabotage breastfeeding every hour of every day.

The pedis are using a home-made procedure book from the hospital in Tromsø.
All the info on infant feeding in it comes from conference proceedings of
the European Society of Pediatric Gastroenterology and the words 'breast
milk' or 'lactation' do not occur in the entire document. Yet this trumps
the skills and knowledge we in maternity care have used to keep babies
healthier than anywhere else in the world for decades. Go figure.

Rachel Myr
Kristiansand, Norway

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