Finding the right words...

why can't they do both? If MD feels the baby is too fragile for breastfeeding/handling then the MD ought to tell the Mom and back it up the same way you would any action that was a patient risk. I know it is frustrating for people NOT to listen to you though.

lmc didn't mention how the triplets are latching, or how long they were kept in the hospital.. However, my take on the mpom's insistance is that her intention to breast feed totally, will evaporate once they're all home.

I've taught some couples who were expecting triplets and wanted lady partsl births. My job was to prepare them for the probable eventuality of a c/s.

Their birth plans were flexible after the c/s class when I show malpositioned fetae pictures. I stress the importance of setting priorities in life and most people agree that their goal with the highest priority is healthy babies. Having that agreed upon, I pose scenarios in which decisions need to be made that preserve health and prevent disease.

If anyone comes to me thinking they won't vaccinate their kids, they drop that when parenting is discussed. The priorities they set before are written in large letters for posting in the babies' room(s). When they see that breastfeeding comes after health, happiness, and achieving potential, they get a sense of what is really important. It's very important to let them know you expect them to make their own good decisions and leave yours out of it!

Some young expectant parents of multiples want to be unique, and may have a stubborn streak, thinking their energy knows no bounds, but usually the thought of having to do more than just feed, bathe, dress, hold their children and do laundry (at least 5-6 loads a day), and have frequernt doctors' office and hospital visits can be presented in a way that lets them appreciate how daunting that can be. Then they have to make whoever isn't sick, get less of their attention......:hpygrp:

So realism sets in and they can visualise realistically how each hour of their days will be spent. Their decisions change for the better, then.

If it's a patient safety issue, you get the doc involved and present a unified front. Situation in my unit recently where the family didn't want one of our neurotrauma patient's to get any kind of sedation. Needed to manage ICP to keep him from herniating so we explained that we want them involved in the plan of care but that was a decision that wasn't theirs to make.

I had a mom who let her baby scream for 15hrs straight because he wouldn't latch and she wanted to breastfeed only. I really wanted to run in there and shove a bottle in his mouth but I just sat at the desk (after pt education of course). Our pedis don't care if the baby doesnt eat for up to 24 hrs and blood sugars were ok, but still...... Eventually the baby latched on but I think making the kid wait 15 hrs after delivery for nourishment is cruel.

We have an interesting shift in our culture. In years past babies were kept NPOX 24 hours, then glucose water and if tolerated given formula. Evidence does support neonates in going at least 24 hours with no concerns. Now it seems that if the babies in my facilities do not latch well and nurse >30 minutes every 2-3 hours our peds have their panties in a wad.

As someone who has been on both sides of the coin I can tell you that a little formula can totally screw up breastfeeding and that it is entirely possible to exclusively breastfeed triplets. It might be helpful in those cases to insure that she has an IBCLC available to help her after discharge and a ped who is actually supportive of breastfeeding.

Lamazeteacher just as an aside there are facilities that do lady partsl births of triplets. Obviously conditions must be ideal but it is possible. Even triplets benefit from avoiding the risks associated with c-section.

I had a mom who let her baby scream for 15hrs straight because he wouldn't latch and she wanted to breastfeed only. I really wanted to run in there and shove a bottle in his mouth but I just sat at the desk (after pt education of course). Our pedis don't care if the baby doesnt eat for up to 24 hrs and blood sugars were ok, but still...... Eventually the baby latched on but I think making the kid wait 15 hrs after delivery for nourishment is cruel.

Was there a ban on a pacifier, too?

What did you do, for pt. ed?

Nothing allowed but breastfeeding for that baby. PT ed consisted of all the normal stuff, of the couple of nurses working we would take turns going in to assess mom and baby and see if she wanted a bottle, etc. But nope. It all ended ok though with baby finally latching on. It was just gut wrenching for me having to listen to the poor little guy cry for hours.

P.S. parents are going to do what they want to do with their kid. Sometimes there is nothing you can say or do to educate them regardless of their decision. I just know what my own opinions are and keep it to myself. And if the baby ends up in the NICU because they won't feed it and sugars are dropping then so be it.

Do you have a lactation consultant on the floor? Many women CAN successfully breastfeed trips with the right support and eduction. Were they rooming in? Nursing on demand?

I totally agree with PP - a little formula CAN totally disrupt supply and sabotage a breastfeeding relationship.

In the case that BS does get low and there is an obvious need for supplementation what about having the mom pump and than feeding that milk to the babe via an SNS http://www.medelabreastfeedingus.com/products/breastfeeding-devices/51/supplemental-nursing-system-sns

That way all feedings are done at the breast and with breastmilk. In extreme cases formula can even be added to the SNS without having to introduce a rubber nipple and cause nipple confusion.

nothing allowed but breastfeeding for that baby. pt ed consisted of all the normal stuff. (what is the normal stuff?) of the couple of nurses working we would take turns going in to assess mom (that is contrary to continuity of care, and by your aversion to the baby's crying, it seems that you were taking care of your need to get away from that, rather than giving priority to your patients' needs)and baby and see if she wanted a bottle, etc. but nope. i'm sorry that you chose to be oppositional to the parents' plan. instead of offering a bottle, you might have supported their goal, taught them how to swaddle their baby effectively, have dad walk around the room with him, sing to him, and cry with him. i have never seen or known of a healthy newborn crying continually for 15 hours. methinks you exaggerate.

it all ended ok though with baby finally latching on. it was just gut wrenching for me having to listen to the poor little guy cry for hours.

that's usually the way it happens. need produces the desired action, especially if no alternative to the breast is offered. you need to read more about the things that could compromise newborns. i think you'll find that they're hardier than you think.

it's really hard for most new parents to do what they've planned, when nurses and possibly even their doctor disagree. that couple must have heard that others acquiesced to your urging bottles on them and their babies. that information spreads in communities, and i have a feeling that couple girded themselves against what you do.

at most big hospitals' ob departments, nurses get less upset by crying babies. they swaddle them well, and support their parents' decisions about breastfeeding.

I am ALL For SNS as said earlier. It's awesome for babies with blood sugar problems, poor latch, etc. And you need an LC on cases like this ASAP

i am all for sns as said earlier. it's awesome for babies with blood sugar problems, poor latch, etc. and you need an lc on cases like this asap

the article below, taken from emedicine indicates the excess amount of fluid (mostly extracellular- ecf), which explains why neonates can go without getting fluid the first day or so of life. when they commence breastfeeding, the fluid intake is much less than they would get if bottle feeding, yet they lose about the same amount of weight by the end of their first week.

it seems too, that they maintain adequate electrolyte balance without receiving additional supplementation, during their first 24 hours. if their bs decreases, there is no cause for concern for that period of time either, unless complications have occurred.

those care providers who prefer accurate measurement of intake, and believe that breastfeeding is inadequate at first, have no justification for that viewpoint, from a chemical standpoint. newborns suffer from the change in their environment following their birth, some more than others, which is why swaddling, cuddling, and continued motion to replace the swaying sensation which was probably soothing in utero, can relieve some of the separation anxiety they can experience.

so please back off if you're a nurse who wants breastfed babies to take formula, as the problems encountered when babies start off with formula feedings, of nipple confusion, preferring the sensation of a full stomach that formula gives them (more volume of that is required to provide nutrition than the small amount of perfect fluid provided by their mothers' breast. that clears meconium effectively from the intestines, has many known and unknown superior nutritional qualities, and causes less elimination of waste.

pushing formula can become quite a power struggle, which is the last thing new mothers need!

the neonates' unique ability to endure less fluid intake safely, allows time for the establishment of breast milk.

fluid and electrolyte principles

• principles of fluid and electrolyte balancing
  
  • total body water (tbw) equals intracellular fluid (icf) plus extracellular fluid (ecf).
    
  • ecf equals intravascular fluid (plasma and lymph in the vessels) plus interstitial fluid (between cells).
    

  [*]body water composition and changes with gestational and postnatal age

  • adult bodies are 60% water (20% ecf, 40% icf).
    
  • neonates are born with an excess of tbw, primarily ecf. they normally lose this excess ecf in the first postnatal week.
    
  • term neonate bodies are 75% water (40% ecf, 35% icf), and term neonates usually lose 5-10% of their weight in the first week of life, almost all of which is water loss.
    
  • preterm neonates have more water (at 23 weeks' gestation, 90% water composed of 60% ecf and 30% icf), and they may lose 10-15% of their weight in the first week of life. small for gestational age (sga) preterm infants may have a higher proportional body water content (90% for sga infants vs 84% for appropriate for gestational age
    

  [*]electrolyte requirements

  • for the first 24 hours, supplemental sodium, potassium, and chloride are not usually required.