Nurses that give bottles to breastfeeding babies.

hoolahan, ASN, RN · Jul 21, 2004

Sounds like where i work. WE NEVER EVER give breast babies bottles UNLESS special medical needs exist that necessitate this. AND even THEN, we cupfeed after breast feeding FIRST. I can't understand how nurses can think they should do this. It's unethical and wrong to go against breastfeeding moms' wishes by sticking a bottle in a baby's mouth. Unless a ped orders it specifically for medical needs, we do NOT do this.

Wow! Can I say something as a former new bf mom?

I was in and out of non-progressing labor for 2 days with minimal sleep. Ended up w C-Section anyway, b/c my first was breech.

Two words...window effect...after epidural...crushing my dream of the beautiful "awake" experience I had fantisized. NOT fun to feel scalpels cutting you. It took me hyperventilating and doing everything I could not to scream, and I have a very HIGH pain threshold, until finally...

No, not local, just fentanyl, expressly against my wishes to receive a narcotic. Basically to shut me up, instead of address the poor anesthesia.

OK, my midwife plans also down the drain as the back-up doc kept me on pit for 24 hours after section. I hated OB nursing in school, so I didn't know this was coming. He also didn't believe in pain meds since I planned to nurse. Abd wound, no pain relief except tylenol, baby born at 7:03 pm. At 9pm, perky young evening nurse comes in for me to bf David. I tried so hard, and had earlier, he was groggy from the fentanyl, and kept holding both his little arms infront of his face. He was screeching and I mean horribly screeching.

This "nurse" insisted I was going to get that kid to latch on. OMG, she dripped water on his head to get his mouth to open, all the while this is making him more peeved, he is beat red, my head is begnning to pound, I am in pain and can't get comfortable myself, and she just kept pushing it. It broke my heart, but finally, after about a solid hour of absolutely no success, I asked her to PLEASE give him a bottle in the nursery, and I would try again in the morning, I was just too exhausted. I was crying myself at this point, and frankly, at that moment, I couldn't have cared less if it was bottle or breast, food is food.

My roomate pulled open the curtain when she heard me sobbing, and was very sweet and encouraging. She said, I can't believe they did that to you!

She took him back to the nursery, gave him some glucose water, 1-1/2 oz I think she said he took, and I was just finally in a position of comfort, after easing the bed down a few inches at a time, cramping from the pit, hurting from pain, headache.

In walks perky, she has the baby with her, and says "He just took glucose water for me in the nursery, he's really hungry, let's try again." I looked at her, and if looks could kill, she would no longer be alive today, and just cried again and said, please, I have decided not to bf, please don't bring him back in tonight, I am in so much pain, I am useless.

So, having shared that, you would still not give the baby a bottle unless it was medically necessary??

I will add, in the moring, I got the best nurse. She was just so relaxed and confident, it made me relaxed. Of course, having the pit taken off by then, and a GREAT 11-7 nurse who had d/c'd it and helped me to wash and feel human again helped a lot! My am nurse just took her time with us, and left us about 20 min later happily bf away.

I am not sure if I do or don't believe in nipple confusion, no experience in this area, other than my won two kids, but I am 100% sure the fentanyl was the problem. My dtr was V-Bac and had absolutely no problems, latched on right 5 min after birth, of course I was a "pro" by then.

The whole time in the hospital, David had his issues with the breast, but once we got home, the milk came in, and there was no stopping that kid.

PS, to "nipple nazi," the only vistors I had were my husband and a brief visit from my in-laws which was uplifting for me. They were smart enough to only stay about 30 min. Also, a new mother has plenty of sleepless nights ahead, why is getting one night of rest so out of the question? Sheesh! I did keep my dtr with me and felt absolutely great after my VBAC, totally different situation. (I didn't even want vistors after her, I just wanted our "us" time.)Do you take these things into consideration? I hope you do, and are just poking a little fun at yourself. No offense intended.

allnurses Guide · Jul 21, 2004

Hoolahan, I'm sorry for your experience. Your doc was nuts about pain relief. He needed Dr. Thomas Hale's book about breastfeeding and mother's milk.

I also had a cesarean with my last child. Normal vag deliveries 3 times before that. I got a morphine PCA. Breastfeeding went fine for me. Laid down sideways and slept with my son. I did go home with a couple of bottles of formula due to jaundice . . . even though I knew better. But the funny thing is when you are recuperating from major surgery and can hardly clear your throat due to cut muscles, your mind doesn't always work.

He had a couple of bottles. But still breastfed. Still breastfeeding to this day. Gonna have to think about quitting here soon. Makes me sad as I know for sure this time that he is the last one.

If mom says bottle feed, then we bottle feed. You are the boss. Glad you had a nicer nurse in the morning.

steph

GR8FUL · Jul 21, 2004

Great article, Mitchsmom. I'm going to print a dozen or so for all of those "I was bottle fed and I'm just fine" friends I encounter.

I though the part about sensitization to cow's milk and diabetes being related - makes me wonder if the African American population, who have a higher proportion of dairy sensitivity, are more inclined to diabetes because of this early introduction to cow's milk. It will be interesting to see if the stats change as breastfeeding increases.

As to the nurse who "likes to feed the baby", I'd throttle her. I kept my daughter in my room during my entire hospitalization for this very reason. It seems there are always a (very) few nurses who think they know best, no matter what the clients choices are. Thank goodness for those who are really there for the patients. In my mind it is malpractice.

Even if you don't believe in nipple confusion, there are other issues with giving formula to a baby who has been exclusively breastfed:
"Just One Bottle Won't Hurt"---or Will It?
by Marsha Walker, RN, IBCLC
Background
* In breastfed infants at risk, hypoallergenic formulas can be used to supplement breastfeeding; solid foods should not be introduced until 6 months of age, dairy products delayed until 1 year of age, and the mother should consider eliminating peanuts, tree nuts, cow's milk, eggs, and fish from her diet. (AAP, 2000)
In susceptible families, early exposure to cow's milk proteins can increase the risk of the infant or child developing insulin dependent diabetes mellitus. (IDDM) (Mayer et al, 1988; Karjalainen, et al, 1992)
* The avoidance of cow's milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals. (AAP, 1994)
* Sensitization and development of immune memory to cow's milk protein is the initial step in the etiology of IDDM. (Kostraba, et al, 1993)
Sensitization can occur with very early exposure to cow's milk before gut cellular tight junction closure.

webbiedebbie · Jul 21, 2004

Houlahan....No offense taken...A baby who is screeching should not be put to the breast anyway. Your nurse used poor judgement. I don't force breastfeeding. I do take into consideration what mom had for pain relief and how it also affects the baby.

I am sorry your experience was so intense at first. That is why I advocate that all nurses are on the same page and receive training in breastfeeding. If the baby is groggy and the blood sugar is okay, it it alright to let baby wait a few hours and let you also have time to rest before breastfeeding. The baby does not need to stay on the breast for 20 minutes each time either.

Hoolahan...I'm glad you were able to limit your visitors. I was speaking about the hospital where I work where visiting hours run from 7am to 11 pm. No, it is not posted that way but we as nurses have no control of who comes on the floor at anytime.

Another thing I notice with parents is that everytime the baby cries, they think it is hungry and they call the nursery for a bottle. Unfortunately, all nurses do not take the time to teach parents about the infant's needs.

When a baby is learning to breastfeed, it is important that bottles are not introduced until a good breastfeeding pattern is established. If a bottle is introduced in the very beginning, they get the flow of formula easily and then when put to the breast, they don't want to "work at" getting the flow of colostrum or milk from the breast.

Some of the nurses where I work get frustrated with helping with breastfeeding. That doesn't help with mom or baby. They are beginning to call on me to help with the breastfeeding. Hoolahan...Your experience changed when you said you got a calm nurse. I'm glad the rest of your experience went well.

fergus51 · Jul 21, 2004

You should make sure to read the language in those studies. MAY is not the same as WILL. I would liken the bottle debate to drinking during pregnancy. No one knows exactly how much it takes to cause harm, so we try not to do it at all.

SmilingBluEyes · Jul 21, 2004

Sorry for your experiences Houlie. I know there are multiple issues in breastfeeding success or failure. I have been to quite a few BF seminars and classes from WHO and LLL. I just know, I will not dishonor a mom's wishes by sticking anything in a baby's mouth other than her breast. Unless there is a medical need, I am bound by trust to do what the mothers want. There are many times when moms are exhausted, problems arise when sometimes, I have cup fed a baby just a bit of formula (with mom's permission) to get them through the night. It's amazing what two to three hours' sleep will do for moms and dads and a calm mom usually does better breastfeeding her baby. But I always leave it up to them.....after educating them. I am sorry some nurses are so clueless when it comes to such issues.

Mags4711, RN · Jul 21, 2004

I am not at all behind the nipple confusion theory, either. I do, however, recognize that it can be somewhat more difficult for an infant who is used to bottle feeding, to breast feed. Flow of milk, etc. Though on the flipside, the breathing is easier with breastfeeding.

My question to all of the (this is said in jest) nipple nazis is: What about the mom whose baby had to go to the NICU? I work NICU and we find it soooooo frustrating when we have mom's who insist on breastfeeding for every feed. Even when their baby is at risk (after all, they are in the NICU, aren't they?) and we all know their milk is not in yet. It is nearly impossible to quantify how much a baby is taking with each feed (no, those Baby Weigh scales are not accurate) and it sometimes comes down to fluid status whether or not the child needs an IV. I have had mom's who (pardon this next statement-not meant to offend, but telling it like it is) are so brainwashed about the whole breastfeeding thing that they insist on their child getting an IV rather than have the baby supplemented with a bottle. Or they insist on NG feeding with no pacifier available to the poor baby when they decide to get a few hours' sleep. (And of course these NG feeds are formula.) What do you as LDR/P nurses teach for the NICU moms? I mean, do you mention that in the NICU things are much different?

I do have to say that I am fully in support of a mom breastfeeding and try my darndest to provide a relaxing and good experience for them for latch-on. But in the NICU that is nearly impossible. You cannot block out the sound of the ventilators and the noise and no matter how many screens I put up, it is not as private as their own room. If a mother chooses while she is still in-house as a patient to come and attempt to breastfeed for each feed, then I will try very hard to make that happen. But these mom's end up being the ones who invariably have problems with production, we think it is because they are getting up, coming down to the NICU, trying for almost an hour to BF, going back to their room and in about 90 mins, coming down again. Not good for mom, nor baby. The stress and the tiredness finally catches up with them and they have production problems, or PPD or temps or something.

Faith

Gompers, BSN, RN · Jul 21, 2004

My question to all of the (this is said in jest) nipple nazis is: What about the mom whose baby had to go to the NICU? I work NICU and we find it soooooo frustrating when we have mom's who insist on breastfeeding for every feed. Even when their baby is at risk (after all, they are in the NICU, aren't they?) and we all know their milk is not in yet. It is nearly impossible to quantify how much a baby is taking with each feed (no, those Baby Weigh scales are not accurate) and it sometimes comes down to fluid status whether or not the child needs an IV. I have had mom's who (pardon this next statement-not meant to offend, but telling it like it is) are so brainwashed about the whole breastfeeding thing that they insist on their child getting an IV rather than have the baby supplemented with a bottle. Or they insist on NG feeding with no pacifier available to the poor baby when they decide to get a few hours' sleep. (And of course these NG feeds are formula.) What do you as LDR/P nurses teach for the NICU moms? I mean, do you mention that in the NICU things are much different?

THANK YOU for posting about this! I have experience the same things in my NICU. The whole breastfeeding/breastmilk thing sometimes becomes an ethical dilemma for us. It doesn't take long for moms to realize that they can't be up in the NICU every 2 hours to breastfeed - it's just too much stress for them and the baby - the kiddo is in the NICU for some reason, so the baby really needs to get some good rest at some point! Rather than allow us to give the baby a bottle of their breastmilk, they insist that we either drop an NG or place an IV. Our docs have MAJOR problems with this, and so do many of us nurses! I just don't understand - these moms would rather have a needle stuck into their baby over and over establishing an IV site or would prefer someone to stick a feeding tube down their baby's throat! We refuse to do it in most instances because it's causing unnessesary trauma to the baby, plus it increases their risk for infection or aspiration, respectively. We don't do cup or finger feedings (seen too many babies come up from newborn nursery with aspiration) at all, so yeah, sometiems we might need to give a bottle. But honestly, if a baby is in the NICU, isn't getting the baby healthy enough to go home more important than risking nipple confusion?!?!

The other problem we have is breast milk itself. Not all moms can provide it, due to medical conditions or sometimes just the stress decreases the milk supply. These moms are beside themselves because they don't get anything when they pump, and we have to explain that formula really is okay, and that we have special ones for sicker babies. With all the information posted above describing how "bad" formula really is, it's no wonder that we have a hard time getting consent to give it! Seriously, guys, it's not the worst thing in the world, and sometimes it's necessary. Even with the moms who have good milk production, we still have to add formula powder at some point for most of our babies. A former 500gm 24 weeker with severe lung damage is NOT going to grow and heal just getting plain breastmilk for nutrition. We need to add powder to increase the calories, fat, and protein.

I do disagree with nurses feeding babies in the newborn nursery just for "fun" or to let mom sleep - even though mom said to wake her to nurse! That is a different situation - but my feeling is that if mom only wants to breastfeed, don't even send the baby to the nursery in the first place! The kid's going to want to eat every 2 hours, so might as well keep the bassinette next to mom's bed. If the mom wants no bottles or formula given, this is the sacrifice she's going to have to make. Or do like Hoolahan did, and say at least for the first night to do whatever the baby needs until mom is feeling better. Mom's recovery and the baby's health should come first, nipple concerns second!

JHMO, of course.

Mimi2RN, ASN, RN · Jul 21, 2004

It's usually the educated moms who insist that their baby doesn't need to suck on anything, and then they have problems breastfeeding.

I feel that the babies can sense when mom is stressed out. It's hard enough when baby has to stay in the nursery, without allowing them to suck. There is something called "non-nutritive sucking".

Our hispanic moms come in to nurse until discharge, then bring milk in for the baby, nursing when they come to visit. These babies will have no problems at home.

A baby that doesn't want to eat may well have something else going on, and we don't cup feed in our nursery, either. We are sometimes sending r/o sepsis babies to the floor, if mom is still a patient. We leave a heplock in, and bring them in for meds.

Houlahan, I'm sorry you had such a bad time after your c/s. Your doc needs his belly cut open, and then not be given pain meds. Your baby certainly didn't need a belly full of sugar water, either. He just needed food to get through the night. Glad things worked out later.

BTW, both my boys were breast fed, now they are 35 and 32. I was given a schedule, told when they would come to my room, and they were kept in the nursery at night. I think I was the only breast feeding mom on the floor. Three days, vag deliveries. No visitors allowed when baby was in the room-not even daddy! How things have changed!

BittyBabyGrower, MSN, RN · Jul 21, 2004

I'm with the other NICu girls..it is so much harder when they have a baby in the unit...and sometimes, that is the only thing that is holding the baby up is feedings! I am all for BF, BF my daughter for 8.5 months, but if it came down to keeping my baby in the hospital or giving a bottle, well, the bottle would win. We have the moms nurse while they are there, and we usually do supplement at least one feed a day with Neosure or Natural Care for the extra calcium and minerals that these little ones usually need. As a matter of fact, we much prefer MBM because it is much better for little immature guts :)

We get the gung ho moms too...and we make it quite clear that she will need to come and feed everytime the baby wants to eat. We do not place ng's or IV's just because the mom wants us too. That is not medically indicated. We also aren't allowed to cup or syringe feed anymore...we had 5 instances of aspiration in the nursery last year, so risk management said no more. (These were all groggy big full termers that were kind of forced to eat..not good). We also explain how non nutritive sucking is a good thing...esp. for pain management.

It is a rock and a hard place in the NICU!

As for that nurse that likes to feed babies...that is nuts! I'd be ticked too!

GR8FUL · Jul 21, 2004

It seems that it's all about finding a balance. When I was doing my practicum in a highly respected NICU (having spent several days in two other hospital NICU's) the most significant difference I saw was a policy of giving NICU babies mother's milk, whether it be by breast, buy tube or by bottle. Non-nutritive sucking was encouraged, and it was explained to the parents that sucking was one of the only coping mechanisms these babies have to deal with pain and overstimulation. They had excellent outcomes, very little NEC and very few babies got Zantac (and yes, it was a level 4 NICU).

I think sometimes mothers feel so out of control of the situation that they try to control what they can. The bottom line is that keeping the babies alive comes first, and minimalizing the pain they experience in the process comes next. It seems supremely selfish for a mother to inflict pain on her child in an effort to assure breastfeeding. Educating the parent and working with them is so important, but so difficult with the constraints of time and interaction.

allnurses Guide · Jul 21, 2004

Hi Mimi! You reminded me of visiting a friend from high school in 1977 who had a baby girl. I was not allowed on the pp floor. She had to get OOB and walk the bassinett down the hall to a glass door and we talked through that. NO VISITORS. When I had my first son 21 years ago I stayed 3 days for a normal vag delivery. And they did the BIG SHAVE :uhoh3: , an enema, an episiotomy and they took my son to the nursery for the entire first night - probably fed him formula too :) . 2 years later and a different town I had my second son. No shaving, no enema, no epis, my son roomed in, I exclusively b/f and stayed less than 24 hours.

steph

It's usually the educated moms who insist that their baby doesn't need to suck on anything, and then they have problems breastfeeding.
I feel that the babies can sense when mom is stressed out. It's hard enough when baby has to stay in the nursery, without allowing them to suck. There is something called "non-nutritive sucking".
Our hispanic moms come in to nurse until discharge, then bring milk in for the baby, nursing when they come to visit. These babies will have no problems at home.
A baby that doesn't want to eat may well have something else going on, and we don't cup feed in our nursery, either. We are sometimes sending r/o sepsis babies to the floor, if mom is still a patient. We leave a heplock in, and bring them in for meds.
Houlahan, I'm sorry you had such a bad time after your c/s. Your doc needs his belly cut open, and then not be given pain meds. Your baby certainly didn't need a belly full of sugar water, either. He just needed food to get through the night. Glad things worked out later.
BTW, both my boys were breast fed, now they are 35 and 32. I was given a schedule, told when they would come to my room, and they were kept in the nursery at night. I think I was the only breast feeding mom on the floor. Three days, vag deliveries. No visitors allowed when baby was in the room-not even daddy! How things have changed!