Vent/rant about hospital policy pertaining to my SIL...

[brittone2]

Well, I'm a new auntie as of Thursday :)

My SIL has BF 4 kids before this, and this was her 5th. The baby was 9lbs 3 oz at birth. They whisked the baby away right away to test blood sugar and gave her a bottle immediately because this is "hospital policy" for all babies over 9lbs. SIL had specified NO formula was to be fed, but they gave the baby a bottle anyway.


Now, I know sugar levels can drop and it can be necessary to give something to keep levels up, but SIL didn't even get a chance to get baby latched to try and get her some breastmilk first. SIL did not have gestational diabetes, and this baby was actually one of the smaller babies she's had. She had two 10+ pounders, and my brother was a 9+ lb baby himself so it isn't any surprise she was a bigger baby. But that isn't ridiculously huge or anything.

Even if it was "necessary" to give her something, I said to SIL who was raging mad (understandably, as was I...) that they 1.) did not need to "sneak" it to the baby, kwim...be up front about it if you feel it is truly necessary and 2.) it could have been fed from a dropper or cup, although I realize this is tougher for the nursing staff.

Sheesh. No wonder moms have such a tough time BFing. She had a heck of a time getting baby to latch then as she obviously was tuckered out by the time she got back to mom, and it was several hours until SIL could get her to latch. It has been going better since then but it was stressful for my SIL obviously.

Am I correct in thinking this was just outdated policy for the most part? I'd like to know more (Tarah or any other docs out there...fill me in please) in case I'm ever in this situation.

I'd have to say that's way outdated. I was in what I considered a very old-fashioned hospital (no rooming in, nasty maternity ward nurses, etc) but even so they waited until I was able to latch before taking DD (who was 9 lbs 1 oz) and did NOT give her anything other than a tiny sip of glucose solution to do the blood sugar test because of her size -- and they told us they were doing it and did it with my DH present. I have a lot of issues with how my situation went down, but that wasn't one of them.

So sorry for your SIL...it's so frustrating to be in that situation -- just makes you want to check out early and go home!!

[cdlamis]

WOW- I would be furious! My first DD was 9lbs 13oz and I never heard that from anyone. Size is determined by so many factors- you cannot assume that the baby has a problem. I feel for your SIL and hope BFing continues to go well.


Daniella
Mom to Julia 6-13-02
and Isabella 12-18-04

[VClute]

Holy cow, I would go NUTS if that happened to me! I'm a nurse, and there are two hospitals in my town, a military one and a civilian one. The military one has very modern (IMO) policies (rooming in, all newborn tests and procedures done at bedside, encouragement of early bfing, etc) and the cilvilian one is VERY (IMO) outdated policy-wise. The old policies (where dad has to watch the newborn tests and procedures from a window and baby sits under a warmer for two hours) is VERY doctor and nurse friendly; they can go about their business largely unsupervised (by parents, that is) and with no one asking questions or taking pictures or "getting in the way." The vitals can be recorded and charted without having to go back and forth to the room. And when the ped comes by, he/she doesn't have to bounce from room to room to do assessments - all the babies are lined up and ready in the nursery.

I learned that while a birth plan is great for getting the delivering person on board with what you want, you have to investigate hospital policy and throw a fit BEFOREhand if there's anything you don't agree with. You'll be too tired and dazed after the birth to stand up for yourself and your baby. (And if you do, by chance, have it in you to question those policies, DO IT! They won't call the cops on you!)

By the way, my son was a 10-and-a-half-pounder and they didn't give him any formula or sugar water. They monitored his blood sugar and were ready with sugar water IF he needed it.

Your SIL should write a scathing letter to the head of mother-baby (who probably handled the post-delivery newborn stuff), the head of the womens and childrens service line, the head of nursing and the head of medicine. Ideally, she could site journal articles showing that their policies are a bunch of crap. Otherwise, just say, "It is well-known among modern practitioners that...."

Best of luck to your SIL and congrats on being a new aunt again!

Amy in NC
mom to Dixon, born 2/14/05

[brittone2]

Yeah, I was crazy about investigating hospital policies before DS was born and we drove 45 mins to go to a "good" hospital where I delivered w/ midwives. However, I had a friend from LLL whose baby was given a bottle there without her consent and not for medical reasons. My DS also almost was "accidentally" circ'd but DH was there watching all of his care and they said something about his circ to which DH said...no...we specified no circ mutiple times on paperwork, etc....at which point they *erased* his name from the "list." Eeek. And this was at a relatively good up to date hospital.

My SIL just didn't have many options due to insurance and a number of other reasons, but I also told her she should write a letter to the hospital. I doubt she will, but if it were me, I would *certainly* write a letter. DH was as livid about it as I was when I told him. We were both just totally disgusted by how things were handled. The hospital policy is to do this with ALL babies over 9 lbs. It must be a lot of babies :(

Anyway, thanks for letting me vent. It wasn't even my child and I was frustrated. If we ever conceive another DC, we will be giving it our best effort to give birth in a birthing center where many of these things are a non-issue. It didn't even happen to me and I feel so strongly about it I could vomit.

Thanks for listening, and thanks for the congratulations on being a new aunt.

[tarahsolazy]

I'd be tempted to sue the hospital for giving my kid a dangerous and uneccessary substance!

This was totally unreasonable! It is not unreasonable, IMO, for a hospital to have a policy for checking a blood glucose on big babies. My DS was 9lb, 11oz, and his was not checked, BTW. However, if the baby is breathing normally, they should be allowed to actually UMMM EAT! before the sugar is checked. That seems obvious, no? If the sugar is low (less than 40 is the seizure risk zone), then the babe should be nursed again. If he won't latch, he does need some glucose, so glucose water, formula, or IV glucose should be given. The oral stuff can be finger fed, which doesn't take longer than bottle feeding. Then, the sugar should be checked 20 min after the glucose or so.

In your sis's case, she had good prenatal care, and no history of gestational diabetes, and had several babies larger than the current cutie. Its ridiculous that this happened to her. If she's up to it, she should raise a HUGE STINK. Write letters to the local papers, the hospital CEO, the head of nursing, her OB practice, etc.

In my case, as I contemplate another baby, I am glad that our hospital has a large Mother's Milk Bank. If my kid needed any supplement, I'd insist on donor milk.

[brittone2]

Today she was told she ***must*** give formula as the baby's bilirubin is 11 and the ped told her "your milk won't be in for 5 days and we can't wait that long" or the baby is at risk of brain damage. Now, I checked my WOmanly Art of BFing which says 20-25 is high for bilirubin counts. I know w/ jaundice there is a small risk of brain damage, but isn't the formula thing again TOTALLY outdated advice? I mean totally outdated?

Fortunately my SIL has good instincts and is refusing to give the formula although she hasn't told the ped that. They go in for a bili recheck on monday or tuesday and she'll see what the #s are then. The baby is nursing pretty well now and she doesn't want to screw it up w/ formula...I cannot believe that she was told that she HAS to give it this day in age. Seriously. I'm disgusted. If she doesn't write the hospital, I will.

Am I off my rocker? This is totally B.S. as far as current guidelines, no? They told her if the bili hit 13 that would be really really bad. I know it isn't great, but to the best of my knowledge a level of 11 isn't enough to freak out about let alone try to intimidate SIL to her to give formula.

I read Womanly Art tonight when I found out and told SIL that IMHO she was doing the right thing. She said she hears the baby swallowing plenty so she's getting milk, and even so...hello...colostrum has a purpose.

Seriously...I can't take it. I'm so PO'd about this I could scream. Thank goodness SIL is an experienced nursing mom and is trusting her instincts on this one.

How infuriating! DD was 10 lbs, 1.3 oz and the hospital checked her blood sugar every hour for 12 (or was it 24?) hours. But they did it in our room or DH followed her everywhere. Her blood sugar was fine, but the hospital still tried to scare us into giving her formula. In fact, we were threatened with them not discharging her and us having to sign her out AMA if we didn't give her any. They never could give a medical reason for it and once DH asked to get that signed and in writing (we're both attorneys and he started telling people that), they backed down and discharged her. We wound up switching ped's offices and we're not delivering at that hospital this time around.

She needs to make a HUGE stink about it IMO. And she better not let that baby out of her or DH's sight!

And see if she can get a second opinion on the bilirubin thing--will her ped's office make a special trip? Since she has 4 other kids, she probably gives them a lot of business... ;)

Good luck to her and tell her we're all pissed for her!

Anna
Mama to Gracie (Sept '03)
and a BOY! (coming July '05)

[dr mom]

I'm so glad that your SIL is experienced with breastfeeding and has the courage of her convictions to persist, even when the hospital and ped are trying to intimidate her into formula feeding. The best cure for a high bilirubin is breastmilk and frequent nursing - not giving artificial baby milk against mom's wishes.

High bilirubin levels are more worrisome during the first hours and days of life, so an 11 on day one is more concerning than an 11 on day three, because bili tends to rise during the first few days. The trend is also important - going in small increments from 11 to 12 to 13 over several days vs bigger jumps from 6 to 11 to 20. Regardless, repeat testing and examining the baby regularly are appropriate - bullying mom into giving formula is NOT.

I'm so sorry that your SIL had a negative experience, but please continue to reassure her that she is right to follow her maternal instincts and nurse her baby on demand. When she feels up to it, I hope she will send a polite but uncompromising letter to the hospital administration, head nurse in the nursery, and pediatrician, outlining her concerns and requesting follow-up on what they will do to avoid similar errors in the future. Sounds like she is going to have an uphill battle convincing them that a mistake was made, but there is ample medical literature to support her position, and I'd be happy to help you track it down if necessary.

In her position, I would be mad as h***, and I'm sitting here angry on her behalf even now. What if she'd been a first-time mom who didn't know how to breastfeed, and wasn't able to work through the latch-on problem? What if the hospital's unnecessary interventions and forced formula feeding had permanently compromised her baby's ability to breastfeed? Utterly unacceptable. I hope she will raise h*** as soon as she feels up to it.

[brittone2]

Thanks girls. I'm actually up at 3:30 in the morning because I'm so PO'd about it right now I'm fuming.

Yes, this baby was born on Thursday and the Bili levels were from today, so an 11 isn't that bad from what I can tell. In any case, regardless, the formula is outdated advice, no?

If *anyone* can help link me some journal articles by any chance I'd be forever grateful. As much as I'd love for her to write to the hospital/ped/etc. I'm not sure she will as obviously with 5 kiddos including a newborn, her time and energy are limited. I'm in the middle of a move and will be moving from PA to NC in 2 weeks, but I'll FIND the energy to write to them and bombard them with literature demonstrating that their practices are outdated and substandard.

Anna-Good for you to stand up for yourselves. Threatening you and trying to say you were getting d/c with DD AMA is just sad on your hospital's part. Super idea to get them to put the "need" for formula in writing...which obviously they weren't willing to do. What I don't understand is in a case like that, they obviously know it isn't truly necessary as they wouldn't sign it, kwim? So why do they persist in undermining the value of breastmilk?

I'm off to search for some journal articles to send this ped on the jaundice topic. I'm hoping to get an entire list of articles together to send to the hospital, ped, and whoever else will listen.