What is your hospital's policy on supplemental feeding?

[cabbage patch rn]

Just curious to know what your policy and or philsophy is regarding this practice. Do you openly encourage supplemental formula or is it prohibited with breastfeeding moms? If you do allow this, do you give it per bottle/nipple or by syringe? In what cases would you encourage supplemental feedings?

[cabbage patch rn]

I don't consider a baby who refuses a bottle once breastfeeding has been established nipple confusion, as much as as "nipple preference". I breastfed all of my children and had the same refusal of the bottle issues. I think they just preferred the taste of breast milk over formula, have you tasted of formula lately? Blech!

But I do think the chinese and hispanic women perhaps are onto something with supplementing prior to their "actual" milk coming in. Many babies come into this world hungry as heck, and colostrum just doesn't cut it. A newly recovering mom with other issues aside from the pressure to breastfeed can become easily frustrated right off the bat with a fussy baby who is at the breast every hour. My last child was one of those babies, and after 24 hours my nipples were actually bleeding and too sore to nurse any longer. The nurse taking care of me was very supportive of breastfeeding but did suggest formula until my milk actually came in. I supplemented my daughter and it was the best decision I ever made. There were no problems when my milk actually came in, she adjusted well and she ended up nursing for 15 months.

I just think that maybe their should be a more comprehensive study done among actual cases of breastfeeding mothers who use formula as a temporary supplement. Many of my nursing friends also supplemented from the beginning until supply was established without problem, actually ended up nursing for at least 6 months or longer. I for one can not buy into the argument against supplements or artificial nipples because of my own personal experience and that of many others. And of the moms who ended up not breastfeeding because they used bottles or forumla, it is my opinion that they did not really want to breastfeed. You have to be committed to it and some people just don't want to bother, the bottle is way easier in the beginning and that's okay too. It's each individual's decision.

[BETSRN]

Your responses are valid of course, but anecdotal at best. There are many mothers who are completely mesed up when their infant is given supplemental feeds. From my experience as a lactation consultantan/LDRP nurse who works with breastfeeding mothers every day, it is my experience that we fluid motivate these babies that are supplemented. Granted, there are medical indications which require this, but as a standard practice, we are setting these mothers up for potential failure and certainly frustration as they wait for a milk supply to catch up (that may be slower because of supplementation) and therefor an infant that doesn't go to breast and stimulate Mom's milk production.

There are many valid studies which would refute your hypothesis.

Betsy

[BETSRN]

.>

I think when nurses do this it is for many reasons. Sometimes old habits die hard. They have the idea that Hispanic women don't breastfeed until their milk comes in, etc.,and so rather than try and educate the person (so that they then make their own decision) it is easier to go along with the old idea and then you don't ahve to work as hard with the patient. As a LC, I run into this frequently, When I sit down with a person who has this "bottle idea because I have no milk yet", when I proble further and check the knowledge bae, most do NOT know about the benefits of colostrum, or that the baby does not need large volumes of milk, etc. frequently, I have spoken to these Hispanic women who then often (but not always, of course) chose NOT to give a supplement but to nurse frequently instead. Sadly, I think often we nurses are too lazy to try and educate. It's often easier to take the easy way out and leave it to thoase of us who profess to have a specialty in this area.

[BETSRN]

Regarding this cultural thing, we have an excellent book at work that explains what each culture believes: ie: how they view birth, death, labor support, breastfeeding, hygiene, rold of mother-in-law etc. Every time I ahve looked up this breastfeeding supplementing thing in regards to Hispanic and oriental women, nowhere does it say that they b ottlefeed until their milk "comes in". I do not have the name of the book committed to memory. I am sorry. I can get it if anyone is interested.

[BETSRN]

For one thing, formula is fortified with vitamins and minerals whereas breast milk contains the mothers and what she eats which is usually not well balanced.>>

RN Rotten nurse. You need to have a little education of the components in breastmilk (and breastmilk synthesis) judging from the quote I have included above. What Mom eats is only a very SMALL component of breastmilk.

[fergus51]

Bets, I think you might be reading a little too much into some posts. I give all my patients the same education whether they are asian or hispanic or white or having their first or their tenth baby. That's really not the issue. I can't make a woman feed a baby colostrum if she doesn't want to, and I'm not going to be able to convince her that bottling will prevent her from breastfeeding successfully when her friends and family members have all done so.

The fact that your book doesn't include this one practice doesn't surprise me. "Asian" is a very diverse group and the traditions of my patients from one area in China could be very different from other groups. I didn't just make this up as a reason to bottle newborns.:)

:"In many cultures throughout the world, colostrum isaccepted and encouraged as the first food for infants.Others, believing that colostrum is “old” milk that hasbeen in the breasts for months and is unfit for the new-born, express it and dispose of it until the “true” milkappears on the 2nd or 3rd day. This practice existsamong people in countries thousands of miles apart,including the native peoples of Guatemala, Saudi Ara-bia, Korea, Sierra Leone, and Lesotho" http://66.102.7.104/search?q=cache:YB3sGrp_bw4J:www.lib.umich.edu/taubman/res/eres/Wismont/NU352/RiordanJ.pdf+%22colostrum%22+%22Chinese%22+%22breastfeeding+practices%22+%22asian%22&hl=en&start=2&ie=UTF-8

EAST ASIAN & SOUTHEAST ASIAN CULTURES

VIETNAMESE, CAMBODIAN & LAOTIAN

Vietnamese & Cambodian people may practice the Yang-ch’i and the Yin-ch’i. The Yang energy is the positive energy source of warmth and fullness, while the Yin energy is the negative force of darkness and cold. Ill health is thought to be caused by an imbalance between these two forces.

Diet is restricted because foods are grouped by their intrinsic features into “hot” and “cold.” Hot foods may include: chicken, pork, ginger, salt, black pepper, boiled rice, and Chinese Tea. Cold foods to avoid may include: raw and cold vegetables and fruits; spinach, melon, lemon, bananas and deep fried or fatty foods.

The most common reason for not breastfeeding is a perceived lack of milk supply. The quality and quantity of milk supply is associated with the mother’s health, which can often be compromised therefore making breastfeeding unstable and unreliable.

The Hmong women may feel that their breast milk is “stale” or “old” and that formula is new and fresh and therefore better for the infant. They may wait to breastfeed until they see the infant as “ready” which may be after the baby has had a couple bowel movements.

Colostrum is seen as old milk and is therefore discarded. Infants in their first days of life may be fed ginseng tea or boiled sugar water. Women living in North America may use formula to feed until their milk comes in.

LATIN AMERICAN & HISPANIC CULTURES

A Hispanic mother may believe that she is at an increased risk following childbirth. There is a 40 day rest period where families support the new mother.

Maternal diet is important as the hot and cold beliefs are also associated with the Hispanic culture. Foods that are seen as “hot” are thought to increase mother’s milk supply (malt drinks, black beer, a drink of boiled corn and milk). Parsley and vegetables are thought to dry up mother’s milk supply.

Colostrum is considered “dirty” and “old.” A mother may wait to feed until her milk has come in and may use herbal teas, olive oil, or castor oil to stimulate the passage of the meconium.

http://www.geocities.com/nursinginquiry2002/jennifer/culture.htm