I can see why you are frustrated Rachel.  It seems like the magic of the first feed is not given a chance.

Here in New Zealand, we have strong protocols around the use of infant formula and it would be unusual for it to be given before the first breastfeed or feed of colostrum. Nation wide BFHI has made a difference.

By and large, the paediatricians are not involved unless there is a referral from a midwife or it is an emergency.

However, we are seeing a rise of supplementation in the first 48 hours for a variety of reasons.  

1.	increased rates of high risk pregnancies
2.	babies not feeding well in the first few days despite lots of skin to skin and opportunities
3.	high obesity levels, which may lead to large breasts and short nipples
4.	definitely an increase in gestational and type 2 diabetes
5.	unexpected low blood sugar levels in otherwise healthy babies - ?? poor maternal diet
6.	post mature infants who dehydrate quickly if they are not feeding well

I think we have moved away from giving formula supplementation for soft reasons like "very unsettled baby", "'mother exhausted'', ''going a bit yellow''. I feel with BFHI and improved education we have more to offer mothers in terms of support in the early days. We have more to offer staff too in ways of assessment - which babies are low risk and you can wait, or which babies need further assessment and careful management of feeding, without undermining breastfeeding totally.

The babies who feed easily and frequently are OK.  But what happens when they can't and don't?  That is what challenges us every day on the postnatal floor.

It has certainly changed from 2 - 3 decades ago.

Karen Palmer
RM, IBCLC
Tauranga NZ
	

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