Chris wrote:
<< I have a theory about how "breast & bottle" gets written on babies' charts.
The mother is in labor. The admitting nurse is doing her admission paperwork
and asks "Breast or bottle?" because she has to check a box on the form.
Mother is planning to breastfeed exclusively at first and use expressed milk
in a bottle or use formula in a few weeks or months; she answers "both"
because she's in labor and doesn't want to go into too much explanation. And
once both boxes get checked off, the nurses feel they have have carte
blanche to stuff the baby with formula any time they get their hands on
him/her instead of helping the mother breastfeed. (I am saying this based on
over 10 years' experience working in a hospital where most nurses thought
giving formula to a breastfeeding baby was No Big Deal.) >>
Thanks for the musings, Chris. They make a lot of sense. I want to address
this from another angle now. We have a lot of work to do since hospitals, etc.
are obviously still clumping the feeding device ( the bottle) with the food
being fed. What I mean is, this Breast of Bottle dichotomy perpetuates several
misleading and perhaps dangerous ideas. For one, it assumes that a bottle
always contains artificial milk. As more and more women breastmilk feed, we need to
dissociate the bottle from the formula. Bottles, in theory, though not in
practice, come empty. They contain what is put in them. So really any chart
should read Breastmilk/Human Milk or Formula/Artificial Infant Milk, etc. Assistive
feeding devices should be specified separately and not assumed. The use of a
bottle as an assistive feeding device might be well-justified for some
mother/baby dyads, but that should not assume that the bottle contains anything but
expressed or donor milk. When hospitals/nurses, etc go from "Breast{feeding}"
to "Bottle{feedingwithFormula}", the baby skips from the first acceptable
recommened feeding of breastfeeding, to the faraway 4th choice of formula feeding,
while missing out on opportunities for expressed milk,, and donor milk, as
well as other assistive feeding devices. This brings up another issue which has
become something I watch out for recently, which is overfeeding in the early
days. If a baby only needs about 1 Tablespoon of colostrum for a full feed on
Day One, it doesn't make any sense for anyone to be giving bottles of anything.
For a nursing dyad with problems latching, expressed colostrum on a spoon
would make more sense and lead to fewer problems than tipping up an ounce of the
artificial milk for a very young baby. Perhaps if it was known, and as was
mentioned, accepted, that babies under the age of 2-3 days do not need ounce
feedings of anything, they would be less likely to step in with bottles, since
spoons or cups would make more sense?
Just musing myself,
Judy LeVan Fram, PT, IBCLC, LLLL, Brooklyn, NY, USA
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