Step number 9 of THE TEN STEPS says “no artificial nipples or pacifiers”.   I’m a hospital based IBCLC. If a baby would not go to breast or caused nipple trauma to the extent that the mother insisted on a break, we did spoon feeding EBM for small amounts and later finger feeding for larger amounts using 35cc syringes and tubing.   Of course if a baby is breastfeeding an needs supplementation then SNS is used. 
 
We’ve been trying to educate L&D staff so babies get off to a better start.  This would eliminate many of the breastfeeding problems.   Low blood sugar is the most common reason for supplementation and if the baby was born by C-section mommy is not available.
  
Most of our babies are discharged before 48 hours of life.  Some babies were being discharged finger feeding.   All babies are seen 24 to 48 hours after discharge in our postpartum care clinic.  There is IBCLC help available at this time.  It was thought by the IBCLC in the clinic that too many of our young parents adopted finger feeding as a way of feeding.  Tired moms let Dad have a turn at feeding.  The couplet would come in at 3 or 4 days of life still using finger feeding and still not having gotten the baby to the breast.  Because of the this, our program Director who is an IBCLC declared that babies could not be discharged finger feeding.
 
We’ve been at odds with Staff for two years regarding bottle nipples being given to breastfed slated babies.  Our special care nursery frequently discharges moms pumping and bottle feeding.  Even if the baby will breastfeed a pediatrician may tell the mom to pump and bottle feed so the EBM can be measured.

Before the Director cast aspersions on finger feeding, I had a heated argument with a Special Care Nursery Nurse.  The nurse told me a baby couldn’t be discharged finger feeding!  I told her they certainly could as long as the parents saw to it that the baby was fed enough.   I imagine now she is delighted to know she was right and the IBCLC was wrong!  Babies can’t be discharged finger feeding and most Pediatricians will not hold up the discharged for breastfeeding problems.  After all, as far as they are concerned there is always the bottle filled with pumped breastmilk or formula.
 
I feel like I’ve lost all credibility with the staff.  They’ve been given permission to bottle feed again!  Our methods are now thought of as the thinking of those “wacky lactation consultants”.

The Medela pump company was shunned for advertising bottle nipples.  Yet the Academy of Breastfeeding Medicine’s Protocols on supplementation and hypoglycemia does not dismiss the use of a bottle.   But Dr. Newman says just one bottle can cause a problems.   I feel it’s a game of Russian roulette bottle feeding newborns.  And they can get hooked on finger feeding too but we are preserving the cupping tongue and rocking jaw.  Cup feeding is fine by me but most nurses aren’t fond of it and I’m sure it will also become banned like finger feeding.

My co-worker is an IBCLC with eight years experience running a lactation clinic that gave close follow up care after discharge.  She feels we can't solve some problems in less than 48 hours; some problems aren't fixed until after mom's milk comes in.  She feels adamant about not  using bottle nipples.

The Ten Steps are endorsed by the AAP and the ABM but their stance on the use of bottle nipples says otherwise.

So my fellow IBCLCs, your thoughts on bottle feeding [artificial nipples] to breastfed babies in the first three weeks of life.

Your feedback is greatly appreciated!

Regards,
Linda Bubeck IBCLC, RLC
In the Carolinas, USA

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