Breast baby after C-Section and GD

DebblesRN, ASN, BSN, RN · Sep 24, 2009

Where I work, our glucoses have to be greater than or equal to 50 or the baby gets formula. We have a GDM protocol--check sugars at 1 hr, 3 hrs, 12 hrs, and 24 hrs.

I try to let mom BF first regardless, so that she gets the stimulation, but we always follow up with 24cal formula--20-30ml every 3hrs. Maybe I am just unlucky, but the sugar never comes up for me with just BF.

We have a few peds that want us to feed every two hours. Man I hate them. The Neos are much better.

I love the idea of the SNS made out of feeding tubes and stuff. We have SNS, but the lactation Nazi keeps them locked up in her office, and mostly refuses to give them out--then complains we are not helping the moms nurse through the sugar issues. Hello--give us the SNS and we can make them successful and not have to use the freaking bottle.

BabyLady, BSN, RN · Sep 24, 2009

I'm taking care of a mom who had gestational diabetes and had a repeat c-section. Babe was footling breech at delivery and had somewhat of a difficult delivery even though it was sectioned. Mom had 10 units of insulin night prior to surgery. Baby's blood sugar after 1 hour was 38 mg/dl. Our policy is usually to let mom nurse and then recheck in 1 hour if less than 40. Blood sugar was 42 mg/dl 1 hour after. The doctor actually wrote orders to recheck blood sugar prior to next feeding and if
(The same doc has another babe admitted at 3 days old with jaundice in which she told the mom just to stop breastfeeding and just pump for now. She did tell her if she got anything we could use it also.) Obviously we are NOT a baby friendly hospital. I really don't feel like we are helping these moms out by telling them to just pump.
The babe is now having trouble latching on and not opening it's mouth wide enough when trying to get latched on. I'm wondering if it might have nipple confusion already?

The physician's #1 priority is helping that baby.

The baby didn't have nipple confusing, once the baby's blood sugar is too low, it does not have the strength to try to nurse so bottle feeding and the higher sugar and protein is the best choice.

The NEXT step if it doesn't improve is to get an IV access and give little junior a bolus of D10W.

I am sure Mom would rather see a bottle feed instead of that.

Neonatologists won't wait an hour because your baby can go severely downhill...if it's not up in 30 minutes, that's it.

Nipple confusion is a myth. A baby that young only knows of it's biological instinct to suck be it a nipple on a breast, a bottle, gloved hand, dog's nose.

It doesn't care.

BabyLady, BSN, RN · Sep 24, 2009

We have a few peds that want us to feed every two hours. Man I hate them. The Neos are much better.
.

The sickest babies in our unit don't feed sooner than every 3 hours.

DebblesRN, ASN, BSN, RN · Sep 24, 2009

Yeah--it is this one group of pediatricians. They drive me crazy. They want the baby fed every 2 hours until we get 3 AC's above 50. We are talking 20-30ml every 2 hrs. They will start IVF if the sugars stay low for too long, but when you have a baby that is being fed every 2 hrs with ACs in the upper 40's, the baby gets tired. Sometimes, if the right doc is on from this group, they will give an order for Q3hr feeds or that a 45 chemstrip is okay. The rest of them are butts.

BabyLady, BSN, RN · Sep 24, 2009

Yeah--it is this one group of pediatricians. They drive me crazy. They want the baby fed every 2 hours until we get 3 AC's above 50. We are talking 20-30ml every 2 hrs. They will start IVF if the sugars stay low for too long, but when you have a baby that is being fed every 2 hrs with ACs in the upper 40's, the baby gets tired. Sometimes, if the right doc is on from this group, they will give an order for Q3hr feeds or that a 45 chemstrip is okay. The rest of them are butts.

Seems like they didn't get the memo in their pediatric residency, that the baby also burns up sugar when it cannot rest.

Q2 feedings actually is detrimental instead of beneficial.

nkochrn, RN · Sep 26, 2009

The physician's #1 priority is helping that baby.
The baby didn't have nipple confusing, once the baby's blood sugar is too low, it does not have the strength to try to nurse so bottle feeding and the higher sugar and protein is the best choice.
The NEXT step if it doesn't improve is to get an IV access and give little junior a bolus of D10W.
I am sure Mom would rather see a bottle feed instead of that.
Neonatologists won't wait an hour because your baby can go severely downhill...if it's not up in 30 minutes, that's it.
Nipple confusion is a myth. A baby that young only knows of it's biological instinct to suck be it a nipple on a breast, a bottle, gloved hand, dog's nose.
It doesn't care.

I understand that she was concerned about the blood sugar dropping, BUT it had already gone up once. Our policy is just to check after 1 hour and if under 40 feed and call. It did go up to 42 after the initial nursing session. We normally wouldn't recheck it at all since it was above 40 after the intial feeding. I didn't mind giving the baby formula, I just wanted to at least be able to let her TRY to nurse first.