I just received a call from a mom that has me very concerned about the
medical advice that is being dispensed by our local health care
professionals.  This mom has a five day old baby.  She has been exclusively
breastfeeding, but with sore nipples.  At day three, the baby began
refusing to nurse and would only scream at the breast.  In the following 12
hours, during which she had not nursed at all, she had no stools.  The mom
then called the pediatrician who told her not to worry and that the baby
will eventually nurse when it gets hungry.  Still worried, the mom called
the on-call nurse at the hospital who told her to just keep nursing (the
mom had already told the nurse the baby *wouldn't* nurse) and that it was
NORMAL for babies to not stool for several days.  The mom didn't feel
comfortable with the information and after another 12 hours (the baby
hadn't fed in 24 hours !!!), she took the baby to the emergency room.  The
doctor there did a digital rectal probe to "stimulate" the colon and gave
them glycerine suppositories to use at home.  He ordered an x-ray to rule
out bowel obstruction.  The mom clearly told the doctor that the baby would
not nurse at all and hadn't eaten in 24 hours.  He told her that when the
baby got hungry enough, she would eat and not to worry so much.  The
treatment plan they were given was to just use the glycerine suppositories
every 2 hours.  At no point did he suggest that the baby was dehydrated
(which she clearly must have been) or should be supplemented.

This wise mom felt the information the doctor told her still didn't feel
comfortable, so, once home, she began pumping every hour and feeding the
baby the scant 15 cc's she could pump (she hadn't pumped or nursed for 36
hours previously).  She fed the baby the 15 cc's every hour and watched the
baby visibly transform into a much more normal affect.  I'll be seeing her
this afternoon and have told her that in the meantime the baby actually
needs at least 60 cc's (per body weight) every two hours and that it is
absolutely ok to feed formula in addition to her milk if she can't pump
that much.

I've seen a lot in my practice, but I don't know that I've ever seen a
situation where a baby was put in more danger by a series of medical
professionals.  This baby had every red flag for insufficient intake.  I
know we see a lot of unnecessary supplementation, but as we lactation
professionals know, there are times when supplementation is absolutely
necessary.  Rule #1:  Feed the baby.  This mom was so wise and kept
following her instincts to protect her baby, despite what she was hearing
from not one but three medical professionals.  What if she had just trusted
them and followed their advice?

As IBCLC's we work as a member of the health care team.  But how
frightening that other members of that team are not educated about normal
and deviant neonatal feeding and excretion.  At what point do they become
legally negligent?  It seems clear to me that there was negligence in this
case.  How often does this happen?  How many babies are put at unnecessary
risk by uneducated medical professionals?

I know this isn't anything new.  I'm sure much worse stories have been
posted here over the years.  But I had hoped we were making progress in
neonatal care.  I deeply concerned by this clear evidence that we are
not.  But perhaps this is an isolated incident.  Do others of you see
similar misinformation in your areas?

Diana West, IBCLC
Gaithersburg, Maryland, USA

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