I'd like advice on how to handle this situation and the Ped.
A mom came to me with her one week old baby-asking for help with
getting baby to latch on quickly, satisfying baby at night, and nipple
pain. Her goal-to breastfeed at least 4-6 months exclusively, then
possibly use some formula.
I did a thorough consult and took a thorough history but I will just
mention the pertinent info here. Mom was awkward at positioning herself
and the baby and baby was latching shallowly. After showing her (and
letting her practice) how to latch baby on deeply, she felt only a twinge
in the nipples for a few seconds and could tell baby was swallowing much
more than she had been. It took about 30 seconds for MER to occur. She
had minimal weight loss and mom reported feeding 7-8 times per day for
about 15 min.
Our mutually decided upon plan was very simple: use warm compresses,
breast massage,and do some hand expression to get milk to letdown before
latching, work on deeper latch and watch for improved swallowing. She had
a ped appt in one week (2 weeks of age) but I told her she could come
back for a free weight check anytime before then or for more help with
latch.
The next day, mom stated that breastfeeding is going smoother and baby
is more satisfied. Mom and Dad brought baby in 5 days later. She had
gained 8 ounces with just breastfeeding but Dad said things were not
going well. I praised her for baby's weight gain and told her to call me
and we'd talk about what's going on and how to make it better. Mom said
she would call me later (I was working with another mom at the time). 2
days later- she hadn't called back so I called her and left a message for
her to call me.
Today-I called her and she said, "The ped suggested alternating
breastfeeding with formula feeding and that has helped tremendously!" I
could just hear in her voice how much the doctor "helped" her with this
problem. Now, someone at this doctor's office recommended she come see me
in the first place. I faxed a report and a copy of the plan to them. This
doctor's office just started referring to me and I want them to
continue-but I am sick about this advice and feel I should say something
to this doctor. He has told my other clients at the first visit that
their baby will be fine if they aren't able to breastfeed! All all of you
know, I'm not trying to torchure this mom-my goal is to help her meet her
goal and enjoy breastfeeding. I'm sure this mom is now getting more sleep
(which was not a concern for her at our first meeting), baby is sleeping
between feeds better, and mom probably feels better and rested---but now
at 3 weeks postpartum, she still has nipple pain that is quite
bothersome. She's worried she'll run out of lanolin!
I explained to this mom my concern over her continued nipple pain and
that her milk supply will decrease very rapidly. With this plan, as baby
grows and needs more, if the amount formula is increased instead of the
breastfeeding being increased, her supply will decrease even more until
it is gone.
I would like the doctor to realize that another visit to work on latch
should solve the problems of nipple pain and make breastfeeding go
smoother as baby will be filling up more--whereas with his advice,
introducing bottles to a baby who is not latching on well will probably
make the latch worse. I would also be sure she can nurse lying down.
Also, if a mom is at her wit's end (which is probably what he thought), a
better approach than using formula for half the feeds would be that she
could use a pump (she told me she already had one) and let Dad "fill the
baby up" with breastmilk in a bottle (or preferably other device) once or
twice per day so she can rest--or using formula only once or twice per
day if that is what she wants to do. I always give mom several options,
not just one as he has. (and I do realize I am just hearing mom's
description of his advice but I'm sure he didn't sit down and discuss all
her concerns and goals about breastfeeding like I do).
I need advice on how to handle this. Of course, bad advice is given
often but I don't want to let this slide. If I handle it right, this
doctor will see what I am really about. I'm in private practice so I
don't see this MD in person so my contact would be by phone or letter.
I'd like lots of suggestions on how to handle this, PLEASE!
Kris Wiedman RN IBCLC
in Tennessee
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