Is immediate, undisrupted breastfeeding needed for long term success?

dansamy · Sep 28, 2009

After my own experience BF'ing 3 preemies, who were gavage-fed and then nipple-fed using those REALLY soft preemie nipples, I'd say that yes nipple confusion is a factor, but if you are committed, a baby who has learned to feed from a bottle is still perfectly capable of learning to nurse from the breast. Just be prepared for it to take a LOT of time and patience.

L&DbutterflyRN · Sep 28, 2009

I believe that Mother's do have to be commited to breastfeed. I find it alot that they say they want to when they really don't. They just dont want to be judged by people that she didnt even try and she is being a "bad mom." Im am a nurse that is an avocate for what ever the mom wants when it comes feeding and not push either way.

I do believe that some babies have difficulities with nipple confusion. If a mom is really wanting to breastfeeding I think it is important to start establishing breastfeeding right after delivery, if the baby and mom is stable of course. We have protocol to start BF and skin to skin as soon as possible. And we are all told that the more you BF the more the milk supply increases.

Meriwhen, ASN, BSN, MSN, RN · Sep 28, 2009

Is this for real? Have you seen this work out? If a woman is having difficulty initiating BFing in hospital, does it really all fall together after her milk comes in- even if baby has been getting multiple bottles a day? I have truly never heard of it "all working out", just the opposite. More often, I've met women who struggled and gave up when supplementing began so early.

It takes committment on the part of the mother for BF to work. It doesn't magically work itself out once mom's milk comes in; otherwise we'd have a lot more successfully BF moms out there :)

BF is a supply and demand matter, the key point being that there has to be a demand before there's an increase in supply. If the kid needs more milk, he'll nurse longer/more--and in a couple of days, mom's production will have increased to match. The problem is that if the baby is receiving many bottles of formula a day, he's going to be full and have no motivation to suckle on mom. If baby's drinking formula, baby is full and nurses less, mom's body produces less milk in response, when baby does finally nurse there's not as much milk there and baby ends up getting formula because he's still hungry; then baby is full and nurses less, mom produces less...and so on until the kid is weaned.

Now, the kid's health is priority: if it's a choice between the baby getting dehydrated and giving the kid a bottle, give the bottle! But either way, mom should have the baby on her breast as much as possible to increase the chances of success. Neonates don't need to be on a set feeding schedule at their age--it should be on demand.

And regarding "nipple confusion"...don't forget pacifiers are just as bad as bottles. They do have special ones that supposedly mimic mom's nipple shape and minimize confusion...but again, if baby's getting all of his sucking needs met with a pacifier, he won't want to be on mom's breast as much.

Elvish, BSN, DNP, RN, NP · Sep 28, 2009

While I agree with all the above, there are cultures that believe that colustrum is harmful to the baby and will bottlefeed in the hospital, and go home to breastfeed beautifully. Whether it's because breastfeeding is also accepted as the norm in those cultures and Mom's kind of expected to do it (and thus gets a lot of support) or it's that other factors are involved, I'm not sure.

cloister · Sep 28, 2009

I'm not an L&D nurse, butI successfully breastfed three strapping sons, so I'll weigh in with my two cents.

Baby #1 wasn't interested in eating (or breathing....or doing much of anything, frankly), and since I brought him home at the 24 hour mark (ah, gotta love the '90s!), he had never breastfed, despite the best efforts of the nurses and myself. I ended up bottle feeding him and seeing a lactation consultant at the 10 day mark, because he just wasn't consistently nursing - he'd scream, and not latch on, and I'd cry and think about what a horrible mother I was. (Hormones - oy vey....)

Long story short, with persistence on my part, he was consistently breastfeeding by week 5, and continued to do so for 11 months, despite my working full time nights. Yes, he was supplemented throughout (my husband, although quite handy with babies, couldn't master the breastfeeding thing.....go figure!) He probably was a little nipple confused (the baby, not my husband), but it worked itself out ok in the end.

Babies #2 & #3 latched on with steel trap jaws within two hours of birth, and other than the pain, were much easier to get going on the breastfeeding. I did supplement them, though, for the first day or two until my milk came in - my experience was that the colostrum really doesn't cut it with a hungry newborn. Others may have had a different experience.

I do think that breastfeeding takes a lot of commitment in the beginning - it never seemed to go like the books said it would, and the pain in the beginning was incredible. Yeah, yeah, I know the book says to make sure the areola is in the mouth and then it won't hurt. Bullfeathers. In the first place, my areola was bigger than the kid's head, making it difficult at best, and in the second, my babies latched on like a cobra going after a rodent. Juxtapose a bear trap with a Kirby vacuum cleaner and you'll get the idea. Pain..........

Hope this helps. Good luck with your teaching!

talaxandra · Sep 28, 2009

Not a midwife, not a mum but for what it's worth my three sibs and I were all breastfed for twelve+ months and all had dummies (aka pacifiers) from birth...

llg, PhD, RN · Sep 28, 2009

The problem is with words like "must" and "always" and "never." As the above posts illustrate, real life is murkier than than the hard and "rules" imply.

Some babies have trouble with breastfeeding even when all the recommendations are followed. Other babies feed eagerly at the breast even though a lot of "rules" get broken. Most babies and moms fall somewhere in between.

whiskeygirl, LPN · Sep 28, 2009

There is no such thing as nipple confusion.

There was a extensive study done at the University of Utah done sometime around 2003, that supported this.

I have had plenty of NICU babies who were NG fed till bottle fed and d/c'd then transitioned to BF, nearly everyone of them were given a pacifier at some point in ther stay.

SiennaGreen · Sep 28, 2009

I'm intrigued by the study about nipple confusion not being factual. I have heard a similar discussion and the person said "It isn't nipple confusion, it is nipple preference" which to me is really semantics. I am really challenged by that, but interested. It certainly would alleviate an enormous amount of pressure and anxiety if it were the case.

SiennaGreen · Sep 28, 2009

i found this from 1992 in american academy of pediatrics.

single daily bottle use in the early weeks postpartum and breast-feeding outcomes

linda cronenwett phd, rn1, therese stukel phd1, margaret kearney ms. rn1, jane barrett msc1, chandice covington phd, rn2, kristen del monte ms, rn3, robert reinhardt md4, and laurie rippe rn1

a prospective study of breast-feeding mothers was undertaken to determine the effects of limited bottle use and infant temperament on breast-feeding outcomes. white, married, primigravida women who were committed prenatally to breast-feeding for at least 6 weeks (n = 121) were randomly assigned to one of two groups: a planned bottle group that would offer one bottle daily between the second and sixth weeks postpartum and a total breast-feeding group that would avoid bottles during the same period. group assignment had no effect on the occurrence of breast-feeding problems, on mothers' achievement of 90% of their prenatal breast-feeding duration goals, or on weeks to weaning across the study period. at 6 months postpartum, 59% of the planned bottle group and 69% of the total breast-feeding group were still breast-feeding. no main or interactive effects of infant temperament on breast-feeding outcomes were found.

however, this was one bottle daily, beginning at 2 weeks after breastfeeding was established. i don't think this is the data i'm looking for.

CEG · Sep 29, 2009

Research shows that getting baby to breast within one hour of birth is PREDICTIVE of success, but not required for success. A hospital that cannot commit to getting a baby to mom's breast in an hour after birth probably has many other practices that are detrimental to breastfeeding.

I have seen many of our hispanic moms bottlefeed until their milk comes in, then succesfully breastfeed. However that is a very common cultural practice and my hispanic moms tend to have more support at home than my non-hispanic moms.