Judy remarks about...<< baby getting AIM by syringe, vs EBM/colostrum by
bottle? I am interested in professional and personal opinions about how
choices are made >>

    I prefer to hold off on formula unless there is a medical indication for
the infant needing to be fed (which, IMHO, is rare). but, since our nursing
staff prefer to push formula despite our best efforts, I encourage the moms
to insist on the baby being cup fed if she is convinced that the supplement
is necessary (I also empower my moms to say to the nurse, "what did my pedi
say"--at 2 AM, not too many nurses are going to call the doc unless they know
it is a REAL medical problem).

    If mom/baby are to go home on formula due to MD orders, I evaluate the
mom's ability to handle everything. I remind them how milk supply works, and
how it can be hindered if the "breast" is not "told" about what extra stuff
the baby is taking. I encourage offering the breast first at EVERY feed, then
topping off with formula when the MD orders supplementation. If mom is not
comfortable with cup feeding (esp if there is no latch problem, but
supplementation recommended for some other isolated incident such as
jaundice--common here), I will have them use a bottle with a nipple that
encourages wide open mouth. I then teach them how to bottle feed
"responsively", i.e. by watching the baby's cues and pausing the feeding
after every 15 cc, to see if baby really wants more or is just swallowing due
to the way a bottle works--a demo with a bottle works wonders in making
parents realize this). If there is a latch problem, then I strongly
discourage bottles and prefer to teach cup feeding as baby-led, vs syringe
feeding which is "forced". I also tell them that pumping is absolutely
necessary in order to "tell" the breasts about the extra that the baby has
eaten, but remind them that if they express any milk, it can be fed to the
baby as the supplement, in place of the "yucky stuff" (yes, I DO use those
words!!!)

    As an aside, my biggest challenge comes from the nursing staff, who get
worried about a baby who does not eat, pee or stool on "my shift", rather
than looking at the 24 hour picture. The nurses then convince the mom that
the baby needs food ("see, he is crying, he must be hungry" or "your baby has
lost weight" or "your baby has hardly had any wets"), make her feel guilty or
worried if she doesn't give in, give a bottle and say "see, he was hungry"
b/c he was force-fed 1-2oz (30-60cc)and THEN, document "baby bottle-fed at
mother's request"...arghh!

Kathy in NJ IBCLC RN C (Maternal-infant), APN C (Family Nurse Practitioner)
 PhD student hoping to study labor and lactation issues

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html