Tricia has certainly described a difficult situation with many stressors
and barriers for this breastfeeding family. I have worked with many
situations similar to this with varying outcomes. One thought came to mind
regarding Sue's comments and that is the original offering of a choice
between a nipple shield and bottle of formula at 1 hour of age. This baby
was post dates and small for gestational age. SGA infants can be difficult
to feed right from the start and are already experiencing a nutritional
deficit. They may be sleepy, sleep for long periods, and not nurse well
which provides insufficient breast stimulation. SGA infants may demonstrate
a lack of vitality or vigor which reduces active and efficient sucking. The
central nervous system is also affected by intrauterine growth restriction
and benefits from the critical components of human milk that promote brain
growth.

This mother and infant were mishandled in the hospital through a lack of
understanding of both breastfeeding and the unique situation of an SGA
baby. Tricia, you may wish to send a letter to the hospital describing the
outcome of the hospital care that was given to this mother. I always kept a
log of these types of situations to demonstrate to the hospital what
happened when there was no clear breastfeeding policy and training for
staff.

Marsha Walker, RN, IBCLC
Weston, MA

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