baby not keen on breast and jiterry..what to do

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guys need help around here.... in my hospital where i practice when a baby is not keen in sucking on breast and the baby looks jittery we will supplement the baby with a dr order( its a standing oder actually if the glucometer level is below 3 mmol/L) although the mothers insist on total breastfeeding... what is your practice in your hospital... what irks me most is even though we explain to mother that your baby's glucometer is low and we need to supplement the baby for one time they still insist on total breastfeeding..And they keep on saying that they say its not harmful to total breastfeed your baby( because they read in in internet).....so what are you guys practicing in your hospital... Have you come across mothers who breastfeed baby on a limited time in night shift so that they can sleep although baby is still crying for milk..And when we say you have to breastfeed longer because your baby still looks hungry, they look unhappy...(like they are expecting us just to make the baby stop crying) .what do you say to these mothers ?? Your experience please?

Good posts. :yeah:I am not A nicu/OB/Peds nurse...but all BF Moms need patience and caring. BF takes time and patience. I will never forget the OB nurse who helped me to get my son latched nearly 33 years ago. I will forever be indebted to her for being such a caring, patient nurse! :nurse:

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Specializes in Community, OB, Nursery.

I think there are a lot of unrealistic expectations out there. I tell new moms the q3hr thing is for us. So we don't let him go longer than that at first until breastfeeding is well-established. It is not a hard and fast rule, and if baby acts hungry before the 3hr mark, it's time for him to eat. We tell new moms that their babies don't have a clock to look at and don't know that it hasn't been 3 hours, all they know is that they are hungry.

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For a baby with hypoglycemia we do skin to skin with moms and hand express colostrum. The colostrum can be fed in a spoon or via syringe. Colostrum works better at bringing up blood sugar than formula! If we cannot express colostrum then we should (but some RNs don't) offer human donor milk. If the mom declines donor milk then we'll use formula, but max 10 mL and typically through a syringe or SNS.

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Specializes in Nurse Leader specializing in Labor & Delivery.
If we cannot express colostrum then we should (but some RNs don't) offer human donor milk. .

That's nice that you have that option.

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That's nice that you have that option.

Yup, it's pretty awesome! Some moms are like "ew, why would I give some strange woman's milk to my baby?" We bite our tongues, but I really want to say "and you're okay with giving some strange cow's milk to your baby?" ;) It's a relatively new option for term infants so we're still figuring out what language works best and how to explain it so that moms understand it's pasteurized, moms are tested for communicable diseases, etc. Sometimes I think they think we just have a bunch of lactating women in the back hooked up to milk machines. It used to be under 36 weeks gave with mom's request, but now RNs are supposed to offer it for supplementation. All pre-term babies receive human milk until they are term, so it's either mom's expressed milk or donor milk if she can't express enough for her baby.

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Specializes in Surgical ICU, Pospartum/Well Baby.

Nursing Student 2011 it is so unfortunate that your nurses didn't even allow you the opportunity to choose breastfeeding for your son. They returned him to you and announced they'd successfully given him his first bottle. Big Whoop. :yeah:You guys have predisposed this baby to obesity, lessened immunity, and lower grades in school, just to name a few. I'm sure your son is doing just fine, but there's a reason breastmilk is the perfect food for babies and it simply cannot be replicated.

At my hospital breastfeeding is promoted above all else and mom's are asked about their preferred feeding plan long before the birth of their child so that they can go to the breastfeeding class and feel confident in their ability to feed once the baby comes.

For our lady partsl deliveries, the baby usually breastfeeds w/n the first hour of life while still on L&D. If the baby is doing well, the nursery nurse will just pop over there and give the baby a look over and the full assessment and bath are completed when mom and baby move to PP. Our C/S babies usually comes straight to the nursery, accompanied by dad if they wish, for a full assessment and bath. By the time that is done, mom is likely coming along in recovery and we'll take baby over to mom in the recovery room to breastfeed.

If supplementation is indicated at any time due to hypoglycemia, we ask the moms about their preferred method of supplementation. No baby is ever given a bottle or a pacifier without mom's consent.

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Specializes in NICU, PICU, educator.

That is a nice option for the donor EBM, we have it but we have to get permission for it, sign a consent and unless it is clinically indicated, some insurances will not pay for it. That sucks.

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What drives me crazy is the moms who want exclusive breastfeeding, no nipples (no pacifiers) and then want to send baby to the nursery all night, with instructions only to be brought out every 3 hours to feed.

I don't mind watching your baby for you to get some sleep, but if you're not going to have that baby in the room with you so you can soothe it, at least allow US the tools to soothe your baby!

yes, i understand klone, that is what im facing in my hospital as well.. Patient in my hospital always does this routine.." its already 11pm pls take my baby back i need some sleep and please keep the baby in nursery tonight" ," my baby has sucked for 60 times, i have done with the breastfeeding, can you please take my baby back", and i will be asking my patients back.." maam, you counted how many times your baby suckled?" hehehe.. and as usual i will tell them that i will have to bring the baby back for midnight feedings as well because you choose to totally breastfeed the baby.. and they will be like " uh? you have to bring the baby back for feeding but i have already breastfeed for more than an hour, and im having backpain" Do you guys also have patients like this in your setting? is this common? i can accept if a first time mother doing this, but what if the mother has 2 or 3 children already? sometimes i just feel like giving up.. is this normal? am i being a good nurse? because when i bring back the baby for midnight feeds patients complain to my head nurse that i do not let them rest in night... is it my fault?

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Specializes in NICU.

You need to check your facility's policy and procedure on babies with hypoglycemia, especially those who are symptomatic and follow that to the best of your ability. Make sure the Pediatrician or Neonatologist is FULLY aware of the situation. Make sure that the mother is educated about the signs and symptoms of hypoglycemia, the causes, and risks of not treating. Make her aware of options available to help raise the glucose levels. DOCUMENT DOCUMENT DOCUMENT!!

Someone on here mentioned hand expressing colostrum and feeding that to the baby. While that sounds ideal, I have had patients get either NOTHING after manually expressing or drops. Then, after applying a pump, all they are getting is condensation in the flange after 15 min of pumping. So that is not ALWAYS a realistic option.

Also, I have on MANY occasions, gotten an infant from L&D who had nursed for 1 hour, and when it gets to me, has a sugar of 25. (we only routinely check sugars on SGA or LGA infants, GDM infants, or symptomatic infants with resp symptoms, low temp, or jittery) So an hour of effective nursing didn't bring the sugar up with colostrum, we give formula and the sugar comes up.

Do I want to give formula to a breastfeeding infant?? NOPE. But it is better to have a few bottles than to spend a day or two in the NICU on IV fluids. It is better to supplement an infant with a SNS than to let them get brain damage from hypoglycemia. Our goal in the nursery is a healthy baby. Sometimes, it doesn't go how mom and dad imagined. My job is to support them through that and make them successful breastfeeders DESPITE the couple of bottles the baby needed.

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What drives me crazy is the moms who want exclusive breastfeeding, no nipples (no pacifiers) and then want to send baby to the nursery all night, with instructions only to be brought out every 3 hours to feed.

I don't mind watching your baby for you to get some sleep, but if you're not going to have that baby in the room with you so you can soothe it, at least allow US the tools to soothe your baby!

Why not educate the mom that the baby must be fed when showing signs of hunger, not by the clock? Maybe part of the patient education could include early signs of hunger (ie crying is a late hunger cue, etc). I don't know about the policy where you work, but I would be of the mind to bring the baby when hungry regardless of whether or not the mother prefers to wake up. It's not fair to the baby, and could actually be detrimental to the baby's health, to make him wait.

For a baby with hypoglycemia we do skin to skin with moms and hand express colostrum. The colostrum can be fed in a spoon or via syringe. Colostrum works better at bringing up blood sugar than formula! If we cannot express colostrum then we should (but some RNs don't) offer human donor milk. If the mom declines donor milk then we'll use formula, but max 10 mL and typically through a syringe or SNS.

That is WONDERFUL! It must be great to work in a hospital that follows current, evidence-based practices. :yeah:

yes, i understand klone, that is what im facing in my hospital as well.. Patient in my hospital always does this routine.." its already 11pm pls take my baby back i need some sleep and please keep the baby in nursery tonight" ," my baby has sucked for 60 times, i have done with the breastfeeding, can you please take my baby back", and i will be asking my patients back.." maam, you counted how many times your baby suckled?" hehehe.. and as usual i will tell them that i will have to bring the baby back for midnight feedings as well because you choose to totally breastfeed the baby.. and they will be like " uh? you have to bring the baby back for feeding but i have already breastfeed for more than an hour, and im having backpain" Do you guys also have patients like this in your setting? is this common? i can accept if a first time mother doing this, but what if the mother has 2 or 3 children already? sometimes i just feel like giving up.. is this normal? am i being a good nurse? because when i bring back the baby for midnight feeds patients complain to my head nurse that i do not let them rest in night... is it my fault?

Perhaps they need to be educated about the baby's current physiological and emotional needs. The baby is your patient, too, right?

You need to check your facility's policy and procedure on babies with hypoglycemia, especially those who are symptomatic and follow that to the best of your ability. Make sure the Pediatrician or Neonatologist is FULLY aware of the situation. Make sure that the mother is educated about the signs and symptoms of hypoglycemia, the causes, and risks of not treating. Make her aware of options available to help raise the glucose levels. DOCUMENT DOCUMENT DOCUMENT!!

That's good advice.

For reference, here's the Academy of Breastfeeding Medicine's protocol on hypoglycemia:

http://www.bfmed.org/Media/Files/Protocols/hypoglycemia.pdf

Someone on here mentioned hand expressing colostrum and feeding that to the baby. While that sounds ideal, I have had patients get either NOTHING after manually expressing or drops. Then, after applying a pump, all they are getting is condensation in the flange after 15 min of pumping. So that is not ALWAYS a realistic option.

Colostrum doesn't come out in sprays. It usually drops or drips out because it's thick and viscous. If the mother is seeing drops, I would encourage her to continue until she has a good size swallow on the spoon or in the syringe to feed to her baby. :)

A pump isn't the most effective way to remove colostrum. Unless you have a colostrum cup to collect (Medela offers these), then most of the colostrum will be wasted in the breastshield, anyway. If using a pump, it's best to hand express first then use the pump for further stimulation.

Here's a super helpful video that discusses hand expression of colostrum in the hospital setting:

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

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Specializes in NICU.

For some reason fear of coma/brain damage doesn't deter some very deterimend women. I could explain until I am blue in the face about why we need to get that glucose up, with no avail, for some people. For the really amament ones, I would explain that we could insert an NGT (and make it sounds as nasty as possible) to feed the baby. Worked almost every time.

For the ones that want to sleep all night, I would take the baby to them every time he/she started crying. Time to get used to what you will be dealing with at home.

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I've actually had "Breast only - no formula/glucose water/artifical nipples" moms complain b/c we brought their screaming hungry baby in for them to feed when it had only been an hour since the last feeding. These are the moms that I tell "you either need to feed your baby or let us feed him/her". I'm a strong advocate for breastfeeding, and will do everything I can to help new moms succeed, including offering to syringe feed, etc with pumped breastmilk or formula, but it just frustrates me when a mom would rather have her baby screaming from hunger (in the nursery, not her room!) than wake up & feed or let us feed.

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