So I had this lovely little guy, about 3700 grams, term, some meconium staining at birth, otherwise completely boring pregnancy and lady partsl delivery. He had some low blood sugars (which we call chemstrips or chems where I work), so they followed their protocal (the chem was still like in the 40's) and put the baby to breast and rechecked, well, turns out the average woman cannot really produce enough milk at hours after birth to raise that kind of blood sugar (sarcasm intended). So they followed their protocol and gave him formula, by cup, because we don't want nipple confusion. Problem is you can only really cup feed so much so he was getting about 20-30mls per feed.
I can understand this if it's like a one time event and gets the kid over the hump, but he had recurring low chems and when he finally dipped under 35 he bought himself a gavage feed and an admission to NICU. Of course we NICU folks aren't quite as concerned about nipple confusion as we are about say; brain damage so we proceeded to bottle feed the kid. So his lowest blood sugar during his entire admission was 63. He wolfs down 60-90 mls of either formula or breastmilk (turns out his mom's milk came in pretty early and abundant). We have had several admissions to our unit that could have been prevented had our General Nursery been permitted to use a bottle (cup feeding only used for babies that moms state want to breastfeed).
So to prevent the threat of nipple confusion this kid had to spend hours separated from his mother until we established that his blood sugars were stable whereupon we started having her breastfeed followed by a pc bottle. He will be going home a day late due to this silliness.
I am so frustrated with cup feeding !!!!!! We are getting frequent admissions of kids who develop tachypnea or resp distress after cup feeding (can you say aspiration?). I know I've ranted about this before, but here I go again.
Those big low sugar babies that are starving but can't quite figure out the cup, because they are that hungry it just goes everywhere as they swing thier head from side to side, rooting. bit like a withdrawer. The kid is screaming all night cos he is so hungry.
I don't agree with it but I've done it in the past.
I love it when they cup feed really well though, it's the best feeling.
Remember all the getting up 3-4x/night to pee the past few weeks? That was training for feeding the baby 24/7.
We do allow ONE family member to stay and "help". How helpful they are is quite variable.
I do tell people the bit about getting up at night being prep for being a parent.
I have a hard time even documenting that there is familial support when Dad (or whoever) is sawing logs over on the pullout bed while Mom is sitting with bags under her eyes with a screaming baby. I call that "helping!" I know what you mean, prmenrs.
Specializes in Newborn ICU, Trauma ICU, Burn ICU, Peds.
Calling it "nipple confusion" is just plain wrong. I haven't seen nipple confusion yet, and I've been at it for about 15 years. What I do see is babies who get used to the easy flow of the bottle and don't want to work at the breast. But they usually do fine after about a week or two of diligent work. We are shifting to the idea of first feeds for our preemies being breastfeeds (if mom is going to breastfeed, that is ) so that they can get used to the work and flow, and to help mom's milk come in or help her supply stay up.
Cup feeding always seemed ridiculous to me.
To answer the question about calories per ounce for breastmilk, I just learned tonight that the average is actually 21/oz and can be easily up to 27/oz. You can actually spin it and increase calories as need be without having to add fortifier.
Specializes in Newborn ICU, Trauma ICU, Burn ICU, Peds.
Apparently our LC's are trying to bring in milk engineering where spinning for caloric content/fat content will be commonplace.
We are building a new hospital due to open in 2011 and they are hoping for a milk bank and engineering facilities to be in it.
They have done some teaching with regard to "hind" and "fore" milk, but that seems to have gone by the wayside for now unless a mom is really into it, then they are of course supported.
The latest thing is trying to get the neo's on board with not bottlefeeding the babies first who are going to be breastfed. The desire is to give them a few days of working with the breast and get used to it, then introduce the bottle. It was emphasized that this was NOT because of "nipple confusion" but as a way to help mom's with supply and babies with getting stronger on the breast earlier.
When the baby is ~ 4wks old, a mom who has been successfully pumping tons o'milk often says, "I'm not getting as much as I used to". Their supply seems to suddenly drop off. Not sure why. Probably some breastfeeding guru knows. But it happens.
Unfortunately, if she's had a premie who's in no way ready to eat, it's hard to get the suckling she needs to get going again. If she's able to kangaroo, or if baby can "non-nutritive" suckle (pump first!!), if does help.
If not, it takes some work to get her started again.
Maybe mom has started birth control and that's why she's not getting as much milk??? Just a thought. Our OBs will often write for BFing/pumping moms to get Depo (or other hormonal birth control) before they leave the hospital or at 4 weeks postpartum. They will tell you there's no scientific evidence to support the statement that it decreases milk supply but there is a ton of anecdotal evidence. Lactation consultants where I am usually counsel mom to wait at least 6 weeks before starting the Pill or Depo or anything to get a good supply established.
I know I waited 6 weeks to start the progesterone-only pills after DS was born (term baby, great BFer) and almost immediately noticed a decrease in supply. Before, I was overflowing, so it wasn't necessarily a problem for me (plus I had a baby who was a great nurser to build the supply back up).
I'm sure there is someone out there who knows way more than me. These are just my $.02. If anyone knows anything else about this, I too would like to know!!
I'm not to sure about that. I've always thought it was because the moms were only able to pump, not actually nurse their babies (too sick &/or immature).
I do believe the fact that they're only pumping does make a difference too. I was just thinking maybe there was something else not helping there. I know when I pumped for my son I never pumped enough but when he nursed he seemed to be perfectly satisfied. I took Reglan & it did help but only if I pumped more frequently.
Also fenugreek is supposed to increase milk supply, some say by twice as much. Maybe that is one of the components of mother's milk tea.
wensday, MSN, RN, APN, NP
125 Posts
On nights there is a term used 'Magic Cup-feed'.
It's a bottle.
Those big low sugar babies that are starving but can't quite figure out the cup, because they are that hungry it just goes everywhere as they swing thier head from side to side, rooting. bit like a withdrawer. The kid is screaming all night cos he is so hungry.
I don't agree with it but I've done it in the past.
I love it when they cup feed really well though, it's the best feeling.