My hospital is working toward becoming baby friendly. This entails that we promote rooming-in and breastfeeding, which I have no problem at all with- what I do have a problem with is how we are being presented with it- and how we must now interact with our patients. Our patients come from a very diverse spectrum of cultures who are set in their ways and I guess I don't really feel it's my place to be like "well welcome to America- this is how we do it, too bad so sad."
We have been ordered to move all formula, nipples and pacifiers to the back room of the nursery (which has also undergone a name change to make it less accessible and friendly sounding) so that NOBODY sees it, patients or family. We don't want them to think we promote formula or artificial nipples. We are instructed now to council every mother who has chosen to formula feed, or do breast/bottle combo on the "dangers of feeding formula to your baby". Yes, these very words were uttered and in writing. There's serious talk of making the mother sign an informed consent before giving the baby any formula- acknowledging that she is aware that she is causing harm to her baby by giving him/her formula, and that they understand that breast milk is superior to formula.
We must extensively chart WHY mom is choosing formula. We have to now keep all the shades in the nursery down so that people don't look in, and THINK it's a nursery and again to make it an in-accessible place.
This really seems out of hand to me. I love where I work, I love the field but boy, we are in for some troubles when a mom from another culture other than white-upper class wants to put their baby in the nursery so they can sleep, or can go for a walk, or wants to formula feed and then gets a 20 minute lecture implying that they're a bad mom for choosing this method. Is this true of any other hospitals out there that are baby friendly or are in the process? I feel like they're trying to brainwash us, or like it's becoming a cult-like atmosphere!
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
Baby was 9 pounds 10 ounces. My son and daughter-in-law have access to a wonderful lactation department that is open on weekends here. So, anytime they have issues, they can drive over and sit and chat. They also make housecalls. There was careful consideration from the pediatrician and lactation consultant about adding formula. Remember, my daughter-in-law had breast reduction surgery and while she was encouraged to try and she wanted to try, there were some troubles with milk production. Baby is 2 months old now and mom has a double pump. She breastfeeds and pumps milk and gives that in a bottle and also gives formula. I highly doubt my granddaughter will turn into a mutant due to formula. I breastfed my kids to toddlerhood so remember, I'm a huge proponent! As Jolie has stated, I'm interested in scientific studies regarding dangers of formula feeding. Thanks![/quote']
So baby saw a loss of about 7%. So that weight loss...not at all concerning. This all leads me to be concerned about the lactation information she was provided. But that's beside the point...
Nobody said formula fed babies become mutants.
And do you want more articles than what others have provided? How many articles discussing risks of formula is enough? Why is it so hard to accept education being necessary here? We educate in ever other department but because mom might feel guilty we shouldn't educate? Oh come on. Please.
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
So risks of infant formula can be viewed in a couple different ways. You can first look the benefits of breastmilk that the child won't get or you can look at the risks associated with the actual formula. The removal of benefits from breastfeeding is the same as creating risk by using infant formula. Formula has a place and will never go away. We can't stop educating because we are worried about somebody's feelings...we don't stop educating anywhere else because of feelings. It is important that we educate and do so in a respectful manner.
[h=1][/h][h=1][/h]The Risks of Not Breastfeeding for Mothers and Infants
11 ounces on a 9+10 baby should not be freak-out level, still a bit away from 10% of birth weight. If output is ok, I'd be inclined to leave well enough alone, but since there are already several providers involved it's a moot point. Breast reduction surgery is definitely a reason to keep a close eye on both baby and mom. (Congratulations, btw, Steph! :) )
The concept behind baby-friendly is a good one. Breastmilk should be considered standard, normal nutrition for newborns. What is often very bad is implementation in the hospital, especially in combination with all the other silly things we have to put up with - unreasonable patient satisfaction expectations, short staffing, and cumbersome charting, for starters.
No staff nurses I work with believe formula is poison. We have a couple LCs whose aggressive breastfeeding approaches I don't care for. Honestly, I don't have a particular issue with whether or not you feed your baby formula, how often, or with what. But you should be able to make your decision based on good information; to do otherwise would be a disservice as a nurse. A 2-day-old baby who wants to nurse all the time isn't by itself indicative of a need to supplement. That kid is acting his age, and parents need to know that before getting discouraged unnecessarily about their milk supply. (Just one example of misinformation possibly leading to unnecessary supplementation.) If, after knowing that, they still want formula, it's up to them and we move on.
I do agree that putting a positive spin on the normalcy of breastfeeding versus the 'risks of formula' is generally a better approach. No one is suggesting that kids will turn into mutants or sociopaths because they got formula. But there isn't really a question that in some cases and for some conditions, formula is riskier. Case in point, NEC. There isn't a single pinpointed etiology for NEC, but there's no debate in the neonatology world that formula fed babies - especially preemies - are at higher risk. Should new mothers spend every single waking moment worrying that they're giving their kid NEC in a bottle of Enfamil? Of course not, and no nurse with a bedside manner worth a flip will tell a mother otherwise. But is it a risk? Clinically? Scientifically? Yes.
I gave both my kids formula, along with breastfeeding each into toddlerhood. My daughter refused my breastmilk from any other source but the tap - after different bottles, nipples, cups, etc. So while I worked 12 hour shifts, she got formula! in a bottle! from her dad. We had a hurricane pass over us a couple weeks after returning to work, resulting in lost power for 60 hours in August. We'd have lost all the stored breastmilk anyway. Formula was our saving grace. I'm glad she didn't starve while I was away from her. (I slept at the hospital between shifts since we had no power and sleeping in a hot house with hot grumpy children and no way to drown them out....not gonna happen.) She finally decided at 29 months that she'd had enough 'chichis' and we stopped, no trauma involved.
I bust no parental chops for choosing formula....but again, a good nurse will make sure parents have access to accurate information that will help them decide best. This goes for all areas of health and wellness, not just breast vs. formula. I don't follow any 'scripts' with baby-friendly stuff, but I do my best to use EBP and best-practice standards. Most of my coworkers do the same.
There is nothing particularly controversial about any of this.
- Have a hospital breastfeeding policy. Common sense. We have a policy for just about everything, don't we?
- 'Inform' pregnant women. Ok, that's our job, and the 'information' should begin prenatally or even preconception. Does not, should not, equal berating.
- Make sure staff is trained. Again....reasonable expectation. Continuing competency is part of a profession. If it's part of your job you should know how to do it well.
- Help mothers initiate breastfeeding within an hour of birth. Easy peasy in healthy term newborn kids....put 'em on mom's chest and leave 'em alone. I've done full assessments, shots, drops, measurements, blood sugars, etc. with babe on Mom. Skin to skin boosts prolactin and oxytocin, keeps babe warm, and calms him down enough so he can get himself organized and latch well.
- Helping mothers maintain lactation when separated. Pump? Hand expression? This doesn't have to be difficult in practice. Hand expression is really easy when a pump is not available or you have a mom for whom a pump would be overwhelming for whatever reason.
- No nourishment but breastmilk unless medically indicated. For those members who were asking about neonatal or maternal meds/conditions that are contraindicated in breastfeeding, here's your answer. The BFHI agrees that when there is a medical indication, alternate forms of nourishment are a good thing to have around.
- Allow couplets to stay together 24 hours a day. Notice this says 'allow'. It does not say 'force.' This is where I think we see many hospitals do a poor job of implementing. We have a nursery, and babies are in our nursery a lot at night. I'd say at least 25% of our moms send their babies there for rest at some point during their stay. Hospitals who completely take the nursery away in the name of BFHI are misinterpreting. But it's a good thing to at least offer parents the option of watching as much newborn care as is practical - we do baths, daily weights, heelstick labs, most meds, and assessments in the room.
- Encourage breastfeeding on demand. Duh. When your baby's hungry, feed him!
- Give no pacifiers or artificial nipples to breastfed infants. It says nothing about what parents give the kid....only what staff do. That means no bottles behind parents' backs, etc. We don't supply pacis but we do tell parents who ask that they want to give one it's their call and we're fine with it.
- Importance of community support post-discharge. Just like so many other things - good follow up and support are vital.
This should not be as difficult as hospital admins and some staff make it when talking about healthy, normal newborns.
Big breast feeding advocate here. But, unfortunately, breast milk has sadly been found to be contaminated with lead, mercury, orificenic and other heavy metals. If nurses educate mothers regarding the proven advantages, they also should be educating them as to how to make the healthiest breastmilk possible through healthier diets and lifestyles.
Unfortunately, though, some contaminants in our environment are difficult to avoid.
But the reality is, breastmilk from a mother who is smoking cigarettes and eating nothing but doritos and coffee is still nutritionally superior to formula, and still provides the benefits of immunity, bonding, GI health, decreased risks of certain cancers and diseases, etc. We know that infants of mothers who smoke have a higher risk of SIDS. Infants of smoking mothers who breastfeed still have an increased risk, but it is *less* than that of formula fed infants of smoking mothers. And remember, formula comes from cow milk or soy. Both of which are grown in the same environment in which we live, and are susceptible to most of the same contaminants found in breastmilk.
It is a common misconception that you can't eat xyz while nursing, you can't drink alcohol, no coffee, no gassy foods, no meds EVER, etc. The reality is that, barring infant allergies/sensitivities, most moms can eat and drink whatever they want while breastfeeding, including alcohol. I educate moms about a healthy diet because a healthy diet is important, not because it is critical to the quality of her breastmilk, because it isn't.
Environmental contaminants do bind to breastmilk. Many contaminants are lipophilic, and are found in the high fat content of breastmilk. While a healthy lifestyle free from as many contaminants as possible is of course ideal, it's not accurate say that contaminants make breastfeeding a dangerous proposition. Maybe if you lived on Three Mile Island or something, but not under normal circumstances.
Here's a good article on breastfeeding, with attention being given to contaminants in breast milk. It does affirm that breast is best in spite of contamination. It mentions dietary ways of reducing it.
In her October 2007 review, Jorissen offered this conclusion: "At this point, there is no evidence of a threshold among the general population beyond which the risks of breastfeeding outweigh the benefits, nor is there any evidence demonstrating a clinically significant negative effect of postnatal exposure to PCBs via breast milk. To date, the majority of studies conclude that despite substantially higher PCB loads among breastfed infants, breastfeeding is still preferable to formula feeding."
Wang points out that many of the environmental chemicals commonly measured in human milk come from the mother's diet. For example, he says, up to 90% of human exposure to the persistent and lipid-soluble dioxin-like chemicals, including certain PCBs, PCDDs, and PCDFs, is attributed to dietary intake. These chemicals are found at higher concentrations in fatty foods such as red meat, dairy products, and fish. Some of the highest levels of contaminants are seen among women in remote northern areas, such as the Canadian Inuit, who eat a diet rich in seal, whale, and other fatty marine species high on the food chain. Meat eaters in general tend to harbor more POPs than people eating predominantly vegetarian diets.
During gestation and lactation, a woman therefore may change her diet to reduce her infant's exposure to such chemicals during critical windows of the child's growth and development. Nursing mothers can also reduce the level of POPs in their milk by maintaining their weight to avoid mobilizing fat stores, says Jenny Pronczuk, a WHO medical officer working in the area of children's health and the environment--who adds that reducing emissions of POPs into the environment is the long-term solution to this problem and one which risk managers should give greater priority.
OP It makes me sad that this is what us Lactation specialists are going to deal with. This is why our breastfeeding rates are so low. There ARE risks with formula. It's not normal, its been normalized, there is a difference.
"I would like to know where you have found scholarly, research based information that pertains specifically to the dangers of formula, independent of benefits of BF, as you indicated is imperative in educating parents."
"Delaying solids decreases the risk of food allergies.
It is well documented that prolonged exclusive breastfeeding results in a lower incidence of food allergies (see Allergy References). From birth until somewhere between four and six months of age, babies possess what is often referred to as an “open gut.” This means that the spaces between the cells of the small intestines will readily allow intact macromolecules, including whole proteins and pathogens, to pass directly into the bloodstream.This is great for your breastfed baby as it allows beneficial antibodies in breastmilk to pass more directly into baby’s bloodstream, but it also means that large proteins from other foods (which may predispose baby to allergies) and disease-causing pathogens can pass right through, too. During baby’s first 4-6 months, while the gut is still “open,” antibodies (sIgA) from breastmilk coat baby’s digestive tract and provide passive immunity, reducing the likelihood of illness and allergic reactions before gut closure occurs. Baby starts producing these antibodies on his own at around 6 months, and gut closure should have occurred by this time also. See How Breast Milk Protects Newborns and The Case for the Virgin Gut for more on this subject."
Think about what would happen if formula was not provided by the government/WIC. :0 I myself breasted as much as possible so I wouldn't have to spend the $$ on formula.....and so my kids would hopefully not develop severe childhood eczema like I had. So far they haven't.
Women have breastfed without formula or pacifiers for centuries. Almost every women nowadays can too. BUT... People did things then that we don't do now. Starving big baby? Pass baby to your sister/aunt/friend/neighbor/wetnurse and SHE, who is breastfeeding her own toddler or infant, will feed your baby a few times. We don't do that in our culture.
A newborn should pretty much be attached to the breast constantly for the first several days. But sometimes baby wants to suck moreso than feed. Keeping the baby at the breast instead of giving a pacifier for that purpose is appropriate in those first days. BUT... Our current teaching says moms can't sleep with the baby. So what will the baby, who just needs to suck, suck on while mom sleeps?
Historically, women would have their first baby at age 18 or so. My experience is that teen moms' milk comes in faster, first baby or not. Milk comes in faster with subsequent babies. Way back when you (usually) would not have a 40 yr old first time mom whose milk takes a week to come in. Nowadays we frequently see AMA first time moms.
Strict breastfeeding and no pacifier isn't always feasible in our culture. This is how I see it.
Women have breastfed without formula or pacifiers for centuries. Almost every women nowadays can too. BUT... People did things then that we don't do now. Starving big baby? Pass baby to your sister/aunt/friend/neighbor/wetnurse and SHE, who is breastfeeding her own toddler or infant, will feed your baby a few times. We don't do that in our culture.
Strict breastfeeding and no pacifier isn't always feasible in our culture. This is how I see it.
I think this is the key that makes breastfeeding a special challenge in present day Western culture. I think we might stand a better chance at success if we were to look at cultures that have extremely high breastfeeding rates.
My hospital is a certified Baby-Friendly hospital though the main interventions are judiciously applied in the NICU where I work. Interesting article I came upon recently:
Enjoy and share. I will be following with another posting on the dangers of formula. Even though I'm a big supporter of pacifiers, I'm passionate about the use of human milk for human babies. I still wonder at the normalcy we have ascribed to allowing another species to feed our most vulnerable.
I have read this thread from the beginning off and on the last weekend as I worked (in a level III large NICU). I didn't have time to respond until today. I have worked there over a decade and watched our unit move to supporting an exclusive human milk diet for all our VLBW kids and only incorporating bovine products at 34 weeks +. I have also watched our unit's rate of NEC drop dramatically.
I know the rest of you are for the most part mother/baby folks and that is another world, but I was attracted to this thread by the discussion of formula as a fine and comparable choice. I heard the work "poison" ascribed to formula. While I don't feel comfortable going that far; I'm pretty close; at least for our kids. We as nurses are there to promote maximal health. Just as we would counsel someone to avoid a diet of highly processed fat and sodium laden diet along with the risks associated, we should advise mothers on the benefits of exclusive breastfeeding as well as the risks of not doing so (i.e., formula feeding). I cannot see anything wrong with having the mom review and sign a paper with that information on it.
I am listing a series of articles addressing the improved outcomes associated with exclusive human milk diet for preterm infants. And for those who have any doubts, let's clarify, improved outcomes with one variable implies poorer outcomes with the other variable. Need clarification? Better results with breastmilk equals worse results with formula.
And to sum it up, a case of anecdotal influence on my mood. Just witnessed a long-time resident of our unit have a likely fatal GI incident within a couple of days after transitioning from exclusive human milk diet to bovine-based preterm formula. Yes, it's unusual and anecdotal, but it's heavy on my mind.
This means that the spaces between the cells of the small intestines will readily allow intact macromolecules, including whole proteins and pathogens, to pass directly into the bloodstream.This is great for your breastfed baby as it allows beneficial antibodies in breastmilk to pass more directly into baby’s bloodstream, but it also means that large proteins from other foods (which may predispose baby to allergies) and disease-causing pathogens can pass right through, too. During baby’s first 4-6 months, while the gut is still “open,” antibodies (sIgA) from breastmilk coat baby’s digestive tract and provide passive immunity, reducing the likelihood of illness and allergic reactions before gut closure occurs. Baby starts producing these antibodies on his own at around 6 months, and gut closure should have occurred by this time also. See 
IrishIzCPNP, MSN, RN, APRN, NP
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