I'm a relatively new postpartum nurse, and I've experienced this situation a few times over the past several months. A few weeks ago, I had a patient that really made me think. Ethically, if a mom says she wants to breastfeed exclusively, should I suggest bottle feeding if the nursing isn't going well? This situation was rather extreme. I don't want to undermine anyone's breastfeeding, but I also want to make sure that the baby is getting adequate nutrition.
My pt, a first time mom, wanted to breastfeed her baby. (I personally don't care if a mom wants to breast or bottle, after all the baby is hers. I just care that the baby is being fed an appropriate amount of an appropriate substance.) I was trying helping her position the baby and get her latched on. Although she said that she wanted to breastfeed and stated that she wanted no bottles for any reason, when it actually came to feeding the baby, the problems began. She sat in the bed with her arms at her sides with the baby on the boppy in front of her. I positioned the baby in her arms, and when I told her to hold her breast and rub her nipple across the baby's lips, she sort of leaned forward and shrugged her shoulder. I tried and tried to work with this new mother, I talked with her about the baby's nutritional needs, but ultimately, I can't hold her baby and her breast, and breastfeed for her. I tried very hard to be patient and understanding, but I still found the situation frustrating. Every nursing session was like this. Each time, the mother would sit with her arms at her sides. I tried to find a nice way to tell her that she need to participate; the baby can't do this by herself. I hope that I succeeded in being nice, I had the baby's best interest at heart. It was especially important to me that this little girl eat because the mother was GDM. Over four days, lactation saw her twice, and once the baby's lost 10% of birthweight, the peds ordered the parents to supplement. I just wonder if I should have encouraged supplementing sooner.
How do you handle this type of situation? If a mom wants to breastfeed, I want to do all I can to help be successful, but in situations like the one above, I also want to make sure the baby is getting enough calories. I also feel that it's part of my job teach parents the basics so they know how to take care of the baby once they get home (and when to ask for help.)
I think a lot of first-time moms don't realize there is going to be a steep learning curve for both her and baby. I know I kind of assumed knowing how to breastfeed was something that magically occurred once the cord was cut . I had no clue.
Nurses definitely make an impact, though. The nurse I had with my first baby was very hands-off. When I called and asked for help (this was twenty years ago) she pretty much just told me to put her on and let her suck--this from the doorway. When I said that wasn't working she said nursing just might not work for me. The baby was bottlefed from that point on. I felt like a failure.
With my second one, I just soldiered through and nursing was lovely.
I think you did a good job in encouraging mom. One idea is to try different positions. I always liked side-lying better at first. I didn't have to coordinate my arms and the baby and it kept at least one hand free to help position. I didn't get tired from sitting and if either the baby or I fell asleep, all was good.
I work in a Level 2 nursery. I am very pro-breastfeeding and definitely support working hard to establish breastfeeding prior to offering bottles when possible and practical. However, I also see just a little too often what can happen if we forget to be practical. We get kids who are admitted from mom/baby because they are 4 days old and completely dehydrated and need IV fluids. Either mom's milk is not in or the baby isn't latching and feeding well. Mom has been refusing bottles/formula all the way along because it's "not natural" but they are ok with their baby having an IV (very natural). And then working on breastfeeding is that much more difficult because mom and baby are separated, and mom has to come to the unit to breastfeed. Discharge gets delayed because we can't titrate the IV rates down until the baby is taking something orally. Or maybe it's the hypoglycemic IDM whose mother is resisting supplementation, so we get the kid and have to put in an IV. Our unit doesn't allow finger feeding (don't ask me why), so if mom will consent to formula but not bottles, the lucky kid gets an NG tube for feeds. Practical logic would suggest considering bottle supplementing before IV fluids, and I'm not sure why our docs aren't more forceful about supplementation when they see a kid heading down one of these roads.
My other breastfeeding frustration stems from mom-baby separation. It is not at all unusual for me to have a term or near term (35-36 weeks) baby who is basically healthy but needing level 2 care for some reason. Mom will say that she is exclusively breastfeeding, no pacifiers or bottles, but is planning on sleeping through the night and will not come up to the unit to breastfeed their baby. Thus, baby spends the night shift very hungry. If I were a mom, I think I would want honesty from my baby's nurse, so if I call a mom for a feeding in the middle of the night and she says she'd rather just sleep, I don't hesitate to tell her that her baby is frantic or has been awake for 6 hours straight or is inconsolable. And yet, mom still sticks to her guns. I really do understand that they are exhausted, but if you are exclusively breastfeeding, you are exclusively breastfeeding. Especially in the first few days as you're trying to establish a supply. That baby is hungry, and your milk is going to take it's sweet time coming in if you're not putting the baby to breast. Meanwhile, the baby is miserable, and so are the babys in earshot. I've tried all different approaches--education about breastfeeding establishment, baby's need for oral activity/contact with mom, honesty about baby being miserable, commiseration about being exhausted, etc etc etc, but some of these moms just don't care. I just find it hard because I want to support their commitment to breastfeeding, but yet...
I'm a relatively new postpartum nurse, and I've experienced this situation a few times over the past several months. A few weeks ago, I had a patient that really made me think. Ethically, if a mom says she wants to breastfeed exclusively, should I suggest bottle feeding if the nursing isn't going well? This situation was rather extreme. I don't want to undermine anyone's breastfeeding, but I also want to make sure that the baby is getting adequate nutrition.
My pt, a first time mom, wanted to breastfeed her baby. (I personally don't care if a mom wants to breast or bottle, after all the baby is hers. I just care that the baby is being fed an appropriate amount of an appropriate substance.) I was trying helping her position the baby and get her latched on. Although she said that she wanted to breastfeed and stated that she wanted no bottles for any reason, when it actually came to feeding the baby, the problems began. She sat in the bed with her arms at her sides with the baby on the boppy in front of her. I positioned the baby in her arms, and when I told her to hold her breast and rub her nipple across the baby's lips, she sort of leaned forward and shrugged her shoulder. I tried and tried to work with this new mother, I talked with her about the baby's nutritional needs, but ultimately, I can't hold her baby and her breast, and breastfeed for her. I tried very hard to be patient and understanding, but I still found the situation frustrating. Every nursing session was like this. Each time, the mother would sit with her arms at her sides. I tried to find a nice way to tell her that she need to participate; the baby can't do this by herself. I hope that I succeeded in being nice, I had the baby's best interest at heart. It was especially important to me that this little girl eat because the mother was GDM. Over four days, lactation saw her twice, and once the baby's lost 10% of birthweight, the peds ordered the parents to supplement. I just wonder if I should have encouraged supplementing sooner.
How do you handle this type of situation? If a mom wants to breastfeed, I want to do all I can to help be successful, but in situations like the one above, I also want to make sure the baby is getting enough calories. I also feel that it's part of my job teach parents the basics so they know how to take care of the baby once they get home (and when to ask for help.)
Sorry this is so long, and thanks for any advice.
Rhee
One thing to consider is that particularly for a first time mom, breastfeeding can be a little intimidating. She may have been embarrassed about having her breasts hanging out, someone touching them, and unsure of what to do, so that transferred to letting you do everything.
When my first child was born I wanted to start breastfeeding but i wasn't sure if I was "allowed" to right then or how to start. After a few minutes the nurse said (and quite snottily I think) "I thought you wanted to breastfeed." In her mind I was probably an idiot who didn't really want to breastfeed, but in my mind I was really unsure and didn't want to just whip my shirt off if it was not what they considered the proper time to start breastfeeding.
My other breastfeeding frustration stems from mom-baby separation. It is not at all unusual for me to have a term or near term (35-36 weeks) baby who is basically healthy but needing level 2 care for some reason. Mom will say that she is exclusively breastfeeding, no pacifiers or bottles, but is planning on sleeping through the night and will not come up to the unit to breastfeed their baby. Thus, baby spends the night shift very hungry. If I were a mom, I think I would want honesty from my baby's nurse, so if I call a mom for a feeding in the middle of the night and she says she'd rather just sleep, I don't hesitate to tell her that her baby is frantic or has been awake for 6 hours straight or is inconsolable. And yet, mom still sticks to her guns. I really do understand that they are exhausted, but if you are exclusively breastfeeding, you are exclusively breastfeeding. Especially in the first few days as you're trying to establish a supply. That baby is hungry, and your milk is going to take it's sweet time coming in if you're not putting the baby to breast. Meanwhile, the baby is miserable, and so are the babys in earshot. I've tried all different approaches--education about breastfeeding establishment, baby's need for oral activity/contact with mom, honesty about baby being miserable, commiseration about being exhausted, etc etc etc, but some of these moms just don't care. I just find it hard because I want to support their commitment to breastfeeding, but yet...
When I worked in NICU and this sort of situation arose, the Neo or the NNP would step in and talk to the mother. Our NICU was also very pro-breastfeeding but we were also strong patient advocates for the baby. The neo would usually tell mom that if she will not allow bottles or even paci's then she needs to come and comfort her baby. Her baby is experiencing discomfort and we simply can't ignore this until after mom has had a good night's sleep and breakfast and shower, etc...I am all for breastfeeding and making reasonable accommodations for it in the NICU, but accommodating breastfeeding is a team effort and mom is a big part of that team and she needs to understand this.
My other breastfeeding frustration stems from mom-baby separation. It is not at all unusual for me to have a term or near term (35-36 weeks) baby who is basically healthy but needing level 2 care for some reason. Mom will say that she is exclusively breastfeeding, no pacifiers or bottles, but is planning on sleeping through the night and will not come up to the unit to breastfeed their baby. Thus, baby spends the night shift very hungry.
Where I am, if a breastfeeding mom does not plan on feeding her baby through the night, we ask point-blank how she would like the baby to eat because that baby WILL be eating. We can feed with a cup or syringe (not my favorite things, but I will do them), or we can give a bottle, it's her choice. But if she does not plan on having her breast available when baby is hungry, we can and will supplement.
I've tried all different approaches--education about breastfeeding establishment, baby's need for oral activity/contact with mom, honesty about baby being miserable, commiseration about being exhausted, etc etc etc, but some of these moms just don't care. I just find it hard because I want to support their commitment to breastfeeding, but yet...
hikernurse
1,302 Posts
I think a lot of first-time moms don't realize there is going to be a steep learning curve for both her and baby. I know I kind of assumed knowing how to breastfeed was something that magically occurred once the cord was cut
. I had no clue.
Nurses definitely make an impact, though. The nurse I had with my first baby was very hands-off. When I called and asked for help (this was twenty years ago) she pretty much just told me to put her on and let her suck--this from the doorway. When I said that wasn't working she said nursing just might not work for me. The baby was bottlefed from that point on. I felt like a failure.
With my second one, I just soldiered through and nursing was lovely.
I think you did a good job in encouraging mom. One idea is to try different positions. I always liked side-lying better at first. I didn't have to coordinate my arms and the baby and it kept at least one hand free to help position. I didn't get tired from sitting and if either the baby or I fell asleep, all was good.