Survey for BF moms

[COElizabeth]

I think the idea of doing one for the nurses is great. I don't remember the peds ever discussing nursing in the hospital, but I do remember one nurse telling me that if DS's glucose was low he'd have to have formula. As far as I know, there was no reason to suspect that his glucose would be low (he wasn't big, only 6 pounds, 6 ounces), so I don't know why she had to "threaten" me with formula. The nurses also told me I'd have to supplement if DS lost more than 10% of his body weight.

It bothers me that there seems to be a lot of variation in the "thresholds" at which peds (or nurses) insist on supplementation. Can you suggest any good references for info on what weight loss percentage and what glucose level are considered dangerous? I will probably have my next child at a hospital where my ped doesn't have privileges, and I can't guarantee the hospitalist will be as supportive of BF as you! :)

Elizabeth, Mom to James, 9-20-02

[lizamann]

ITA about the nurses being the sticking point. My MD's were behind the bf'ing, but the nurses made me feel guilty that dd was "crying because she's hungry because your milk hasn't come in." I wasn't about to let them bully me into supplementing, but it just seems so wrong to have to advocate for yourself and baby at such a vulnerable time. Not to mention how furious it made me that these women didn't seem to know the first thing about bf'ing that I'd picked up by reading a stupid book! It's their job, for crying out loud! The lack of nursing help and support was appalling and by far the worst part of my whole hospital experience.

Sorry to rant there, but you get the picture...

[jubilee]

With my 1st son I was told by the ped that I would have to supplement because of how big he was (9#13oz), and I think a lot of people think that big babies can't breastfeed- so please tell your patients that it IS possible!

Also, tell them about nipple confusion, so they don't end up with a baby that wants the bottle because it is so much easier.

And explain about jaundice makes the baby so sleepy he won't wake up to breastfeed. My 2nd son had to be on the biliblanket for 4 days while I finger-fed him breastmilk because he wouldn't wake up to even suck. I wish I knew sooner the warning signs of jaundice because I delayed treatment 2 days because I thought the yellow would "go away" and that his sleepiness was normal.

Thanks for asking!!

[sirensrise]

thanks for taking the time!
i wish the pedi would tell me how normal it is for a newborn to eat
ALL the time!i wish they told me all babies are different, as a first time mom, all i had to go by was the books nad did not expect that. i also wish they would tell me more about just stick with it even if it is not easy.
the nurses, oh boy! i think some of them might need some more education. no offense, MIL is a nurse. i had nurses in the pedi's office tell me all sorts of things. they esp. PRESSURED me to give dd solids when she turned 4 month. by 6 month, i was told that she was starving. (no, her is BIG for her height, and i had a LOTS of milk, i mean a lot)i wish the pedi would have educate the nurses about the new aap about the new guidelines. it is one thing that they are unfriendly to breastfeeding, it is another that they gave parents wrong info. they insisted that solids would make dd sleep through the night. solids solids solids! MIL was asking me about solids when dd was WEEKS old!she was not rude or anything, but still, the mis information!my pedi is great, but his associate informed me that there is absolutely no reason to feed my baby less than 2 hours, since the breat would not have been filled.
sorry, i dont mean to be ranting about all this. i believe a woman should be able choose whatever is best for their baby.breast or formula.

[cinrein]

I don't have much to add to what others have said. I just wanted to share that my practice did something that I thought was so great and I don't know if it's commonplace or not. A nurse called me around 9:00 the first morning we were home after our first full night home with a new baby. The purpose of her call was to find out how things were going, especially feeding. We chatted a bit and then she gave me her direct line and urged us to call if anything at all came up. I love them for that! I think it's a great way for a pro-breastfeeding practice to encourage Moms to continue breastfeeding when you hit the inevitable rough patch.

Cindy and Anna 2/11/03

[sntm]

I think one thing is to assume breastfeeding is the norm in the way in which you refer to it. Don't ask "are you going to breastfeed?" ask "you are going to breastfeed, right?"
Praise moms for their decision. Reinforce to them that they are doing the right thing. Warn them that it might be hard and that they may feel pressured to use formula, but tell them that the need to supplement is rare. Tell them before they give formula or consider giving up breastfeeding, they need to talk to their ped at least or an LC.

And definitely educate the nurses. That seems to be the weak link in most cases (not an insult to the nurses -- just a reflection of how medical education occurs). Tell them that they are the key to a mom's breastfeeding success. Latch techiniques are essential. Make sure they are comfortable handling a mom's breast (if you have a very willing patient, see if she and her baby will come in for your talk to demonstrate.)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
shannon
not-even-pregnant-yet-overachiever
trying-to-conceive :)
PREGNANT! EDD 6/9/03
mama to Jack 6/6/03

[KGoes]

I wish my ped had discussed breastfeeding a jaundiced baby (due to ABO incompatibility). There were several issues. First, the jaundice. DD was treated aggressively with bili lights to make sure that her count never went near 17. I wholeheartedly supported this since it enabled us to go home in two days. But. . . . The lights made her sleepy because she did nothing but fuss while she was naked and under them. This made nursing more of a challenge, since once she got to me, all she wanted to do was cuddle and sleep. The nurses scared me with warnings of low blood sugar, etc. If it had not been for a rather militant LC on staff, I would have been quite discouraged. Now, I am not faulting the nurses because I truly believe that they had DD's best interest at heart, but breastfeeding support was left to the LC, who I had to ask for. Here's my point to a ped - with my child ill (and I know it was not that serious, but to me at the time it was extremely serious and traumatic) any time that the ped can spend with me talking about breastfeeding issues would have been time valued beyond measure. Even hypothetical - you may find that your DD is sleepy with jaundice; here's what you can do, etc. Second, DD was also on antibiotics due to an increased white blood cell count that was ultimately linked to birth trauma as opposed to infection. The antibiotics led to a nasty, nasty case of thrush. I personally believe it was so nasty because it took me awhile to realize that the pain in breastfeeding wasn't "normal." I had never heard of thrush, and if it hadn't been for an off-hand comment by a maternity store owner, I would have suffered much longer before seeking medical attention. I would have been eternally grateful if the ped had mentioned this as a possibility when DD and I were on antibiotics.
In short, information and support can be in short supply with new moms and breastfeeding. The cure is time and information from the ped. A specific list of possible things to watch for - like sleepy babies who will latch better in a few days once they are less jaundiced (remember, it is in these few days that well-meaning family members often push formula to "help" the exhausted and overwhelmed new mom)and symptoms to look for that may be thrush would be invaluable.
Kelley
DD born 7/03

[lynettefrancois]

I know a couple people who did not breastfeed for personal reasons that were perfectly legitimate, so I would be wary of imposing BF on anyone. Why not ask patients if they have received any information on the benefits of BF? Or if they have received enough information to make an informed decision on whether they will breast or formula feed? I would hope anyone who is presented with a little info will make the best choice, and in this format, would seem less threatening to all.
Also, I wanted to add that I spent the first two months with a bad latch (it didn't happen in the hospital or during the first visits with 2 different LCs, only after I went back, knowing that I surely wasn't supposed to have terrible nipple pain at 2 months). I also spent the first two months diagnosing silent reflux, which made her scream while eating (my husband thought maybe my milk was "bad" so I went on nearly a total elimination diet for awhile), and then the last 2 months with thrush. I couldn't get my pediatricians to prescribe anything but nystatin, so I switched offices finally, this week. Why? They were condescending, which REALLY ticked me off, on top of not giving it the attention needed- they only saw it in her mouth once, but my symptoms persisted. I've been trapped in my own home to air out my breasts! The nurses INSISTED that if there were no white patches, she didn't need to be treated! If I hadn't been so committed to BF, I would have given up at least 2 dozen times. If I hadn't done any research, I would never have figured out anything (and would have quit), since our old pediatricians' office were not up to date on their information (nurses and doctors included). And how would I have know the difference if I hadn't looked it up myself? Plus, EVERYONE around wants you to formula feed- if you mention any problems with BF to someone who didn't, they will immediately tell you to formula feed because BF is a pain and formula is fine. I hadn't expected that; nobody told me of the resistance to BF I would encounter. I guess what I'm saying is to tell patients to keep asking for help and information until they get what they need- maybe even tell them that some people are not up to date with their info, so they'll have to be persistent about getting the best information if problems arise. Also tell patients to connect with other BF mothers so they have a safe place to voice concerns without getting attacked for BF in the first place! HTH...

[HelenD]

1) Ask the patient if they have any questions about BF and PATIENTLY answer them....
I know that Drs. have very little time and are extremely busy, but you can't imagine how immensely wonderful it is to have a Dr. who doesn't, literally or figuratively, have their hand on the door knob the entire time they are speaking to you. I think this is the number one impediment to patients (BF or not) asking the questions they really have. So, my number one comment is to check your body language for "ready to bolt" signals when you ask the patient (as I assume a good Pediatrician would) if they have any questions about BF (or anything else).

2) Ask the patient if they are aware of local support for BF after they leave the hospital…
Personally, the one thing that prevented me from giving up all together on BF was the local support group of moms hosted by a lactation specialist. This group offered support, education, and information that was just LIFESAVING for me. For the first 9 weeks, I lived for that Wednesday group so I could go and ask all the tons of questions I collected over the week. It was just VITAL for me in terms of the BF relationship surviving. You can’t imagine how much it helps to have some other mother who just had a baby say, “Yup, my DD nursed every hour and a half for week too, but they don’t keep that up forever – it’s just a growth spurt, and it will pass”. I think it’s very important for a doctor to understand that it’s not the questions they can think of at the hospital, when a patients just been through this mind, body, and heart (emotional) blowing experience. It’s the questions they’ll have tomorrow and over the next really hard few weeks. It would be WONDERFUL for a doctor to acknowledge this and to advise a patient of their options for support over the next weeks. It’s one thing to have a nurse tell you about something like this, but if the doctor can tell the patients about these groups in the area and explain how much it helps maintain this important BF relationship to have others with first hand experience and expertise to talk with – it really means something.

3) Tell the patient what’s normal for a BF baby…
Someone else mentioned this, but I do think it’s important for the doctor to acknowledge how hard those first weeks are; how the baby will want to nurse all the time AND why that is – ie not because they are starving or anything else horrific. Tell the mother what the poop should look like (all the variables and the loose consistency that are normal), how to know if the child it getting enough milk (suggest counting diapers if they’re worried, etc), how often the child will nurse at first and how it does get better, and any other general, basic things a new BF mom should know. It would be great if in a positive manner, the Dr. could dispel many of the BF myths all the well meaning neighbors, aunts, and grannies will give them over the next weeks about BF.

4) Tell the patient what’s not normal for a BF baby…
Give the parents guidelines or things to watch for that warrant a call to their pediatrician.

5) Encourage, Support, and Praise…
Tell the patient in terms of the health of the baby as well as their own health how GREAT what they have chosen to do is. It would take 2 minutes for a doctor to just run down very quickly some of the advantages of BF in a very congratulatory, praising manner. I think this kind of encouragement on the healthy choice they have made for their baby will help in the hard weeks ahead.

Sorry this is so long winded. I hope it helps some.

Helen

[lfp2n]

I just wanted to agree with other people. I think its important to emphasize that most people don't make much milk for the first 2-3 days and thats normal and the baby will be OK.

I think nurses need to be educated, you see them far more than peds and they are the ones who make you feel bad by saying they are crying because they are hungry- you could give a little formula.

People kept asking me whether my milk had 'come in', to this day I didn't know when it happened and I found the question very stressful. I didn't get engorged and it wasn't obvious what was happening.

I had to deal first with jaundice and bili lights and then with slow/no weight gain. I think that reassurance that both are fairly normal and it is completely possible to get through both without supplementation would be good. Just to take away the guilt that you might be doing something 'selfish' and harmful to the child by zealously sticking to BFing.

The other thing I think I learnt from these boards which seems obvious now is that most BFing supply problems are solved by more Bfing.

Hope the conference is good

Lucy (DD 3/27/03)