Hi, my only experience is in med-surg nursing, so I was wondering if I could run a possible birth plan by you guys and get professional opinions on it. I kept it short and sweet because I know you guys don't have a lot of time to read an essay:) Also, do most hospitals put the erythromycin ointment in the babies eyes right away? I don't want to go as far as to refuse it, even though I know I'm std neg, but I did want to wait until after I had a chance to do my first feeding before it was applied. Anyway, here is what I have so far...
I would like to have the baby placed on my stomach/chest immediately after delivery.
I would prefer that the umbilical cord stop pulsating before it is cut.
I would like to hold the baby while I deliver the placenta and any tissue repairs are made.
I would like to hold the baby for fifteen minutes before he/she is weighed and measured. I would also prefer the evaluation of the baby be done with the baby on my abdomen.
I plan to breastfeed the baby and would like to begin nursing shortly after birth.
I do not wish to have any bottles given to my baby. If supplements are needed I would prefer syringe or finger feeding.
While I would like minimal interventions, the health of my baby (first) and I (second) are the priorities. Thank you for being here and helping us achieve these goals.
I have not ever seen a true case of nipple confusion. There is as much of a difference between a breast & a syringe as there is between a breast & a bottle. So many patients breast and bottle feed and it works fine.
That said, I do encourage breastfeeding before anything else, and have seen many many times over that having baby nurse for a good 20-30min will bring a blood sugar up in a normal newborn.
There are times, however, if blood sugar is *really* low (
I agree with this . . . and anecdotally . . . my youngest was jaundiced and they still were recommending a bottle 6 years ago for breastfeeding jaundice. I breastfed and bottle fed him for a few days. He breast fed until he was 3 1/2 years old.
I see a ton of our babies that learn to bottle feed and then do very well when put to the breast, once they are old enough to suck/swallow/breathe at the breast. No nipple confusion there.
To me, giving a syringe just doesn't seem natural. The natural instinct is to suck.
It will depend a lot on how your birth goes. My first was a very difficult birth with forcep delivery. After two hours of pushing by the time she was born she was in a little bit of stress, so the doctor cut the cord and they took her immediately to make sure she was fine. As soon as she was given back to me I attempted to breastfed but being a novice it was not easy.
My second baby was a breeze of a delivery. He was placed on my stomach immediately and then my husband cut the cord. As soon as they cleaned him up they put him in my arms and I nursed him right away. He had no problem latching on.
I think a lot of it will depend on your comfort level, the birth itself and the baby. My suggestion is to stay flexible and good luck!
I have not ever seen a true case of nipple confusion. There is as much of a difference between a breast & a syringe as there is between a breast & a bottle. So many patients breast and bottle feed and it works fine.
Maybe it depends on what circles you hang out in. :) I have met several people who have, usually at LLL meetings. Women often come in with their second child, wanting to learn how to have better success with breastfeeding when they had a failed first attempt. There are several factors that go into what people call "nipple confusion". The literal nipple of a bottle is very different from the nipple of a breast. It is narrower, so a baby who uses a bottle often learns not to open his mouth wide enough for the breast and finds he can no longer latch on to the breast well enough to get milk.
Also, milk basically pours out of a bottle. If you hold a bottle upside down, it drips. Breasts don't. This is significant because the baby learns it is easier to attain nutrition from a bottle, where they have to work at the breast. They begin refusing the breast as the muscles in their mouth do not develop the strength for true suckling. You may not notice in the hospital on the first day, but mothers often find that babies who started on a bottle too early end up completely weaned within a few weeks. This is why there is a recommendation not to start supplementing until the baby is at least a month old and breastfeeding is well established.
Another issue with introducing bottles automatically in place of breastfeeding is that it sets the example (often unnecessarily) to parents that this is a solution to breastfeeding problems. You may see it as a one-time thing: The baby is hypoglycemic and needs a bottle. But what the parents see is that even though they hear the phrase "breast is best", medical professionals give the example that bottle feeding is actually ideal whenever things aren't picture-perfect. So the parent witnesses bottle-feeding as a common tool (in some hospitals it is actually rare for a baby to leave without having supplemented in some way), and they go home with their package of freebies from the hospital that includes bottles, pacifiers, and free formula. Within a few weeks, somehow their baby has weaned and they just don't know where they went wrong with their breastfeeding efforts.
So back to the syringe issue - one more reason for using a syringe rather than a bottle is that it sends the parents (and medical professionals) a powerful subconscious message that this is a temporary solution to a medical problem, NOT a substitute feeding method to be used whenever breastfeeding appears to not work.
Right that proves my point about neonatal jaundice, CEG. There is increased incidences of polycythemia (an increase primarily of RBC) in those newborns with delayed cord clamping. Since most neonatal jaundice is physiologic in nature their systems can't handle the increased breakdown of those extra RBC ang get jaundiced.
Now are there benefits to delayed clamping, yes but because of the jaundice issue our doc don't like to do it. Will we if the parents ask, yes but that's not our doctors preference.
Your second article also says longitudinal studies are needed so long term benefits of delayed and immediate cord clamping have not yet been studied. Eh parent perference on this one.
You have to beware: at least 32 years ago, when I was in nursing school and pregnant, another student and I did a presentation on supporting breastfeeding moms AND bottle feeding moms. One of the LLL books we used as a reference, made this quote: "all bottle fed babies have had bottles propped during feedings." Just what do they base that bold statement and LIE on? I had already had one child, who was bottle fed, and she was held each and every time she ate. She didn't even know she could hold the bottle herself, as I always held it as I held her. My son, a bit more active, did hold his own bottle when able, but he was also always held. My kids never had a feeding unless they were held and snuggled and cooed to and bonded with. So it doesn't surprise me that a LLL meeting would have those in the audience who might have been brainwashed, just a little bit. JMHO. (and my own experience).
Also, milk basically pours out of a bottle. If you hold a bottle upside down, it drips. Breasts don't. This is significant because the baby learns it is easier to attain nutrition from a bottle, where they have to work at the breast. They begin refusing the breast as the muscles in their mouth do not develop the strength for true suckling. You may not notice in the hospital on the first day, but mothers often find that babies who started on a bottle too early end up completely weaned within a few weeks. This is why there is a recommendation not to start supplementing until the baby is at least a month old and breastfeeding is well established.
Another issue with introducing bottles automatically in place of breastfeeding is that it sets the example (often unnecessarily) to parents that this is a solution to breastfeeding problems. You may see it as a one-time thing: The baby is hypoglycemic and needs a bottle. But what the parents see is that even though they hear the phrase "breast is best", medical professionals give the example that bottle feeding is actually ideal whenever things aren't picture-perfect. So the parent witnesses bottle-feeding as a common tool (in some hospitals it is actually rare for a baby to leave without having supplemented in some way), and they go home with their package of freebies from the hospital that includes bottles, pacifiers, and free formula. Within a few weeks, somehow their baby has weaned and they just don't know where they went wrong with their breastfeeding efforts.
I understand that there is a difference between the nipple of a bottle and the nipple of a breast. I know that. I know that the flow is different. Nowhere did I say that I don't support breastfeeding. I breastfed my own son for 15mo and would have til he was 3-4yrs had he not decided he was done; he never ever got a bottle in the hospital or at home. I fully support breastfeeding. And I did say that if parent wants me to cup or syringe feed their baby, I will. As much as I don't like to do it, I cup/syringe feed hypoglycemic babies if they haven't been put to breast & they're in my nursery. (Hello, aspiration!)
I have never ever seen a healthy baby be unable to open his mouth wide enough to get a breast nipple into his mouth even if he's received a bottle at some point. I work with Hispanic mothers who breast and bottle feed their babies in the hospital, and then go on to do the same for well over a year. I know this because I used to work in a community health center doing well baby checks and moms breast & bottle fed til their kids could have cow's milk, and often beyond that. If Mom is choosing to breast and bottle feed, we always encourage them to breastfeed first, then if she wants to give baby a little formula, who am I to tell her she can't? This is her baby, not mine. If she wants to do it via SNS, I help her set it up & use it. Great!
It is against our hospital policy to supplement breastfed babies unless with an MD order or by mother's request. So please don't think I'm in the nursery sneaking breast babies a bottle. I'm not, I don't, and I wouldn't. It's not the right thing to do. And my hospital does not hand out pacifiers in our goodie bags. We do hand out formula, though I don't like that.
What I am saying is that, in a hypoglycemia situation where the baby has already nursed or for whatever reason Mom can't/won't nurse, I am much more comfortable giving a bottle. With a glucose-starved brain running on limited fuel, I do not like having to tax it (the brain) by asking it to figure out what to do with this cup or syringe. The most natural thing is to suck, and I feel better with a bottle in said situation.
We explain what we are doing and why. We explain that this is likely a one-time thing in a well baby. We explain the consequences of untreated hypoglycemia. If it were me and my baby, I would be willing to live with him getting a bottle for a glucose of 25.
If Mom is really dead set on no formula, we respect it and work around it, believe me. I just do not believe that formula is poison, and have heard some lactation consultants refer to it as such.
I own and have read multiple times The Womanly Art of Breastfeeding and think it is a wonderful resource. But I do think some folks can be a bit over the top in telling mothers that if you don't breastfeed your baby, you're a bad mother. That's wrong. You're a bad mother if you don't feed your baby at all, not if you choose to formula feed.
I know breast is best. I tell my patients that, and encourage breastfeeding if they want to at all. I just know that I have never ever seen a true nipple confusion case, and I do think I'm smart enough to know it if I ever DO see it.
I do not mean this to come across as a flame. I just happen to have pretty strong feelings about it and it bothers me immensely to see a breastfeeding baby who's hypoglycemic, jaundiced, dehydrated, and/or losing too much weight (or all of the above) whose parents have been told they're doing the wrong thing if they supplement with formula.
There is one more point I've never seen adequately explained. If breastfeeding does not sufficiently raise a baby's BS, and formula is allowed, how can one claim that bottle feeding is detrimental, but syringe feeding is safe? Babies swallow what they have sucked into their mouths. If one argues that bottles allow formula to flow too freely, not requiring sucking on the infant's part, then how can it possibly be safe to use a syringe to squirt liquid into the infant's mouth, requiring no sucking on the baby's part?
I have never cared for an infant in the NICU who aspirated liquid from a bottle. Can't say the same about a syringe.
right that proves my point about neonatal jaundice, ceg. there is increased incidences of polycythemia (an increase primarily of rbc) in those newborns with delayed cord clamping. since most neonatal jaundice is physiologic in nature their systems can't handle the increased breakdown of those extra rbc ang get jaundiced.
now are there benefits to delayed clamping, yes but because of the jaundice issue our doc don't like to do it. will we if the parents ask, yes but that's not our doctors preference.
your second article also says longitudinal studies are needed so long term benefits of delayed and immediate cord clamping have not yet been studied. eh parent perference on this one.
actually it says the polycythemia is benign and does not mention increased jaundice, only a decrease in anemia. polycthemia is the desired/normal condition in the newborn and is not pathological. the second article says further studies are needed because cochrane reviews always say that.
here is some info from who (http://www.who.int/reproductive-health/publications/msm_98_4/msm_98_4_chapter4.en.html) : "early cord clamping reduces the extent of placental transfusion to the baby and results in significantly lower haematocrit and haemoglobin levels in newborns.32,54,55,56 however, these differences diminish quickly over time and become negligible by 3 months of age. neonatal bilirubin levels are lower after early cord clamping but there is no significant difference in the incidence of jaundice"
i just did a pubmed search and there were no studies linking delayed cord clamping with jaundice that i could find so i would love any references you could give me so i could be better informed. and i could stop hijacking the thread;) thanks!
You have to beware: at least 32 years ago, when I was in nursing school and pregnant, another student and I did a presentation on supporting breastfeeding moms AND bottle feeding moms. One of the LLL books we used as a reference, made this quote: "all bottle fed babies have had bottles propped during feedings." Just what do they base that bold statement and LIE on? I had already had one child, who was bottle fed, and she was held each and every time she ate. She didn't even know she could hold the bottle herself, as I always held it as I held her. My son, a bit more active, did hold his own bottle when able, but he was also always held. My kids never had a feeding unless they were held and snuggled and cooed to and bonded with. So it doesn't surprise me that a LLL meeting would have those in the audience who might have been brainwashed, just a little bit. JMHO. (and my own experience).
I’m surprised no one has responded yet to this post, especially since it seems I was thought of as extreme!
LLL has been recognized as a worldwide authority on breastfeeding, not a shady organization intent on brainwashing naive women who happen to cross their path. I’ve never really encountered negativity toward them until this thread here. Even pediatricians have referred mothers to LLL for breastfeeding information and support, and some hospitals post information on local LLL meetings in each room in L&D. LLL is not an extreme group, it *is* the mainstream source of education on breastfeeding.
It really surprised me that women who have personally experienced nipple confusion are assumed to have been misled somehow. It’s rather insulting to imply that a personal experience didn’t happen, or that somehow a mother who believes she is experiencing one of the most common breastfeeding problems is uneducated or even lying. Babies do not automatically feed from any source. If breastfeeding is not established within the first few days (and many give it weeks), a baby will not latch on. You can't really start breastfeeding at any point if a baby isn't used to it, even for women who have not had issues with supply. Likewise, if a baby doesn't take a bottle within the first few weeks, they will refuse the bottle entirely. Mine wouldn't take one at 7 weeks old, and I have met people who have left their babies with a sitter for hours or even days (although that baby was 8 months old and on solids) because they believed if the baby was just hungry enough they would surely take a bottle. And no, not all of these people have been "brainwashed" by LLL. They are just real mothers with real experiences.
I agree with you that babies should be held during each feeding, especially since it promotes eye contact and physical touch. However, this still doesn’t mean it’s a “bold-faced lie” to claim all babies are encouraged to hold their own bottles. It would have been 26 years after you read this in LLL literature that an RN in our pediatrician’s office asked if my daughter was holding her own bottle. This was during an evaluation of developmental milestones. I innocently told her that she didn’t take a bottle since she was still breastfed. The nurse was so shocked she left the room to go speak with the doctor. Apparently this doctor assumed everyone supplements, and being able to hold a bottle in considered an important part of development. Anyhow, I don’t think it’s too far off to say that it is assumed and even encouraged that babies will be bottle-feeding themselves.
Anyhow, I don’t think it’s too far off to say that it is assumed and even encouraged that babies will be bottle-feeding themselves.
It is a shame that you assume that bottle feeding parents engage in behavior that is neglectful of their babies' safety and developmental needs. That is painting with a pretty broad brush.
Spidey's mom, ADN, BSN, RN
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