Breastfeeding questions

FutureNrse · Feb 17, 2005

Breastfeeding continues to provide immunological, emotional and physical benefits, well past a year. The average and normal age for human weaning is between 2 and 4 years. It also continues to provide benefits to mom, including lowering her risk of breast cancer.
http://www.lalecheleague.org/NB/NBextended.html this has a lot of good information about extended breastfeeding and why it is beneficial to continue it beyond a year.
Plus, keep in mind that nursing a child that age isn't at all like nursing a newborn, it's typically before/after naps/bed, depending on the child, and occasionally needed if the child is injured in some manner. But it's not their sole source of nutrition by far.
If only by looking at our teeth, it's clear we are supposed to be nursing for much longer than we do; we keep our milk teeth for quite some time. The reason we have stopped nursing so long in this country is because of our unnatural hangups about sex and breasts.

Sorry but I cannot agree with your thoughts on this matter. I'm sure that if you looked hard enough you could find some supposed expert who says it's okay to BF until the child graduates high school, but that would hardly make it the average or the norm. If we are taught that a baby should be weaned from a bottle at about 12 months, why should we treat BF differently? A bottle could be considered a comfort measure, but we don't give them past a certain age for a variety of good reasons. A child of three needs to learn ways of coping and comforting, that do not involve a bottle, breast, or pacifier.

FutureNrse · Feb 17, 2005

Years ago, moms who did not want to breastfeed (for all kinds of reasons) used wetnurses. Moms who had a baby close in age, maybe had lost their own child. The other feeding choices were very poor, gruel, sugar titties, cow or goat's milk if available.There was a high mortality rate.
I lost track of this thread.
For the most part, I don't believe in "nipple confusion". We have many moms who come in to feed their babies after discharge, the rest of the time they take a bottle. As long as they are fed, the babes don't seem to mind. We have premies who are tube, then bottle fed. They usually go to breast before they go home. Some moms just want to pump, and bottle feed, even at home. We don't cup or finger feed in our level II. The neonatologist doesn't feel it's appropriate. If a baby won't eat on pp, they have to cup feed (lactation gets upset if they don't, or document why not...."mom asked for a bottle") Why doesn't the baby want to suck? If I don't feel good, I don't want to eat, so why assume a baby will?
I wish that meth babies didn't go home with their moms. Too many of them do, and God knows what kind of life they have. If mom is high, who will feed them?
And then we have methadone babies. Of course they can breast feed, if mom so chooses. After all, most of the babies have to come of it cold turkey. Some of them are so bad that they have to be started on methadone, and weaned off before they can go home with mommy.
The joys of feeding babies.
I don't do much of that right now, I take care of ones who are too sick to eat, or have just started gavage feeds. I do like a nice chubby nine pounder, though, who's feeling good enough to eat, and then socialize and snuggle.

When I wrked in social services, I hated when I'd have to go to the hospital to pick up babies who were born with drugs in thier little systems. It was terrible and heartbreaking to see how they suffer. I'd have to take them to a crisis nursery or a special needs foster home, and just the short amount of time I spent with those babies still haunts me. But as much as I hated that, I would gladly do it every day of my life if it meant that they would not be going home with the mom who put the drugs into them.

FutureNrse · Feb 17, 2005

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Also wanted to add that my NICU doesn't do cup, spoon, or finger feedings. It's breast, bottle, NG, or nothing. In six years, 100% of the hyperbili re-admit babies I've seen have been exclusively breastfed. Either they're sleeping at the breast, or sucking like crazy and mom is producing only drops. Yes, colostrum is very nutritious, but we're talking hydration here, and many of the moms just don't understand that. When they do accept the fact that the baby needs fluids, many of the moms say they'd rather have an NG placed down their baby for feeds or poked for an IV for hydration. I just don't get this!!! Is the threat of nipple confusion or the horror of man-made formula so bad that they'd rather have their baby go through NG or IV placement than get a couple of bottles? It just hurts me to do this!!!

If the baby is on full IV fluids, then we'll allow breastfeeding if the bili is on its way down. If no IV, then only pumped milk is allowed so that we can keep track of fluids. In severe cases, we give formula instead of breastmilk because the docs say that breastmilk has bilirubin in it??? Overall, we try to keep SOME feedings going on since of course it only helps clear out that liver. Once the bili is low enough for the lights to be off, formula and IVs are DC'ed and exclusive breastfeeding can resume. Bili is checked a few more times before discharge.

Okay, said my bit. Tried to stay quiet, but I finally blew!!! JMHO, as always.

It shouldn't be the parents choice. A baby should never have to go through any painful procedure like that when there is a safer, easier alternative.

FutureNrse · Feb 17, 2005

And sadly, this is being given as a reason why a woman should not BF. Isn't this a reason why they should not be caring for an infant reguardless of the feeding method? Scary to imagine a drug addict taking a helpless infant home.
Tracy

Thank you! I thought that I was the only one sitting here thinking " Why is this an issue? Take that baby away from them!"

LilPeanut, MSN, RN, NP · Feb 17, 2005

I do know of a bipolar woman who was in contact with Dr. Hale and was similar to the case stevie dealt with - denying her BF because of the medication would potentially cause her to either not take the medication or increase her mental distress. He had spoken to her that if regular serum levels were taken of the infant and their levels remained low and they were without side effects, she could attempt breastfeeding. She decided later that she didn't want to put her child through the multitude of blood draws that it would require (which I think was a good choice in her case) But, there are options for people even in more extreme circumstances.

There's even been research to support exclusive nursing of HIV positive mothers, in African or other third world settings. Exclusive nursing is important though, because once a food other than breastmilk is introduced, it makes the child's gut vulnerable to the virus. They've found that if the child is never given anything but breastmilk, and then when introduction of foods is started, nursing stops, that there is no transmission of the virus. This seems to us to be a pretty nitpicky situation, but in places where there is not a clean water supply to mix the formula with, or when they cannot afford formula and dilute it to make it last longer, it is an important development. In 1st world countries, it is of course still discouraged, because there is safe and clean water and the ability for the mother to get formula supplies.

Hmmm, though it would be interesting to consider a case of an HIV+ mother who delivers a child with severe Cystic Fibrosis. CF patients have such a hard time digesting, nursing is heavily encouraged because of the immunological and nutritional benefits to the child. Sorry, what ifs intrigue me at times

fergus51 · Feb 17, 2005

What was scary for me and what I forgot to mention is the mom was going to go off her meds if she couldn't breastfeed so she could breastfeed. And that was what would have put her at risk.
steph

Oh yeah, we had that happen once which resulted in the mom going nuts in the unit one day.... Honestly I think it's cases like this where the societal pressure to breastfeed is harmful.

rainbows4me · Feb 17, 2005

I agree with your feelings on this. I think that 3 and a half is far to old to be breastfeeding. We don't condone giving a child a bottle at that age, or infant formula, so I don't understand continuing to BF so long. I have a 3 year old, who also plays soccer, so I know where you are coming from. He's no longer a baby, he's a little boy now. There is a natural order to things even if there aren't hard and fast rules, and if your child potty trains while still BFing, then you're doing things out of order.

I think you need to suspend your judgement... No one in this forum has judged you for your values on breastfeeding, so what's your point of judging these mothers? As far as what we 'condone' as a culture here in the US regarding breastfeeding, it seems to be less based on medical/biological facts and more based on our cultural linking of breasts with sex. In my life before NICU nursing I was a teacher - and one of the nicest, most thoughtful, well-adjusted highschool boy students (and popular to boot) I ever taught I later found out had been breastfed until the age of 5. He is a wonderful young man now from a beautiful family and is extremely successful in his chosen career. Since then I have met many people (now teen or adults) who were breastfed until 'older' ages (though it's not usually something they mention for fear of these kinds of judgements and attitudes) and not one of them has had any negative effects. I think this is more common than people think - but people don't talk about it because of the reactions of others.

Gompers, BSN, RN · Feb 17, 2005

It shouldn't be the parents choice. A baby should never have to go through any painful procedure like that when there is a safer, easier alternative.

I totally agree that when parents sign consent forms to treat their baby in the NICU, that we should be able to do whatever we need to help that baby - be it giving a bottle, formula, etc. But in this day and age, it's all about "the customer" and keeping them happy, so the docs usually DO give the parents a choice.

allnurses Guide · Feb 17, 2005

I totally agree that when parents sign consent forms to treat their baby in the NICU, that we should be able to do whatever we need to help that baby - be it giving a bottle, formula, etc. But in this day and age, it's all about "the customer" and keeping them happy, so the docs usually DO give the parents a choice.

I agree here too . .. putting a child through a painful procedure rather than feed them anything except breastmilk is ridiculous. It shouldn't be the parent's choice at that point, definitely.

I am really not a nut about breastfeeding. I truly have no problem with bottlefeeding if the mom really wants that. I just want people to have all the information and I'm glad to teach them. What they do after that has to be what THEY find comfortable, not me. As Deb says "It ain't about me". :)

steph

LilPeanut, MSN, RN, NP · Feb 18, 2005

It though is not always as cut and dry though. A parent might choose an IV over formula and you might think it's stupid, but you don't know what their familial allergy history is: maybe she has another child who is severely allergic to milk and/or soy, or she or her husband are. Depending on the age of the child, there's a concern with NEC, which is almost exclusively associated with formula. Enterobacter sakazakii is a known contaminant of powdered formulas and that is a real risk to some kids and if I had to choose between an IV and them potentially getting NEC, I'll choose the IV every day of the week.

That's why we give the parents the choice. What may seem like pointless fussing to you, is the entire world to the parents. This is their child and often times, they think think the sun rises and sets with the child and if they were not in the NICU, they would have choices in caring for their child but when in that environment, it's hard for them to even feel like a parent because the NICU nurses are doing everything for the baby and maybe looking down at you because they don't understand the full situation.

Personally, when my son was in the NICU with RDS and other preemieish issues, I had a nurse say to me "You know, next time you can get proper prenatal care and prevent this from happening" or something to that effect. Well, she can go F herself (I did report her to the nurse manager and had her removed from my child's care). Just because I looked young and sloppy, didn't mean that I was. I owned a home, had a college degree, had excellent prenatal care (which is why he was a 34w and not a 24w or dead) and spent four months on bedrest and medications to prevent his delivery. I just happen to look young and forgive me that after that much time on bedrest and having just given birth, I'm not a fashion plate.

I think NICU nurses need to be more understanding for the caring parents who are in there. Of course there are always some jerks, but there are also parents that are trying to do the best they can in a difficult situation and feeling like the nurse looks down on you wouldn't make it easier.

fergus51 · Feb 18, 2005

I think that's a valid point. Personally I don't think inserting an NG or an IV is that big of a deal if a parent wants to avoid bottle feeding formula. In most cases, an infant in our unit would have an IV inserted anyways, so that's a bit of a moot point. And I don't think one NG insertion that takes all of 15 seconds is so bad. We do a lot of procedures and lab work that isn't necessarily 100% necessary and don't think twice about it, so I don't mind an IV or NG.

Lilpeanut, that comment is shocking. SHOCKING! I am flabbergasted by that one.

LilPeanut, MSN, RN, NP · Feb 18, 2005

Believe me, so was I. Which is why I reported it immediately. On the whole, I had such wonderful NICU nurses and they are a large part of what has inspired me in my becoming a nurse. But it's amazing how those few bad things can stay with you. I got a lot of dirty looks when I was pg with my son. I looked about 16 I was told (I was 24) and since I was always on bedrest, I never bothered to get maternity clothes, I actually just wore scrubs usually. Plus, even when I wasn't hospitalized, I was supposed to only shower every 3-4 days to not be up too much (man did I look forward to those days ) But I'd come to my peri appt for a cervical length scan and afterwards, I'd be good and lay on the little couch by the door where my ride was picking me up. But with my messy hair, oversized clothes and my belly was never very prominent, I looked a bit like a homeless teenager, camping in a hospital. I will say I think I looked better after delivery. I was still preoccupied and not fitting into normal clothing, but at least I was allowed to take a shower before going to the NICU *LOL*

But I recognized, even then when it was only my 2nd day in the NICU with my son, that the nurse who treated me shabbily was by far the exception and not the rule of NICU nurses. They all remember my boy still, and it's been nearly 5 years and he was never critically ill. He was the little irish boy with the name bigger than he was (His name is Declan Thomas McMorrow O'C-----) *g*