[Hopefull2009]

Originally Posted by wulfbourne

I had read, probably by someone here, that even if I don't have STD's the erythromycin ointment was still a good idea due to just the general level of germs in the hospital. Does anyone have any information about this? If I was having a home birth I would refuse it, but I'm worried about hospital germs. Also, I don't want to put anyone in a bad position as far as disobeying hospital policy.

Sorry for the double post.


As a wife who just found out a few months ago that my husband was having an affair (and I am a very, very sharp individual, I suspected nothing, and would have staked my life on his fidelity), there is no way I would refuse the ointment b/c it's just a simple thing to make sure their eyesight is intact...bottom line, you never, ever know what another person is doing 24 hours a day.

The vitamin K is the same issue...1% chance of bleeding is 1% too great for me.

[Spidey's mom]

Originally Posted by Hopefull2009

Sorry for the double post.


As a wife who just found out a few months ago that my husband was having an affair (and I am a very, very sharp individual, I suspected nothing, and would have staked my life on his fidelity), there is no way I would refuse the ointment b/c it's just a simple thing to make sure their eyesight is intact...bottom line, you never, ever know what another person is doing 24 hours a day.

The vitamin K is the same issue...1% chance of bleeding is 1% too great for me.

I agree - the ointment is no big deal. Neither is the Vit K.

(I'm sorry about your husband - truly).

steph

[eden]

Your plan does not sound unreasonable to me. We do all of this rountinly here including the thorough assessment on mom's chest, if so desired. The only thing we don't like to do is not cutting the cord until it stops pulsating. The reason is there are studies that showed delayed clamping causes an increase in jaundice.

[RainDreamer]

Why does LLL recommend syringe feeding over bottle feeding? If you give a bottle of EBM or formula for hypoglycemia, are they really going to get nipple confused? I'm just curious as to why the syringe feeds are recommended.

And I have seen babies in the unit for aspiration due to syringe feeds.

[Elvish]

I have not ever seen a true case of nipple confusion. There is as much of a difference between a breast & a syringe as there is between a breast & a bottle. So many patients breast and bottle feed and it works fine.

That said, I do encourage breastfeeding before anything else, and have seen many many times over that having baby nurse for a good 20-30min will bring a blood sugar up in a normal newborn.

There are times, however, if blood sugar is *really* low (<30) that baby just doesn't have the strength to suckle at the breast. Rare though it may be, I'd rather my baby get a bottle than be brain damaged. That's just me, and if a parent wants me to cup/syringe feed their baby, I will.

[CEG]

Originally Posted by eden

Your plan does not sound unreasonable to me. We do all of this rountinly here including the thorough assessment on mom's chest, if so desired. The only thing we don't like to do is not cutting the cord until it stops pulsating. The reason is there are studies that showed delayed clamping causes an increase in jaundice.

Actually this is not true. There are many benefits to delayed cord clamping. There are few benefits to early cord clamping. Active management of the third stage is the only evidence for early cord clamping and studies have not isolated whether the early cord clamping is of any benefit.


From JAMA- March 2007:
Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.

Hutton EK, Hassan ES.

"Late cord clamping was delayed for at least 2 minutes (n = 1001 newborns), while early clamping in most trials (n = 911 newborns) was performed immediately after birth. Benefits over ages 2 to 6 months associated with late cord clamping include improved hematologic status measured as hematocrit (weighted mean difference [WMD], 3.70%; 95% confidence interval [CI], 2.00%-5.40%); iron status as measured by ferritin concentration (WMD, 17.89; 95% CI, 16.58-19.21) and stored iron (WMD, 19.90; 95% CI, 7.67-32.13); and a clinically important reduction in the risk of anemia (relative risk (RR), 0.53; 95% CI, 0.40-0.70). Neonates with late clamping were at increased risk of experiencing asymptomatic polycythemia (7 studies [403 neonates]: RR, 3.82; 95% CI, 1.11-13.21; 2 high-quality studies only [281 infants]: RR, 3.91; 95% CI, 1.00-15.36). CONCLUSIONS: Delaying clamping of the umbilical cord in full-term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Although there was an increase in polycythemia among infants in whom cord clamping was delayed, this condition appeared to be benign"

Also:
Midwifery Womens Health. 2001 Nov-Dec;46(6):402-14. Links

Current best evidence: a review of the literature on umbilical cord clamping.

Mercer JS.
Nurse-Midwifery Program, University of Rhode Island College of Nursing, Kingston 02881-2021, USA.
"Immediate clamping of the umbilical cord can reduce the red blood cells an infant receives at birth by more than 50%, resulting in potential short-term and long-term neonatal problems. Cord clamping studies from 1980 to 2001 were reviewed. Five hundred thirty-one term infants in the nine identified randomized and nonrandomized studies experienced late clamping, ranging from 3 minutes to cessation of pulsations, without symptoms of polycythemia or significant hyperbilirubinemia. Higher red blood cell flow to vital organs in the first week was noted, and term infants had less anemia at 2 months and increased duration of early breastfeeding. In seven randomized trials of preterm infants, benefits associated with delayed clamping in these infants included higher hematocrit and hemoglobin levels, blood pressure, and blood volume, with better cardiopulmonary adaptation and fewer days of oxygen and ventilation and fewer transfusions needed. For both term and preterm infants, few, if any, risks were associated with delayed cord clamping. Longitudinal studies of infants with immediate and delayed cord clamping are needed."

[Spidey's mom]

Originally Posted by Arwen_U

I have not ever seen a true case of nipple confusion. There is as much of a difference between a breast & a syringe as there is between a breast & a bottle. So many patients breast and bottle feed and it works fine.

That said, I do encourage breastfeeding before anything else, and have seen many many times over that having baby nurse for a good 20-30min will bring a blood sugar up in a normal newborn.

There are times, however, if blood sugar is *really* low (<30) that baby just doesn't have the strength to suckle at the breast. Rare though it may be, I'd rather my baby get a bottle than be brain damaged. That's just me, and if a parent wants me to cup/syringe feed their baby, I will.

I agree with this . . . and anecdotally . . . my youngest was jaundiced and they still were recommending a bottle 6 years ago for breastfeeding jaundice. I breastfed and bottle fed him for a few days. He breast fed until he was 3 1/2 years old.

steph

[RainDreamer]

I see a ton of our babies that learn to bottle feed and then do very well when put to the breast, once they are old enough to suck/swallow/breathe at the breast. No nipple confusion there.

To me, giving a syringe just doesn't seem natural. The natural instinct is to suck.

[Piglet68]

It will depend a lot on how your birth goes. My first was a very difficult birth with forcep delivery. After two hours of pushing by the time she was born she was in a little bit of stress, so the doctor cut the cord and they took her immediately to make sure she was fine. As soon as she was given back to me I attempted to breastfed but being a novice it was not easy.

My second baby was a breeze of a delivery. He was placed on my stomach immediately and then my husband cut the cord. As soon as they cleaned him up they put him in my arms and I nursed him right away. He had no problem latching on.

I think a lot of it will depend on your comfort level, the birth itself and the baby. My suggestion is to stay flexible and good luck!

[kythe]

Originally Posted by Arwen_U

I have not ever seen a true case of nipple confusion. There is as much of a difference between a breast & a syringe as there is between a breast & a bottle. So many patients breast and bottle feed and it works fine.

Maybe it depends on what circles you hang out in. I have met several people who have, usually at LLL meetings. Women often come in with their second child, wanting to learn how to have better success with breastfeeding when they had a failed first attempt. There are several factors that go into what people call "nipple confusion". The literal nipple of a bottle is very different from the nipple of a breast. It is narrower, so a baby who uses a bottle often learns not to open his mouth wide enough for the breast and finds he can no longer latch on to the breast well enough to get milk.

Also, milk basically pours out of a bottle. If you hold a bottle upside down, it drips. Breasts don't. This is significant because the baby learns it is easier to attain nutrition from a bottle, where they have to work at the breast. They begin refusing the breast as the muscles in their mouth do not develop the strength for true suckling. You may not notice in the hospital on the first day, but mothers often find that babies who started on a bottle too early end up completely weaned within a few weeks. This is why there is a recommendation not to start supplementing until the baby is at least a month old and breastfeeding is well established.

Another issue with introducing bottles automatically in place of breastfeeding is that it sets the example (often unnecessarily) to parents that this is a solution to breastfeeding problems. You may see it as a one-time thing: The baby is hypoglycemic and needs a bottle. But what the parents see is that even though they hear the phrase "breast is best", medical professionals give the example that bottle feeding is actually ideal whenever things aren't picture-perfect. So the parent witnesses bottle-feeding as a common tool (in some hospitals it is actually rare for a baby to leave without having supplemented in some way), and they go home with their package of freebies from the hospital that includes bottles, pacifiers, and free formula. Within a few weeks, somehow their baby has weaned and they just don't know where they went wrong with their breastfeeding efforts.

So back to the syringe issue - one more reason for using a syringe rather than a bottle is that it sends the parents (and medical professionals) a powerful subconscious message that this is a temporary solution to a medical problem, NOT a substitute feeding method to be used whenever breastfeeding appears to not work.