I have been a nurse for 7 years now and still feel like I have not found the right words to tell a new mom that breastfeeding is not her baby/babies best option right now (after multiple attempts and initiating pumping of course). I have been presented with this situation numerous times over the past few weeks and am hoping you all have some suggestions. The most recent situation was new mom G1 of 35 week triplets ranged from 4lb 6oz- 4lb 11oz. It goes pretty much like this...mom declares she wants to solely breastfeed her little 35 weekers, blood sugars are decent in the 50's, but they are only 4 hours old and you know that if these kiddos don't get formula the sugars don't take long to plummet. Doesn't seem to matter how much I explain to them about preemies, blood sugar, brown fat, the brain needing glucose, dehydration, jaundice, multiples, etc, etc. They just don't get it!
I know that 9 times out of 10 they do allow formula once the sugars do drop (a few refuse and prefer baby goes to NICU for IV fluids rather than have a drop of formula hit their baby's mouth), but I feel like it is my nursing responsibility to prevent it from getting to that!!!!!!!!! I mean we know from doing this every day that with the little ones (and the big ones once they are a few days older) a little formula can go a long way.
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.
I don't know that we need to be quite so hard on the OP for her concern. For heaven's sake, these are 4.5-lb 35-weekers she's talking about. Those kids by rights don't even have to know how to latch and suck. And yeah, getting a 35-weeker with a tiny mouth to suck is a LOT harder than it is to get a FT 7lber to do the same. SNS is great, but the kid has to be able to latch and suck. If they can, great. If not, and sugar is low, then something has to give.
For term kids with more brown fat, liver glycogen stores, and water weight, I don't worry about blood sugars quite so much - but for late pretermers with less of all the above? Heck yeah I worry.
I don't know that we need to be quite so hard on the OP for her concern. For heaven's sake, these are 4.5-lb 35-weekers she's talking about. Those kids by rights don't even have to know how to latch and suck. And yeah, getting a 35-weeker with a tiny mouth to suck is a LOT harder than it is to get a FT 7lber to do the same. SNS is great, but the kid has to be able to latch and suck. If they can, great. If not, and sugar is low, then something has to give.
For term kids with more brown fat, liver glycogen stores, and water weight, I don't worry about blood sugars quite so much - but for late pretermers with less of all the above? Heck yeah I worry.
Sorry, I was off the original example given by the OP; and didn't indicate that my post was actually a followup on the post of RNBelle, who was miffed because she couldn't get her patient to give bottled formula to her crying fullterm baby that she wanted to exclusively breastfeed. There seems to have been a concerted effort to use formula in that situation, by getting the patient's doctor to speak to her; and no other alternate soothing seemed to have been taught. The baby was a "crier" who didn't latch for his first 16 hours of life. Once he achieved a proper latch, there were no firther problems, the poster said.
I agree that preterm triplets definitely need some supplemental feeds at first, by SNS! I didn't include the whole resource that was cited by the OP, which contained nutritional and electrolyte requirements for premies, as I wasn't thinking of that example.
The words needed, which had been the topic of this thread, that I would have used, would have been those saying that we all want what's best for these babies, to get on a common level of concern. Then I'd explain how they'd received 1/3 of the nutrition that one baby normally would get, during their gestation. Then I'd discuss birth weight nutritional requirements of neonates, check to see if we were on the same page of thought, and ask her (in a concerned, not mocking tone) how she thought their needs could be met. Following that, problem solving and a plan for feeding these tiny beings could be established, with cards in their isolaettes that described who was getting what, and when and by whom.
While hearing my baby cry breaks my heart and makes me do whatever it takes to give them what they want (/need), every breastfeeding pamphlet, article or book I ever read said that if you want to nurse and baby doesn't get it right away, giving a bottle is not the answer. We all know baby won't starve if they don't eat right away...and breastfeeding takes a lot more effort from baby than bottle. If they learn first from a bottle, it will be harder to get them to take the breast. These days, breastfeeding is pushed as what's best for baby and what a good mother would do. To women who have planned for nine months (or their whole lives) to breastfeed, just a taste of formula is a failure! My first baby didn't cry when she was born. They tried to suction the fluid from her lungs, but I don't know if the nurse was new (or dumb) but she was saying things like "I need help...", "I don't know..." and no one wanted to help her. Therefore, there was still fluid in her lungs and a doctor decided she had pneumonia and she went to the NICU for a week. I'm all for precaution when it comes to my baby, but while there I wasn't allowed to nurse her at first. She wasn't weak, or small (8lbs 14oz!), but they have their reasons. A couple days later, when I was allowed to nurse her, I got this nurse that would FORCE me to "top her off" with a bottle of formula, even though she had just nursed 20 minutes on each side. I HATED HER! (She also didn't want me to hold her too much, she would say "you're going to spoil her and she's gonna wake up and want to be held", so I told her I was taking her home soon and that was alright with me. Her response "You're not here 24 hours and when she wakes up she's just gonna lay there and cry") Well, she didn't suffer from "nipple confusion", and she's perfectly health (despite the evil formula!), but my second has never had a drop of formula and she also is healthy. So unless the baby's in danger... I think we all know the saying "Mother knows best!"
Ok, that last response was meant for the people talking about the crying babies. I forgot the original question was about tiny triplets! Solely breastfeeding? In the words of my two year old, "Her's CRAZY!"
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I would prefer SNS over sticking a pacifier or bottle in a baby's mouth to quiet him or her because they are hungry. It really works! But I also agree never to guilt parents one way or the other. The damage done is greater than we know I believe.
I would prefer SNS over sticking a pacifier or bottle in a baby's mouth to quiet him or her because they are hungry. It really works! But I also agree never to guilt parents one way or the other. The damage done is greater than we know I believe.
While I'm not in favor of bottle feeding formula to babies whose mothers intend to breastfeed them, I haven't seen nipple confusion when pacifiers are offered, possibly because no satisfaction of hunger occurs with the pacifier, and newborns seem to realize the difference. It's my belief that more good happens, in that crying stops, which has to have been hard on babies' nerves as well as others; and there is relief of tension when a pacifier is used (and the baby will accept it willingly when it is offered gently and frequently).
The problem with formula, is that there is no duplication of "after milk" which has a soporific effect for newborn babies who may be very tense due to the atmospheric changes they've had to endure. I don't know what earlier experiences mothers have had with rejection/accusation, so it's hard to say what psychological deficits could be exaccerbated by opinionated nurses who criticise new moms as relentlessly as an earlier post indicated.
When babies reject/refuse to nurse, many formerly self confident moms thinks they themselves have been rejected; and that sets up a distinct pathological psychologic reaction for those who weren't self confident before
having their baby. Unless that is handled sensitively by nurses, it can go on for a long time........
I think, too that babies need to express their needs and have them accepted (as best we can). Of course their immaturity can result in the I want it, I don't want it, at the same time reactions. We've all seen the frustration that causes in older babies/toddlers.
With a longer, more firm artificial nipple stuck far into their mouths, babies have little personal choice about what they should do with it. I think the human nipple was made the way it is, for a reason.......
My last child, who is 8, was given formula initially due to the old breastfeeding jaundice myth . .. but he never got nipple confusion. I had a cesarean and breastfed as soon as I was out of recovery. The nurses started giving him formula on the 3rd day due to the jaundice.
He breastfed until he was 3 1/2. :sofahider
As to the OP's concern with the premies - I agree with Deb's and other comments.
It is hard to teach when parents feet are sunk in the concrete thinking of any kind of birth plan. Thank God for Lactation Consultants! They have more patience then I have.
:sofahider
lamazeteacher
2,170 Posts
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
[*]body water composition and changes with gestational and postnatal age
[*]electrolyte requirements