Nipple confusion/syringe/cup feeding policy

I'm in the US. Policies are likely to differ in hospitals across the US, but at my facility, these are the normal newborn orders:

Breastfeed on demand or at least every 3 hours. No formula unless by doctor's order or by mother's request.

For late pretermers (34-36 6/7 weeks), the orders read:
Breastfeed on demand and supplement with each feeding:
10-15ml either donor breastmilk, expressed breastmilk, or 22 cal/oz formula.

There's no specificity in the late pretermer orders whether the formula comes from a cup/bottle/syringe/whatever. For a pretermer, these kids spend so many calories just trying to keep warm, I'm perfectly willing to feed them with a bottle, esp when they may not know how to suck really well anyway. Perfect way for them to learn.

Babies are so much smarter than we give them credit for.

Medically indicated = doctor's order.

In practice, however, if it's 0100 and I've got a baby that's starving and has lost more than 10% of his birthweight (that's our cutoff) I talk w/ mom and tell her why supplementing would be a good idea. I put a little extra emphasis in there if baby is jaundiced or showing signs of dehydration. Most of the time, at that point Mom will consent to supplementation. It depends on Mom's preference whether we use a bottle or some other form - but most are ok with bottle-feeding.

We have a high Latin American population who combine breast- and bottlefeeding beautifully. I wish the BFHI would take a lesson from them and slacken up. We are kind of in the same quandary at my place as you are at yours, it seems.

My institution has BFHI plaques up in staff-only areas, mainly because the institution will never be a baby-friendly one, thanks in part to the formula companies who donate product for patient use and perks to management for allowing them to do so. Infant formula is a very political issue, even though we may not be directly involved in the politics.

We have a wide assortment of ethnic populations who combine breast and bottle feeding quite well. I had a huge argument with a former manager about how we respect the rights of these women to make a culturally based choice, but for some reason we don't seem to afford the same right to women from our own country. It seems to me that if you're caucasian, you better exclusively breast feed or you'll be "poisoning your baby with formula" is the prevailing attitude. My position is and always has been that the choice is with the parents (regardless of culture or race), and I am there to inform them of their options and then support that informed choice, whether it's exclusive breastfeeding, bottlefeeding or combination feeding.

If the mom wants to exclusivey breastfeed, but for whatever reason cannot, we will start her pumping within 6 hours of delivery with a double electric pump. We encourage "power pumping" or "cluster pumping" rather than a q3h schedule as it simulates baby's clusterfeeding behaviour. EBM can be given by cup, fingerfeeding, feeding tube or bottle. Some of the late pretermers have so little energy to suck effectively for the period of time required for adequate milk transfer, so we make it easier for them by giving EBM or formula by cup or spoon.

We don't really have any policies at all on anything. We don't encourage cup feeding but if someone could provide me with some evidence based research on the benefits of that it would be helpful. Right now or staff is pretty against cup feeding - but like I say we are not armed with good research. Where I work it is moms either breast, bottle or do both for their infants. I had one mom the other night who didn't feed her baby for about 14hrs because the baby would not latch on and she would not give him a bottle and we don't support cup feeding (parent's have to bring their own cups). Are pedis don't tend to care about until it his 24hrs of a baby not eating.

Here's a video link that we use to show just this very thing! Once staff members see the baby perking up and showing interest after taking just a few drops of EBM, it makes them all jump on the hand expression band wagon.

http://newborns.stanford.edu/Breastfeeding/HandExpression.html