Breast baby after C-Section and GD

miss81, BSN, RN · Sep 18, 2009

We do this too, but we will either cup feed the formula (most of the time) to top up after breastfeeding or some of the breast feeding consultant insist we use a small suction catheter taped to the mom's nipple and placed in a bottle of formula. They will suck the nipple and the catheter at the same time. Sometimes the mom's will just say to go ahead and bottle feed. Most of the time we cup feed though...

SunnyRN2010 · Sep 19, 2009

There are babies that get nipple confusion right away, even though some don't at all. The bottle requires less muscular coordination of the babies mouth, since it drips out on its own with very little effort from the baby. Babies are smart, and right from birth they can tell the difference and want the milk to just drip out of mom's breast. To encourage breastfeeding, try having baby and mom spend lots of time skin-to-skin without attempting breastfeeding. This alone has been shown to coax some babies into nursing. Also, if the baby absolutely must recieve formula (and it kills me to write this) the SNS (supplemental nursing system) would be the ideal choice, since baby would still be at the breast. That is what the previous poster described w/ the catheter taped to mom's nipple and the milk in a bag higher up, so it flows by gravity. Feeding by cup or syringe would be another two better choices than the bottle, if at all possible. Good luck with this mom! I would love an update; I really hope mom sticks with it!

BabyLady, BSN, RN · Sep 19, 2009

We are blessed to have an LC that doesn't believe in nipple confusion.

More like nipple preference.

Rationale: Full termers develop a preference for pacifiers...and if you don't get them the right one, they'll pitch a fit.

Same thing with nipple/bottle feeding...nipple preference. Breastfeeding doesn't instantly "take" for all babies.

We are also blessed that cup/syringe feeding is banned, per facility policy on all babies due to aspiration risk.

SmilingBluEyes · Sep 19, 2009

Agree 100% with above post. And you don't have to formula feed "instead" of breastfeed, but rather PC formula after breast. Or like another post says, try SNS. And current standards/evidence suggest cup and syringe feeding ARE contraindicated. I agree nipple confusion is not the issue, but preference is. But when you have a GD baby whose sugars are in danger of falling into the basement, it's usually either bottle feed them or start the IV. I prepare my GD moms for both possibilities after explaining how a baby's pancreas acts after birth and why sugars are such a problem in diabetic moms. Most understand and are very much OK with our doing what it takes to keep sugars stable.

NEVER FORGET: Skin to skin for mom and baby is proven to benefit by stimulating baby to suckle/bf AND keeping sugars stable much more than being swaddled. I always put babes skin to skin with mom right after birth and keep them that way as long as I can. The sugars are much more likely to be stable when you do this, as temps stay that way and babe is much less stressed.

SmilingBluEyes · Sep 19, 2009

duplicate information/sorry!

Marymoomoo · Sep 19, 2009

The babe is now having trouble latching on and not opening it's mouth wide enough when trying to get latched on. I'm wondering if it might have nipple confusion already?

I would suggest having the mother hold the baby upright on her chest skin to skin. This is often enough to help the baby's rooting reflexes kick in. If the baby is sleepy, you can suggest the mother hold baby skin to skin before attempting to nurse, then someone can help mother with latch on (if needed). In that case, line baby's nose up to the nipple, then suggest the mother rub her nipple up and down across baby's lips. This will cause baby to open his mouth wide. Since his nose is lined up with the nipple, he will have to tip his head back in order to latch on. This usually leads to a more comfortable and effective latch. There's a great video online through the Ameda website that shows why this is and how to acheive a deep latch--if you google "Ameda latch" it should be one of the first results.

I would also suggest that the mother hand expresses onto a spoon after feeding, and baby can be fed that directy off the spoon. I posted some videos from Standford Medical School and the ABM's protocols for hypogycemia and supplementation here, if interested.

Marymoomoo · Sep 19, 2009

Same thing with nipple/bottle feeding...nipple preference. Breastfeeding doesn't instantly "take" for all babies.

I wouldn't say it's an issue of preference, as in what the baby likes best. The issue is that there is a different mode of sucking and/or a different rate of flow. Some babies do become accustomed to the ease of the bottle and "prefer" the fast flow with little work. In that case, a combination of slow flow bottle nipples, paced bottle feeding methods, and illiciting the letdown reflex before latch on can help.

Mimi2RN, ASN, RN · Sep 19, 2009

Our policy is a stat blood glucose for a PCX

With a PCX around 45, I would be on the phone to the doc before I sent it to P.P. I have to call for Normal Newborn orders, anyway, so by then the doc has some idea that we have a potential problem.

If the first sugar is good, baby goes to P.P. Our mother/baby nurses know where we live if things change. We don't have a Newborn Nursery, all well babies stay in couplet care.

nkochrn, RN · Sep 23, 2009

I only worked the first night after the baby was born and they went home the next night, the baby was starting to latch on and nurse for short periods and mom was supplementing with formula after nursing each time. She sent baby to the nursery and it was very alert and fussed a lot, so I didn't check another blood sugar.

I feel dumb for not thinking of the SNS! I've never used one though and don't think we even have them here, gonna have to talk to the OB supervisor about that since it seems we may have more patients that this Doc does this with.

The doctor's order actually read, "If blood sugar less than 50 give formula INSTEAD of breastfeeding" the blood sugar had increased slightly after the mom nursed the first time and the doc wasn't even going to give him a chance to nurse again and get it up. That really bothered me.

We're a rural hospital so basically moving to PP means walking across the hall :) Same nurses taking care of you and baby the whole time.

Elvish, BSN, DNP, RN, NP · Sep 23, 2009

I HATE cupfeeding, and wish it would be banned forever at my facility as well.

Our peeps are ok with a BG of anything above 40 in the first 24hrs. So with a sugar of 38, then a feed, then 42, I'd be ok with just checking it in an hour, because so often the sugar will come up on its own. 42 is low normal for us, but still normal, and I'd be willing to watch the kid and wait.

Our policy is a glucose at 1, 2, and 4 hours of age. If any one of the 3 is low, baby eats (breast or bottle) and we recheck again in an hour. I don't believe in gratuitous bottlefeeding, but I'm also not ok with a baby's glucose dropping too dangerously low either!

I'm surprised this pedi is alarmed at a glucose of 40-50 this early on and so willing to go with formula. Agree w/ those who suggest skin-to-skin as a way of getting baby interested. Also suggest (if it hasn't been already) maybe squeezing a few drops of colostrum onto the nipple. Sometimes that gives them just the incentive they need.

One trick I learned with an SNS is not to try to get baby onto the nipple with the SNS tubing in place. Get baby latched onto the breast first and slide the tubing into the kid's mouth...SO much easier. Learned from a NICU nurse who happened to be my patient one night. :up:

CEG · Sep 24, 2009

I feel dumb for not thinking of the SNS! I've never used one though and don't think we even have them here, gonna have to talk to the OB supervisor about that since it seems we may have more patients that this Doc does this with.
.

You don't have to get SNS (they are expensive). You can actually use any medical lines. I can't remember what I used with my baby but it seems like it was NG tubing (?) You put the expressed colostum/milk or formula into a bottle and put the tube in. Tape it to the side, then run the tube to mom's breast and tape it. Slide the tube into babys mouth and you have and SNS. You can also tape the tube to a finger and finger feed. Works well and a nice temporary fix without laying out the money.