Can we talk about breastfeeding and breastmilk please?

TigerGalLE, BSN, RN · Mar 23, 2014

Oh and to add.... Our NNPs and Neonatologist strongly encourage pumping and breastfeeding. But they are also very generous with formula and feel supplementation is normal and even encouraged.

I just did some research on this topic and found it has sparked some heated debates. I understand that sometimes it is medically necessary to supplement. But the situations I’m talking about aren’t always that situation.

NicuGal, MSN, RN · Mar 24, 2014

I think part of it is that in our world we are number crazy. So many mls and kilocals per day. Probably more so in the gainer and grower population. We are getting away from supplements as much as we can but we try to use pumped milk that is fortified.

maccheese · Mar 24, 2014

Seems like the nursing culture in that unit needs to be adjusted from the top down. If the medical director of the unit and nursing leadership are educating the nurses on the importance of encouraging breastfeeding and how it positively affects the health of neonates, I would think that the staff nurses would follow suit.

BeachsideRN, ASN · Mar 24, 2014

There is a study at one of the hospitals in Cali, good Sam maybe. It is a highly controversial topic. But the preliminary data from the study is showing some good results from babies that the moms were allowed to pump and bottle feed. I will see if I can find the study. I think it was in micro preemies

Bortaz, MSN, RN · Mar 24, 2014

I think most NICUs are volume-driven rather than infant-driven. We're trying to move away from volume-driven feeding, but it is meeting a lot of resistance.

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tinkerbell419 · Mar 25, 2014

On my ward we actively encourage all mothers that expressed breast milk is very beneficial for ill babies. Now we dont force them to express milk because some mothers are not able but ive never come across a mother who is horrified at the suggestion.

Many neonatal units have breastpumps and breastfeeding nurses or champions that teach on the wards. It is really the best milk to give a baby but we have the formula ones too because we cater for everyone. And mothers can openly breastfeed on the ward in private.

With surgical babies the doctors prefer the baby to start feeding on expressed milk but we always respect the wishes of the parents.

Bortaz, MSN, RN · Mar 25, 2014

I always encourage breast feeding and pumping, but I'll be honest...if the mother makes it pretty obvious she isn't trying or isn't interested, I don't waste my time. I'll just get a formula order.

TigerGalLE, BSN, RN · Mar 25, 2014

I'm not really talking about pushing moms to BF if they don't want to. I'm more finding that nurses seem annoyed when moms want to take the time to try to BF the baby. It takes longer for the baby to feed and get back into the crib/warmer. The nurse just want to give it a bottle already. Or they give the baby formula out of a nipple instead of out of a syringe like the mom requested.

katierobin23 · Mar 26, 2014

I'm not really talking about pushing moms to BF if they don't want to. I'm more finding that nurses seem annoyed when moms want to take the time to try to BF the baby. It takes longer for the baby to feed and get back into the crib/warmer. The nurse just want to give it a bottle already. Or they give the baby formula out of a nipple instead of out of a syringe like the mom requested.

This brings up a good point for me. I'm all for breastfeeding and I don't have a problem helping a mom do it as much as I can, but you mention syringes, we don't use them but we do use cups...and I think it's the dumbest thing in the world. I once had a set of parents request that I cup feed their 9.5 pound baby who was two days old and taking upwards of 55ml every three hours. Didn't happen. I did give it a try, but he just tried to suck on the cup and got so mad that we had to totally stop so I could swaddle and calm him before trying to feed him again. He ended up eating with a slow flow nipple for the rest of the night and did just fine going back to the breast when mom came back in the morning.

Another case I saw was a little girl who took to the cup like a champ, really got it (most times we have to slowly drip the milk/formula in their mouth and hope they don't choke, but this baby lapped it right up)...well, the next time mom tried to put her to breast, she lapped at the nipple and ended up so upset and frustrated. Talk about confusion.

At least with a nipple, the mouth opens, the baby latches, sucks and swallows. Much more natural than a cup or syringe, IMO.

JRich · Mar 27, 2014

I'm not really talking about pushing moms to BF if they don't want to. I'm more finding that nurses seem annoyed when moms want to take the time to try to BF the baby. It takes longer for the baby to feed and get back into the crib/warmer. The nurse just want to give it a bottle already. Or they give the baby formula out of a nipple instead of out of a syringe like the mom requested.

I think time has a lot to do with it. When you have a busy 4 baby assignment and all are PO feeders having parents that need help with breast feeding can put you behind. My hospital is currently working towards baby friendly, and honestly sometimes it is such a huge disaster. I have a huge problem with it when parents are asking to not supplement with formula and their baby ends up in the NICU because they become dehydrated, have none to little urine output, and develop glucose and bili issues. So instead of formula we stick the baby to get IV access and start giving them TPN. The doctors are not accurately describing what TPN is most of the time. The parents don't know how harsh TPN is on the liver or the veins of their baby. These parents usually also refuse passies, but they don't want to sit in the NICU 24/7 to keep their infant calm. Breast feeding is great when it works. Same with pumping and feeding the baby that way. We do need to do what is best for the baby. Sometimes that is breast feeding and sometimes it isn't

TiffyRN, BSN, PhD · Mar 27, 2014

OP,

I'm all with you about not supplementing with formula. I've seen the tremendously improved outcomes in our unit since we started strongly advocating for using more human milk. In the past, all infants under 32-34 weeks have automatically been given mother's or donor EBM as the default feeding. Recently the standards have expanded to cover late preterms and even diabetic infants. We have been told we don't require consent though a parent can refuse (it's been years since I heard of a mother refusing donor milk).

So at least in our unit, the issue is not usually human milk/cow milk. The problem is that most of the kids in the our unit are there because they had a problem. Nature's plan for these kids; if we let nature take it's course, is that they would be "selected out". We choose to intervene, and part of that intervention is aggressive nutritional support. I suppose if the child had no glucose issues, no weight gain issues, no temperature issues; and mom was available to offer her breast to the child at all times (as nature intended), then I could go for the BF only, no supplement at all stance.

Maybe you could advocate for your unit to offer donor EBM as an option to these infants. It does take commitment from leadership due to the cost and physicians as they must order it but it can be a huge advantage to the kids. Also, I've seen quite a few of the types of parents that would have preferred their kid have an IV over a bottle feed concede to nipple feedings if we use donor EBM.