Cup Feeding Strikes Again! - page 5
So I had this lovely little guy, about 3700 grams, term, some meconium staining at birth, otherwise completely boring pregnancy and vaginal delivery. He had some low blood sugars (which we call... Read More
Jan 27, '07Occupation: ICU Nurse Specialty: 21 year(s) of experience in Newborn ICU, Trauma ICU, Burn ICU, Peds ; From: US ; Joined: Jun '04; Posts: 265; Likes: 32Apparently 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.
Jan 27, '07Occupation: Re-retired Specialty: 42 year(s) of experience in NICU, Infection Control ; From: CA, US ; Joined: Dec '00; Posts: 12,436; Likes: 3,807When 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.
Jan 28, '07Joined: Nov '06; Posts: 20,715; Likes: 23,954Prmenrs --
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!!Last edit by ElvishDNP on Jan 28, '07 : Reason: clarity
Jan 29, '07Occupation: Re-retired Specialty: 42 year(s) of experience in NICU, Infection Control ; From: CA, US ; Joined: Dec '00; Posts: 12,436; Likes: 3,807I'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).
Jan 29, '07Occupation: RN-Retired Specialty: 27 year(s) of experience in NICU ; From: US ; Joined: Jul '02; Posts: 1,400; Likes: 163We have had the moms start taking Reglan, it does seem to help increase the milk supply.
Jan 29, '07Occupation: Re-retired Specialty: 42 year(s) of experience in NICU, Infection Control ; From: CA, US ; Joined: Dec '00; Posts: 12,436; Likes: 3,807We used Reglan and recommended "mother's tea", usually obtained @ natural food stores, like Whole Foods, Henry's, ?not sure about Trader Joe's.
Also, http://www.amazon.com/Traditional-Te...?ie=UTF8&s=hpcLast edit by prmenrs on Jan 29, '07
Jan 29, '07Joined: Nov '06; Posts: 20,715; Likes: 23,954I 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.
Jan 29, '07Fenugreek IS one of the ingredients, and you can buy it separately, too. In the tea, it's only 35mg. These capsules are 610mg: http://www.amazon.com/Vitamin-Shoppe...791421-2517227Last edit by prmenrs on Jan 29, '07
Feb 4, '07Occupation: RN Specialty: NICU, Telephone Triage ; Joined: Apr '06; Posts: 703; Likes: 298Quote from TiffyRNSo I had this lovely little guy, about 3700 grams, term, some meconium staining at birth, otherwise completely boring pregnancy and vaginal 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.
This makes me want to SCREAM!!! In my new unit, the order was to dropper feed a baby BID. I've never done it, never will. Refused to do it...he wouldn't bottle feed yet...so he got gavaged. I don't want babies aspirating for ME!! They can write me up, don't care. This is a nurse who will not cup or finger or dropper feed. They can either breast, bottle or gavage feed when I'm on.
Feb 4, '07Occupation: RN Specialty: NICU, Telephone Triage ; Joined: Apr '06; Posts: 703; Likes: 298Quote from navyscrubsFor most healthy babies, they can breast and bottle feed. It usually takes a week or 2 to get br. feeding established even if that's all they've had. It's not easy sometimes.Nipple confusion does exist. I tried to breast feed my baby in the hospital and he wouldn't eat. The nurses kept bothering me and making me nervous and asking if he had breastfed yet. It was really making me angry because they were feeding him formula behind my back and so he was never hungry. Because of this it took me about a week and a half to get breastfeesing my son fully established.
May 22, '07Occupation: RN (OBGYN) Specialty: OBGYN, Neonatal ; Joined: Jun '04; Posts: 728; Likes: 58Curious!
I am soon to be a NICU nurse (start job in September) but this is a question as a mom...LOL
When I had my son he was 11.4 lbs (yup I'm a diabetic, type I since age 12). Good control through pregnancy HA1c of 5.9/6) but he was still big. Anyway, b/c his blood sugar was low they admitted him to the NICU. They put him on IV and monitored his blood sugar until it was stabilized. Now we did say we wanted to breastfeed but we gave him bottles too b/c in my opinion I'd rather him have some nipple confusion and get stabilized quicker than slow down his progress...ya know what I mean?
Anyway...I wonder now if they could have just had him in the regular nursery? Must have been a protocol thing there. But odd. We only ever got one or two successful latches going forward and he was not happy with it (not fast enough I guess LOL) but I don't think it was just b/c he got bottles right away. Could be, but I'm not upset over it, you know- I'm just glad he survived and is doing great! He is an 18 month old boy full of energy!
I guess my question is...there is a law saying you can't use bottles if they want to breastfeed? Wow! I never would have thought that. I mean I understand the fear but YIPES. I'd be worried about cup feeding too. I do remember now that our pediatrician told us about cup feeding when he was about a week old but it looked too "odd" to me...and just not really comfortable.
May 22, '07Occupation: RN (OBGYN) Specialty: OBGYN, Neonatal ; Joined: Jun '04; Posts: 728; Likes: 58Quote from nellYeah I think in my case it would be a necessary evil. I'm a type 1 diabetic and my son was born with low blood sugar. But they (and I) kind of expected it so we were prepared for what might be done (he had an IV, admitted to NICU, returned to me 24 hours later). But I'm guessing that back in the day of my grandmother quite a few babies of diabetic mothers did not survive either b/c of lack of needed prenatal care for a diabetic mom or lack of knowledge about how to care for an LGA infant of a diabietc mommy.So midwives don't test the infants of diabetic moms? Or LGAs, SGAs or preemies? And how "high risk" are you talking?
How do you know those babies didn't suffer any harm? Where harm from low blood sugar shows up is in learning disabilities and maybe autism.
As far as "our Grandmothers" doing it that way - - - people used to live in extended families and/or groups. There was usually a lactating woman around to feed the screaming/starving infant when the mother's milk hadn't come in yet and the colostrum wasn't enough or the mom just couldn't produce for any reason. The rich had wetnurses. Today we have bottles.
Thank goodness our hospital doesn't allow any of those nutty "alternative" feeding practices, although the Lactation consultants still try to pull a fast one now and then. One of our long term preemies visited a while ago- the LC got her to syringe feed the kid after discharge and a year later she was still being fed by syringe!
Then there's the practice of giving IV fluids instead of that nasty unnatural bottle when the mom wants to breastfeed exclusively and the kid needs hydration. An IV is soooo much more natural.
In 20 years of neonatal care, the "nipple confusion" I've seen has been the result of flat or inverted nipples that the kid just can't get a latch onto. It's not confusion, it's physiology.
May 24, '07Occupation: newborn nursery Specialty: 8 year(s) of experience in nursery, L and D ; Joined: Feb '07; Posts: 1,020; Likes: 344I've heard that the new recommendations are for a otherwise health pregnancy that may end with a baby with an unstable blood sugar is that for mom to pump starting at 38weeks. This is so the baby can get cup/dropper/gavaged with colostrum instead of formula so as not to disturb the ph of the gut. Thought this was kind of interesting and it kinda fit here!