Anyone going baby friendly?

Elvish, BSN, DNP, RN, NP · Sep 18, 2009

I've seen this in the community setting. Oftentimes, these mothers read parenting books that tell them that babies should feed no more than q3-4h or their babies will be spoiled, control their parents, not sleep enough for development, etc. For some babies, this may work fine. For others, it could lead to undernourishment and even failure to thrive. Since these books often have religious basis, it's hard for the parents to understand why it might not work for them. They want to trust the "expert" rather than their babies and their own mothering instincts.
In these cases, you can make a concerted effort to point out the baby's feeding cues to the parents. :) You can also educate about the necessity to feed on cue (including baby's small stomach capacity, the digestibility of breastmilk, and the individuality of breast storage capacity). In cases were the parents want to stick to a strict schedule, I would encourage you to inform the lactation consultants and/or the baby's pediatrician as this can be a red flag for difficulties.

Yes....I know. And I do. :)

JPRloverNurse · Sep 18, 2009

What's so great about breastfeeding? My children were born less than a year apart. I bottle fed my 1st kid because he was born early and had to eat EXTRA calorie formula.The hospital tried to help me breastfeed him but he wouldn't or couldn't suck. I breastfed my 2nd kid even though I had TONS of formula (given by the hospital AND left over from my son) and the hospital NEVER tried to get me to breastfeed (I decided to try it on my own at home) I gave birth in 2 different states. My premature, bottlefed child is very rarely sick and my right on time perfect pregnancy and delivery, breastfed baby has a non stop cold! She DOES seem a lot SMARTER than her brother....but I think that's because she's a GIRL.

greeniebean · Sep 18, 2009

When I had both my children I was given a breastfeeding bag, with a free manual brest pump, coupons, breast pads, and samples of nipple creams. I thought it was really nice that even though I BF I still got a little bag of goodies. However, I learned when I had my second son, that the FF moms got nothing. No bag, no samples, no coupons. I don't think that was very fair, and it really seemed as though the hospital didnt approve of FF (im sure they didnt really care, but by offering only a BF bag, Im sure it made some of the FF moms feel that way.)

I think there should be a bag for both FF and BF moms.

BabyLady, BSN, RN · Sep 19, 2009

In a situation like this, I would wonder how are the mothers who wish to breastfeed are being supported. Are they provided with a pump, education about using it, the support of an LC, etc? Are they taught how to hand express colostrum and how to combine hand expression with pumping in order to maximize production?
If the mother is unable to pump enough to meet her baby's needs, is the option of using donor milk available while she's building her milk production?
I don't think breastfeeding is simply about "personal desire". It's an issue of long term health for both the baby and the mother. In no way should a mother ever be made to feel that she is compromising her baby's health if she is unable to pump a certain quantity on demand. If it were a choice between brand A or brand B of formula, that would be one thing but we're talking about the biologically normal food for human infants vs a manmade substitute. There two aren't equal choices and no mother should be forced to feed her newborn formula unless it is an absolute medical necessity.

We provide them with a hand pump and equipment to use the hospital pump with.

However, rental and electric pumps will vary with insurance companies. We have two LC's on staff.

Our facility does not have a donor milk program.

Breast feeding IS a personal desire when you weigh that against an infant that will drop weight, have low blood sugar or end up on TPN and LIPIDS if it doesn't eat.

Yes, the baby's health IS COMPROMISED if not enough milk is produced....Baby's cannot just be left to drop weight...if Mom can't pump enough, then she can't pump enough...we can't make sure do it or make more milk come if she is trying all she can...the baby either needs to be supplemented or formula fed.

When it comes to an infant losing weight and low blood sugar that can lead to death if they don't feed...yes, that ranks up there with medical necessity.

dscrn · Sep 19, 2009

Low blood sugar can be a very sticky issue, with parents who are sure that ANY feed other than colostrum will have horrible effects on baby...if an infant has repeated blood sugars less than 45. IT IS medical necessity. (I know pumping and cup feeding could remedy the situation-sometimes, mom pumps-nothing but perhaps a drop or two.) When I have run the possible complications, I've had parents tell me "now you're just trying to scare me..."

BabyLady, BSN, RN · Sep 19, 2009

Low blood sugar can be a very sticky issue, with parents who are sure that ANY feed other than colostrum will have horrible effects on baby...if an infant has repeated blood sugars less than 45. IT IS medical necessity. (I know pumping and cup feeding could remedy the situation-sometimes, mom pumps-nothing but perhaps a drop or two.) When I have run the possible complications, I've had parents tell me "now you're just trying to scare me..."

If Mom even has a few drops of colostrum available...new Mom's don't realize how valuable it is...and we encourage them to bring "anything" that they have.

If there isn't enough for a whole feeding...well put the nipple in the baby's mouth...pull up about 3 mls of formula into a the breast milk syringe...put it into the nipple so we are sure the baby gets every drop of the colostrum...then we remove the nipple, attach it to the bottle of formula and put it back in the baby's mouth.

We don't put it into the entire bottle because the baby may not get it all.

meluhn · Sep 19, 2009

Some women want to breastfeed and can't. I attempted to breastfeed and I was not producing enough milk. I was young and not well informed about breastfeeding. (was not a nurse yet) My son wanted to nurse all the time, always seemed hungry and I was just told- " You will make milk to meet his demands." This is not always the case. I got the flu when he was 1 month old and was given medicine by an MD and after the 1st 2 doses called the pharmacy w/ question and was told in no uncertain terms I could not breastfeed after taking this med. When we tried my son on formula, he only drank 1- 1 1/2 oz every 3-4 hrs!!! Tried water, etc, finaly took him to the ER and MD said try pedialyte. He drank 2 oz q 4 hrs for the 1st 2 days, then started developing an appetite! I know that it takes a while for babies to acclimate to formula, but MD at ER said that I was not producing enough milk at all!! So what about those moms who would LOVE to breastfeed, but can't? I feel that is very discriminatory and very pushy of the hospital to attempt to push the issue! It should be left to the parents to decide after getting all the facts.

It sounds like you got alot of misinformation. Your doctor that prescribed the meds for flu obviously was not thorough enough because he should have known you were breastfeeding, the fact that he did not take a hx borders on malpractice.

As far as making enough milk, you probably were making enough and just didn't know what to expect from a new born. They have a stomach about the size of a quarter so they eat little and often. They tend to eat and poo more often when breastfeeding because it is more easily digested. My daughter breast fed every 2 hours at first. As long as they are wetting enough diapers they are fine. Your son taking 1 1/2 oz of formula q 3-4 hours is also normal for a newborn. I would bet that most nurses know more about breastfeeding than an ER doc.

I agree that pushy breast feeding advocates are annoying. I had one stalking me for weeks after I brought my daughter home from the hospital. However, you might have been successful if you had had the correct information and knew what to expect and what to watch out for.

SmilingBluEyes · Sep 19, 2009

I vehemently disagree with "all or nothing" thinking. Baby friendly is great, but we also have the responsibility and ethical obligation to support ALL parents including those, who having been appropriately educated, choose to bottle feed. Really, it's up to them; they are the ones raising their babies, not us. And we should never cross the line to "guilting" anyone into one choice or another. I would MUCH rather see us go "family friendly" than "baby friendly". IMHO of course......

Ok off my soapbox.

babyktchr, BSN, RN · Sep 19, 2009

My sentiments exactly. Now...will you tell my lactation consultant this?

dscrn · Sep 19, 2009

Many of us feel the same..not so sure that we would convince the "consultants"...not sure that there are lactation consultants that work the overnite..if so, I stand corected. Would be nice to give one a call at home about 3am, to tell her that plan for baby Jones needs some tweeking-she's in the nursery screaming, and mom does not want her back until 6...

dscrn · Sep 20, 2009

my hunch isthat this is a somewhat dated video...what about universal precautions??

Marymoomoo · Sep 20, 2009

BabyLady,

Some hospitals do use those protocols because they are evidence based. What in them would be a lawsuit waiting to happen?

dscrn,

The videos were made in 2007. Definitely NOT dated. ?

The CDC this about breastmilk handling:

Quote

CDC does not list human breast milk as a body fluid for which most healthcare personnel should use special handling precautions. Occupational exposure to human breast milk has not been shown to lead to transmission of HIV or HBV infection. However, because human breast milk has been implicated in transmitting HIV from mother to infant, gloves may be worn as a precaution by health care workers who are frequently exposed to breast milk (e.g., persons working in human milk banks).

https://www.CDC.gov/breastfeeding/faq/index.htm