LACTNET Archives

Lactation Information and Discussion

LACTNET@COMMUNITY.LSOFT.COM

Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Show All Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
Subject:
From:
"Donna Zitzelberger BSN, CLE" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 22 Oct 1996 23:24:24 -0700
Content-Type:
text/plain
Parts/Attachments:
text/plain (100 lines)
Hi All,
        Just catching up on my digests and came across the sleepy baby/early
feeds discussion that Trisa posted.  This is something I face each day I
work on postpartum.  There is always at least one sleepy baby.  I have come
up with a system to deal with it - sometimes it works, sometimes it doesn't.
Let me know what you all think - your thoughts are very welcomed.

        My first concern is to reassure the mother so she doesn't give up.
The nurses and doctors are very rigid with the every 2-3 hour schedule
(makes me crazy at times).   The mothers are told an array of explanations
for the sleepiness - i.e. "he's lazy", "she's just a baby that needs a
little extra help (ABM) to get going", etc.  Mom/Dads end up getting so
confused and so exhausted that they just can't wait to choose bottlefeeding
and the baby is often less than 12 hours old!  These babies are shoved at
the breast so much that they begin to shut down and refuse (wouldn't you?).

        Trisa, this is where nurses can make or break breastfeeding (IMHO) -
but I know I'm right!  If the mother is given consistent, supportive
assistance with breastfeeding she will often do just fine.

         Here's my check list:

        1- Review the mother's history for any significant illness that
might be affecting baby.  Diabetes is a big one.  If the mom has diabetes or
was a gestational diabetic, the sleepy baby may be a hypoglycemic one and
the md will usually want a chemstrip.  Our hospital has a chemstrip protocol
that pretty much covers these bases.

        2- Review the chart for any significant L&D occurances - cord around
the neck, maternal narcotics w/in four hours of delivery, newborn narcan,
ROM (rupture of membranes) greater than 18-24 hours, hours of labor, hours
of pushing (once had a mom that pushed 5 hours - that baby was tired!), etc.
These will cue you into possible problems with the baby.  Eg.  If mom was
ruptured over 24 hours and baby is not going to breast well, you'll want to
check out some other signs and symptoms for sepsis and notify MD

        3-  Assess the baby from head to toe.  Check the head for
cephalhematoma or caput (may be leading to early jaundice), severe molding
(some babies just whimper pathetically when their heads are touched -
they've probably got a whopper of a HA and a nurse jamming them against the
breast is not helping), check the jaw alignment and suck, skin color (early
developing jaundice or poor oxygenation), check the clavicles for possible
fractures, get a heart rate and listen to the rhythm of the heart (once
found a baby with a heart anomaly who was a "sleepy baby"), watch the baby
breathe and listen to the lungs (some "sleepy babies" are beginning to go
into respiratory distress and may sound like they are "singing" on exhale),
and while you're doing all this, get a temp (get the baby skin to skin with
mom to warm  baby up, if baby doesn't start warming up within an hour
something more severe may be going on - eg. sepsis).

        Giving the mom, labor/delivery, and baby a thorough check will rule
out any major reasons for concern.  It will also give you the ammunition you
will need when you advocate for the mother/baby with the md and staff
nurses.  The doctors want to know the facts - if you present them with a
thorough history of the mom, labor/delivery, and baby , they will be more
apt to listen to your plan of care.

        If everything  checks out to be normal, then what you most likely
have is a normal sleepy baby who will probably come out of sleepiness within
the first 24 hours of life if not sooner.  The mother will need CONSISTENT
assistance with the breastfeedings and reassurance. I will often inform the
nursing supervisor that the sleepy baby will need a higher acquity.  This
will sometimes allow more nurses on the floor. I also check the staffing for
the evening shift and night shift.  I leave notes for the nurses asking them
to assign these babies to nurses that are experienced with breastfeeding
challenges. The mother will need to get sleep as well.  Too many times, the
mom is talking on the phone and to visitors instead of resting during those
early post delivery hours and then has no energy left to feed the baby.  I
usually attempt to get baby to breast every 3 hours.  I don't spend more
than 15-20 minutes "attempting" - it's just too tiring for the mother. To
wake the baby: unwrap her, change her diaper, rub her back, sit her up,
tickle her toes.  I've had better luck putting a sleepy baby in a clutch
position (football), they don't seem as cozy as when in the traditional
cradle position.  Some of the peds will allow a few feedings to be skipped
(i.e. will let a baby go for 6 hours before supplementing, they've never
gone longer).  If the md orders supplementation, I provide mom with lots of
reassurance and book her into our breastfeeding f/u program for support.

        I've been down this "sleepy baby" road thousands of times.  It can
be a frustrating road.  I try my best to use humor with the moms so they
don't get overwhelmed with it and to assure them that the baby will wake up.
(e.g. I've seen lots of moms crying because the baby won't feed and the next
day they are crying because the baby won't STOP feeding!)  I also spend time
talking to the staff nurses and educating, re-educating about the sleepy
baby and ask them to give consistent information.  For the most part, they
are pretty good. However,it becomes a nightmare when registry personnel or
floaters come through.  The main goal is to keep the mom breastfeeding
through this period.  I've had some mothers completely give up (usually on
night shift - when they are exhausted, overwhelmed).  When the light of day
hits, they are often willing to try again and are encouraged as the baby
starts waking up.  These moms usually need a lot of f/u support because even
when the baby starts nursing well, they are so tired they continue to focus
on the negative. If your hospital doesn't provide breastfeeding f/u, get mom
in touch with an LC.

        Hope this helps.

        Donna Zitzelberger, RN BSN CLE
        waiting on pins and needles for those results

ATOM RSS1 RSS2