Torn about breastfeeding

klone, MSN, RN · Apr 23, 2010

Yes, it is statistically true that babies who are supplemented generally aren't nursed as long, or that their moms give up because their milk supply is not adequate (either real or perceived).

Are you certain that these babies are latched on correctly? When they nurse, are you hearing and seeing active sucking *and* swallowing? Are you teaching the moms to use an asymmetrical latch (nipple pointed towards the roof of the mouth)?

Babies like to suck. And colostrum, while perfectly adequate for their nutritional needs for the first few days, is low in volume. So it stands to reason that those babies may need to eat much more frequently.

If you ate a small snack, say a handful of peanuts or blueberries, you will get hungry again soon after. If that's all you're eating, you will need to eat it every hour or two in order to feel satiated. OTOH, if you eat a Big Mac and supersized fries, then you're probably not going to be hungry again for several hours.

Wanting to nurse frequently is not a failure of breastfeeding, it's a simple fact of breastfeeding, especially in those early days. Babies who are supplemented may SLEEP longer, but that doesn't mean that they're "doing better."

Unless there is a medical need for supplementation (too much weight loss, high bilirubin levels) then IMO you're doing a disservice to these moms by supplementing their babies. You're sending them the message that their breastmilk is not adequate. And in the cases where supplementation IS medically indicated, the root cause needs to be addressed and fixed, the mother should also be pumping to preserve milk supply.

If the baby is fussing and rooting after an hour of breastfeeding and the mom needs some rest, ask if you can give baby a pacifier. Or take a gloved finger and let baby suck on your finger. I will try to appease the baby for about an hour that way, but if baby is still acting like he needs to eat, I will bring him back out to mom and explain that baby really needs her. I will assist with latch, making sure that baby is latching correctly, and I will point out to mom when I hear/see a swallow, assuring her that means baby just got a mouthful of milk. Sometimes just letting these moms know that what they're going through is normal, and baby is not starving and IS getting milk, but that it's in small quantities at first and therefore needs to eat frequently, will give her the self-confidence she needs. These moms who insist they are "not producing anything" I like to actually hand express some colostrum (with her permission). When they see the colostrum bead up on their nipple, they almost always react with amazement. Yes, there IS stuff in there!

klone, MSN, RN · Apr 23, 2010

Also want to add - when a mom says "he nursed for an hour!" did he actually NURSE for an hour, or was he asleep at the breast with the nipple in his mouth for an hour? Newborns are VERY flow dependent - when it slows down, they fall asleep. Making sure the baby is latched correctly, and teaching the mom breast compression, will help make sure the baby is actually actively nursing, not just dozing at the breast.

Here's a link to the explanation of breast compression - teaching this to your moms is a very valuable tool to help baby get more milk and be satisfied for longer after feedings: Breast Compression

dandk1997RN, MSN, RN · Apr 23, 2010

As a devoted "lactivist," i just wanted to say thanks for the great info, Klone. I'm amazed by how little many people know about the primary food source for humans babies! :~)

PureLifeRN · Apr 23, 2010

I tried to keep my baby awake during feedings. It was really really hard but worth it when he wouldnt be hungry for at least 2 1/2 hours.

kcochrane · Apr 23, 2010

So why is this? I know that technically supplementation should not be necessary, so what is the problem? And on another note, many of these babies end up jaundiced.
Thanks for you opinions.

Jaundice is more common in breastfeeding babies and lasts a bit longer. Many times this scares new mothers and causes them to stop breastfeeding, when in fact in most cases it is harmless (physiologic jaundice).

http://www.americanpregnancy.org/firstyearoflife/breastfeedingandjaundice.htm

This is a good article on it and the different types and treatments. It is rare that breastfeeding may need to be stopped as a treatment. :)

makes needs known · Apr 23, 2010

I successfully breast fed all 3 of my children, and I recall that my real milk did not come in until 3 days after I was discharged from the hospital. Some babies are fussier than others, and I think the mothers of those fussier babies probably need their rest before they go home. Once they get home they will have their hands full. It might be difficult to comfort those tiny babies that need something, but their moms need something too, sleep! My kids are in their 20's now but I remember the nurses being very supportive about teaching me with my 1st child and bringing my babies to me every 2 hrs. Breastfeeding my babies was well worth it. :)

dscrn · Apr 23, 2010

Breastfeeding is well worth the effort. I nursed all 4 of my kds...the first was a fussy baby...let's face it some are...I've also worked for years in nursery, and it is hard to watch babies who are "starving to death" (remember brown fat-they'll surv ive) I deally, mom should keep baby with her to nurse, and room in. I have to say, we had a large Hispanic population, who bot nursed and formula fed-sometimes 4 oz for a newborn! Babies never seemed nipple confused, however, I do feel tat they were overfed. In this day of childhood obesity, maybe it's goi gto have to be ok to tet baby fuss until feeding...shoule be nursingg q 2hrs...and some more frequently

CEG · Apr 24, 2010

I really can't add much to Klone's fabulous post! But re: breastfed babies getting jaundiced more often. Remember that while we see formula as the magic cure, in fact formula is constipating and may actually slow down the poops. Colostrum is a natural laxative. Also, bilirubin is an antioxidant, and there is research going on about the fact that it may have a protective effect in the newborn. So to extrapolate, a breastfed baby developing jaundice may be some sort of protective mechanism while the formula fed babies have that suppressed.

Newborns are not supposed to sleep for hours. The reason that a pacifier helps prevent SIDS is that it keeps baby more active in sleep. This is also linked to why breastfeeding decreases SIDS, babies wake more frequently. Try to look at what breastfeeding babies do as the norm and what formula feeding babies do as the exception and it helps.

Keep in mind that you have no idea what goes on with breastfeeding after mom/baby leave. Before I was a nurse I was a doula and I saw firsthand the damage that is done by a well-meaning nurse. I have had to stop myself many times from "helping" a mom.

But the fact that you are even contemplating this and took the effort to post here tells me that you are probably are great asset to your breastfeeding moms.

crysobrn · Apr 26, 2010

I think that babies physiologically NEED to be at the breast when they are brand new. What I tell my moms is "think about it he/she was just in a nice warm, quiet, dark, cuddly place for 9 mos. Now it's cold, bright, quiet and we throw them in a crib and expect that they will sleep for hours on end" I certainly encourage rooming in but if a mom wants to send her baby to the nursery so she can rest. I make it clear that the only way the baby can truely be content may be at the breast and he/she will have to come back out if I feel like they need to. I've only had ONE mom in the last 6 yrs be upset that the baby had to come back out.

My babies never left my side while I was in the hospital and honestly they were nursed almost constantly until my milk came in. But I think that's the way it's supposed to be. I think it helped my milk come in faster. I've nursed each of my kids progressively longer. I'm still nursing my 18 mo old and I'm 25 weeks pregnant... She's never even had a drop of formula. Were there days that I thought it'd be "easier" to just plug her with a bottle... YUP. But I get much more satisfaction knowing she has had her mama's milk this long.

~Mi Vida Loca~RN, ASN, RN · Apr 26, 2010

I BF all 4 of my children but was only "successful" with my last one. I was so very misinformed on so much. Things with my boys went well but after about 6-8 weeks it seemed they were always hungry and so I was sort of convinced that even though I had tons of milk, they weren't getting the sustenance they needed So I caved and switched to formula.

When I had my daughter when I was much older and more informed i learned about the whys more and I successfully fed her for 8 months. The only reason we had to stop here is because she was eating a lot on her own but I was in the hospital for a total of a week and it was hard to pump and nurse her she just sort of lost interest then but I was very happy to get those 8 months on.

klone, MSN, RN · Apr 26, 2010

I'm still nursing my 18 mo old and I'm 25 weeks pregnant... She's never even had a drop of formula. Were there days that I thought it'd be "easier" to just plug her with a bottle... YUP. But I get much more satisfaction knowing she has had her mama's milk this long.

I tandem nursed my older two for two years (they were 27 months apart). :) They nursed until 4 1/2 and 4, respectively. I hope you find it just as rewarding as I did.