Our hospital is just beginning to look at becoming baby friendly. I personally don't have much hope in our achieving such status because of our "baby goes to the nursery" policy. We have a hard time getting babies back out of the nursery once they go in, nursery nurses here are generally more interested in following their protocols than in getting babies to the breast.
Anyone here got baby friendly status? How did you do it?
Having that baby get a proper latch is soooo important. I may have a baby that I hear sucking/swallowing at the breast, but still only have his mouth open about half as wide has he can actually get it. Without having the nipple as far back in his mouth has he can get it (with mouth wide open), he may be sucking, and even getting some colostrum, but he's not going to be getting all he can possibly get unless he's got a good latch, because he's going to be compressing those milk ducts instead of expressing them fully.
I'm not a boob taskmaster. I had a patient last weekend, having her 6th baby, that would breast- and bottlefeed her kids for a week, then once her milk was in, she'd breastfeed exclusively, no more bottles, for a year. Do you think I messed with that or told her what she was doing wrong? Nope. And are there babies that do need supplementation? Sure. But not as commonly as it would seem. I think people sometimes have unreasonable expectations about breastfeeding - that the baby is going to eat only every 3 hours, when the reality is he may want to eat every 1 - 1.5 hours, and that is perfectly normal.
We are supposedly making the transition to being a BFH. It's going to be interesting. Most of our moms keep their babies with them anyway, but the whole no-paci, no-formula thing, it will be interesting to see how that plays out at my place.
Specializes in Emergency Dept. Trauma. Pediatrics.
Is there anyone out there who can give me an unbiased answer as to why breastfed only babies are screaming their heads off by day 2? Like Daisy Child said, she knows a hungry baby when she sees one and so do I. When babies are frantically sucking their fists, crying incessantly, and not sleeping, even when they have been on the breast for sufficient time, then what do you call that? If they aren't super hungry, then why, when the mom finally gives formula because she is exhausted and in pain,does the baby suck so vigorously, it could drink the whole bottle down in about a minute?
I have had 4 kids, I BF them all. My first 3 boys though I didn't last more then 6 weeks. I was uneducated about BF and lacked the support. I ended up caving in to bottles around 6 weeks because I thought they were not getting enough, they were always wanting to eat and so I was convinced they were starving. I call BS on it now. I wasn't aware at this time they were having a grown spurt and were wanting to eat more frequently and this was normal. Just like in the beginning they cluster feed and tend to go to the boob more at night and frequently.
First out of all 4 kids none of them were screaming their heads of by day 2. Second a woman having the support and knowledgeable staff is crucial. I am very happy to see the trend going back to pro breastfeeding and the support being their. Our hospital is WONDERFUL on this and when I was doing my rotation there were not screaming starving babies. In fact I didn't come across one mom that was bottle feeding and they could have if they wanted to. Even the NICU baby moms were pumping.
With all the evidence that shows how good breastfeeding is, it should be promoted and supported. Of course in the end mom should get to chose, and should not be harassed. But if people wouldn't be so quick encourage the bottle because it's the "easier" route and would take time to help mom, I bet more woman could be successful.
Breastfeeding isn't painful if it's being done correctly. This is where having knowledgeable staff comes in. At our hospital all the staff on the L&D and Womans care units are trained on Breastfeeding. Good training at that.
They drink the whole bottle because they don't know when to stop when it's not a natural flow and when being given bottles it seems the mom or whoever is feeding will keep trying to push that the baby finish the bottle.
Here is something I did notice in breast feeding my sons from 6-8 weeks to nursing my daughter for 8 months.
My sons when they stopped feeding I gave them 4oz bottles of formula, I would keep trying to get them to always finish it, I was told they needed food early on by everyone and I obliged, by 3 months they were eating 8 oz bottles and lots of them. Their first year they were always in the 80th-95% for their weight. (I broke them all of the bottle at 1). They were very chubby and would eat tons.
My daughter on the other hand I had the support and knowledge and she nursed until 8 months, she weaned off when I was in the hospital for a week from surgery and complications and everything got thrown off. My daughter was always in the 15% for her weight but was also tall and she was healthy. She didn't look to skinny and going off the WHO charts for BF'ing she was a little higher then that.
When she stopped nursing and was switched to bottles, she would eat about 5 oz at a time. She wasn't over fed because she knew when she was full and not. BF babies are very good at stopping when they are full and not overeating. I at first was worried that she wasn't drinking 8-10 oz of formula at one sitting when my boys were at 3 months. But the proof was in the pudding. She had healthier eating habits, was at a healthier weight and it has stuck with her.
I have seen first hand the pros of BF'ing and seeing how important support and education and ENCOURAGEMENT can be and I will continue to follow that. If I try all these things and the mom wants to formula feed, No problem, i will respect that.
Oh and babies are content longer with formula, it's because they can't digest it as well. I knew this from how bad my babies got constipated and how much they spit up all the time and how fussy and gassy they were once they went from Boob to formula. It seemed like the constipation was endless and I can't tell you how many times I had to take a "rectal temperature" to avoid having to give suppositories but to help them be able to poop.
Our county hospital is seeking to go "Baby Friendly." After reading the other posts, I can see we have some real issues to deal with. First, we do not have mother/baby unit, we have the well baby nursery. Second, we have a large number of indigent and illegal immigrant moms at our hospital. Third, L&D, OB and newborn are NOT all on the same page. Fourth, the mom's that say they want to breastfeed have no prior knowledge of what this entails until they have already had their baby, and after possibly hours of labor, or pain of C-section, they are told, " you need to bfd your baby every 2 hrs. aound the clock for milk synthesis, etc. Because of this and many other issues, All the newborn nurses are at odds with our lactation nurses.
The education that is included in becoming BF certified and retaining that certification will hopefully solve many of the problems you've listed. Hopefully, your community WIC and OB/midwife practices will be participating in antenatal education (Have a local breastfeeding coalition? Get them involved!). I would suggest encouraging the mother to watch for feeding cues instead of regimented "by the clock" feeding. It doesn't take any extra time to teach the mother what to look for, including instructions to feed more often if baby isn't waking on his own to feed or isn't producing adequate output.
First, we have mom's that want to both breast and bottle feed. I ,for one, believe in the rights of the mother to feed her infant however she chooses even though I agree that breast is better (I breastfed my children.)At our hospital, the lactation nurses feel it is their business, through fear and guilt, to control/limit that mothers choice to supplement after bfg. My dilema is being caught in the middle. On the one hand, we literally have to give an account to our lactation nurses as to why we didn't do more to dissuade a mom from supplementing thereby incuring the downright anger of the lactation nurses, versus doing what the mom has said she wants to do. The bottom line is, these lactation nurses may be able to get these moms to "fall in line" as it were, while in the hospital, but as soon as they go home, they will do exactly what they want to do. In the meantime, the newborn nurses go through heck with lactation. We do not force rooming in. I have had nights where I might have 4 mom's that are bfg. only, but want their babies brought to them when time to feed. That means I am up and down hallways my whole shift, at least 32 times.
Studies have proven that supplementation should only be given to newborns if there is a medical need. The reason for that is clear, supplementing interferes with the normal establishment of lactation and formula feeding has risks. Supplementing can lead to delayed LII, which can in turn lead to increased risk of weight loss and related issues (such as jaundice). The LCs (hopefully IBCLCs) aren't wrong to educate mothers about this very real risk. This could be an even bigger problem for a mother who is living on a low income as long term formula feeding may not be feasible or affordable. Of course, mothers should not be guilted into making any certain decision, but they absolutely should be told about the risks of supplementation and of formula feeding in general. That's not about guilt or force. That's about informed consent.
Mothers should also be educated about why their newborns should stay in the room with them, skin to skin most of the time. (Plenty of recent research on this subject, as well!)
An IBCLC that is abiding by the Code of Ethics wouldn't tell a mother that it was just fine to supplement with formula (unless medically indicated, of course) because that practice is NOT evidence-based.
You might try looking at this from another perspective. Once the mother leaves your floor, she's no longer under your care. If breastfeeding doesn't go as the mother hoped (for example, because of early and unnecessary supplementation), she isn't going to come back to see you. If she doesn't wean completely, she may come back to see the IBCLC with a trainwreck situation that now *requires* supplementation. Or worse, she may end up back in the hospital with a baby who is very ill d/t compromised milk supply, altered sucking skills, etc. If you can get a mother off to the best start as possible in the hospital, she and her baby will have the best chance at breastfeeding success.
I just want to say that I *do* understand the cultural issues that are involved with early supplementation. And yes, some mothers do supplement those first few days (or not breastfeed at all), and all goes well for them and their babies. However, that's not what happens for every dyad, and we have to educate all mothers about the risks of supplementation. It's then her choice of how she wishes to proceed.
Here is a suggestion of something that you could initiate that might help your hospital get just a little closer to being "baby-friendly". It might take some time and convincing of your coworkers, but with the right presentation, you could succeed. In the last year at the large hospital I work at, we initiated and promoted skin-to-skin with baby for the FIRST HOUR of life. We discuss it with mom on admission, explain reasons for doing it (promotes bonding, helps with successful breastfeeding, eases transition, calms baby......) and almost EVERY mom wants to do it. I don't want you to think that this change came easily....it did not! Nurses who were used to whisking the baby off to the warmer for immediate head-to-toe and shots and footprints, weights and measurements initially had a hard time warming up to this. Doctors who wanted to fill in there progress notes with baby stats learned to wait. There are still a few nurses and doctors who begrudgingly go along. But the response from moms and families has been so positive that this is now our new "norm". Don't give up! Even if this is all you do and the baby still "needs" to go to newborn nursery, at least you've done something to help this couplet start out right.
That's great, redbeads!
We are in the process and it has been a bumpy road. We get to deal with starving Infants during the night. I don't care what the experts say. I know a hungry baby when I see one and many ARE hungry. Not all mom's produce colostrum right away... the ones who are able to pump 10 ML's the day of delivery are few, but their Infants are the happiest. During the day, lactation is there, at night the Nurses have to deal with many issues, concerning breast feeding, ON top of our regular duties... when you have a mom who just had a c section, cant get OOB, and has been told formula is basically poison and paci's are evil... you are in a terrible situation. Count on spending a lot of time in her room.
Colostrum isn't easily "pumped". Some mothers have plenty and yet are unable to remove even a drop with a pump. A baby who is latched on well is most efficient at removing colostrum. If a baby can't breastfeed, hand expression and combined hand expression/pumping (known as "hands on pumping") is the most effective way of removing colostrum. Have you read the latest research from Morton? If not, these two videos are a great place to start. Then head over to Google scholar and look up the studies.
If a baby is truly hungry, he shouldn't be given a pacifier. He should be fed! Beyond that, pacifiers are known to be detrimental to the establishment of breastfeeding. Even the AAP recommends that breastfed infants do not receive a pacifier in the first month. It sounds like mothers are making an informed choice not to use them in the hospital.
If a baby in your care is hungry, I would suggest taking him back to mom, putting them s/t/s, then assure that when he is ready for a breastfeed he is latched on well. Afterwards, the mother can hand express her colostrum and feed it to the baby right then and there. There are many benefits to this method of teaching, including building the mother's confidence in her mothering skills. A mother who knows what to expect and is assured that she understands normal newborn behavior won't be keeping you in her room all night.
I explain that frequent emptying of the breasts is what drives milk production and if they take a sleep break at night they must pump even more during the day to keep the same supply. I suggest they use a pumping log to see if the altered pump schedule is hurting or helping supply. If the baby can go to breast at all I maximize that opportunity, the baby is better than the pump.
You might consider talking to the head of your lactation department about both the situations you described, as well as the latest research regarding milk expression for the preterm infant. Many mothers do need to pump at least 8x a day to maintain milk production, but others do not. This is because mothers have varying storage capacities (basically the amount of milk the breast can hold before beginning to shut down production). A mother with a large storage capacity may only need to pump 4x a day, while a mother with a smaller storage capacity may need to pump 8x or more. One thing that you might suggest she take under consideration would be to educate mothers that the goal is to maintain an output of at least 600 ml per 24 hours (some experts are recommending 750 ml). All mothers should start out pumping frequently (with hand expression and hands on pumping--see Morton), but some will be able to decrease pumping frequency and still maintain production. This would allow greater freedom to individualize care to the needs of the mother.
Moms with delayed onset of lactation are told that their child won't learn the breast if they bottle supplement while waiting for milk to come in. Yes, because when I get a readmit who has lost 15 percent of birth weight and has a bili of 22 while fingerfeeding for 5 days that is a desired outcome, right? The SNS would have helped here...but mom was told to only use 10 cc in it per feed....
Rule #1 (always!) is feed the baby. A baby in that dire of a situation couldn't have been getting enough to eat.
There are great alternatives to bottles that should be explored as options, but if a parent chooses bottles to supplement for their familiarity and ease, we should support that. Parents can be taught paced bottle feeding techniques as well as educated about which bottle nipple shapes are best for breastfed babies. Bottle feeding can actually be used as a tool to preserve the breastfeeding relationship. See here:
Bottle-Feeding as a Tool to Reinforce Breastfeeding
At last, someone who has observed the same thing I have.Breast fed only babies are starving in those first couple of days before the milk comes in. (See my first post.) When was the last time the "experts" worked night nursery? The only Baby Friendly hospitals that possibly could be succeeding are those where the moms know what is involved and are willing to make the sacrifice. At our hospital, moms (most are indigent and uneducated) haven't got a clue what's going to happen to them if they say they want to breastfeed. The fact is, most of them want to do both (breast and bottle) and don't realize their wishes will not be respected by our one lactation nurse, who literally forces her will over the wishes of the mother by discouraging the mom from supplementing,with all the so called " horror stories" of bottle feeding, pacifiers, etc. As I stated in my first post, the Baby Friendly movement is just another attempt by an organization to take away a woman's right to feed her infant the way she wants. They may say they are not forcing a woman to breastfeed only, but when you forbid formula except for medical reasons, I call that taking away her choice and thereby forcing her to comply, at least while she's in the hospital. Seems our once great country that respected the rights of the individual is slowly, but surely moving to becoming a nanny state. Notice that most of the countries that have Baby Friendly hospitals are countries with socialized medicine. What does that tell you?
Baby Friendly isn't about taking away a mother's choice. Not at all! The intention of baby friendly is to increase the standard of care for both mothers and babies.
I think that Klone did an excellent job of explaining what is normal for a breastfed newborn. Please do your own follow up research, as well. A newborn is not "starving", but especially after a medicated birth and sleeping the majority of the first 24 hours, he may "wake up" and cue to feed more frequently on the second day of life. Parents should be educated about this so they know this behavior is normal. They should be holding baby s/t/s, breastfeeding frequently (on cue) with the baby latched on well. If breastfeeding isn't going well, she can hand express after feedings (one method is to hand express directly onto a plastic spoon) and the baby can be supplemented immediately after. Colostrum is available to baby in the perfect amount to suit the newborn's physiological state (stomach capacity).
As for your concerns about low income mothers in your community, you may wish to read this paper:
Evidence for the ten steps to successful breastfeeding
At delivery, babies are placed skin to skin and babies temp is taken while baby is on mom's abdomen. After roughly an hour of skin to skin and breastfeeding initiation, baby will be weighed, measured, given vit k (if mom desires) and any necessary labs done (at mom's bedside). After 2 - 3 hours, couplets are transferred to our unit. Until about a year ago, infants were whisked to the nursery for an assessment. Now, moms and babies go to their room together and initial assessments are bedside. On some occasions, a baby may need to go to the nursery for an O2 check. We are now in the process of starting to perform baths (which are done 6 hours post delivery) at the mom's bedside and then put in skin to skin for warming. I think these are wonderful things, but many mothers do not comply with kangaroo care, which makes me nervous. All in all I think it is a change in culture (nurses, patients, physicians, etc) that will take some time, but will reward us all with multiple benefits.
Amen! So glad to hear of all these facilities practicing evidence-based maternity care. :redbeathe
Is there anyone out there who can give me an unbiased answer as to why breastfed only babies are screaming their heads off by day 2? Like Daisy Child said, she knows a hungry baby when she sees one and so do I. When babies are frantically sucking their fists, crying incessantly, and not sleeping, even when they have been on the breast for sufficient time, then what do you call that? If they aren't super hungry, then why, when the mom finally gives formula because she is exhausted and in pain,does the baby suck so vigorously, it could drink the whole bottle down in about a minute?
What is considered "a sufficient time"? Ideally, baby should have unrestricted access to the breast. In addition, time/frequency doesn't matter so much in the grand scheme of things. Baby should be latched on well, transferring milk, and wetting/soiling diapers. If a baby is still displaying hunger cues after nursing on both sides (assured baby is latched on well), why not suggest the mother hand express and supplement baby with her own milk?
Ideally baby should be s/t/s with mom and not in the nursery. A baby who is separated from his mother will cry (hungry or not). Babies are stressed by separation, and this stress has a known detrimental effect (short and long term). Here's a few articles for more information:
Christensson K, Cabrera T, Christensson E, Uvnas-Moberg K, Winberg J. (1995) Separation distress call in the human neonate in the absence of maternal body contact Acta Paediatr 84(5):468-73
McKenna JJ, Mosko SS. (1994) Sleep and arousal, synchrony and independence, among mothers and infants sleeping apart and together (same bed): an experiment in evolutionary medicine Acta Paediatr Suppl 397:94-102
Michelsson K, Christensson K, Rothganger H, Winberg J. (1996) Crying in separated and non-separated newborns: sound spectrographic analysis Acta Paediatr 85(4):471-5
As Klone explained, a baby will "guzzle down" a bottle because he has no other choice. The liquid is coming faster than he can handle and he must swallow in order to protect his airway. I challenge you to hold one of the formula manufacturer supplied nursers upside down...now compress the nipple a little...what happens? Look at the nipple tip--formula nurser nipples often have cross cut holes, so the flow is even greater than "newborn" or stage 1 bottle nipples.
No matter if parents formula feed or supplement via bottle, IMHO, they should be educated about newborn stomach capacity as well as paced feeding methods.
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Elvish, BSN, DNP, RN, NP
4 Articles; 5,259 Posts
Having that baby get a proper latch is soooo important. I may have a baby that I hear sucking/swallowing at the breast, but still only have his mouth open about half as wide has he can actually get it. Without having the nipple as far back in his mouth has he can get it (with mouth wide open), he may be sucking, and even getting some colostrum, but he's not going to be getting all he can possibly get unless he's got a good latch, because he's going to be compressing those milk ducts instead of expressing them fully.
I'm not a boob taskmaster. I had a patient last weekend, having her 6th baby, that would breast- and bottlefeed her kids for a week, then once her milk was in, she'd breastfeed exclusively, no more bottles, for a year. Do you think I messed with that or told her what she was doing wrong? Nope. And are there babies that do need supplementation? Sure. But not as commonly as it would seem. I think people sometimes have unreasonable expectations about breastfeeding - that the baby is going to eat only every 3 hours, when the reality is he may want to eat every 1 - 1.5 hours, and that is perfectly normal.
We are supposedly making the transition to being a BFH. It's going to be interesting. Most of our moms keep their babies with them anyway, but the whole no-paci, no-formula thing, it will be interesting to see how that plays out at my place.