Those of you who went to Sibley and BF....

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[Post New]02/11/2008 20:04
Anonymous
Agree with PP, the Breastfeeding Center is awesome! My ped (Edmonds) did give me bad advice, confirmed by the Breastfeeding Center who got me on the right track.
[Post New]02/11/2008 20:37
Anonymous
I am the PP who asked to supplement for one feed in the middle of the night . . . just wanted to mention that supplementation is no guarantee that your baby will not lose weight after birth. Despite supplementing, my son still lost more than 10% of his birthweight in the first few days. Luckily, we had no nipple confusion problems, and he had a good latch/suck from the start. I just kept offering him a boob or two every 90 minutes or so during the day/evening, and let him suck for as long as he wanted. My milk came in on the third day and he was back to his birthweight within a week after we left the hospital. I am a huge proponent of using the nurses and the nursery while you are there--get some sleep, because you won't once you get home--but you shouldn't feel pressured to supplement, and should only do so if you want to. If you'd rather not, you can still send your baby to the nursery and they will bring him/her to you for every feed in the night.

And--unsolicited advice--take some snacks. The food at Sibley leaves a lot to be desired and you need calories to make milk!
[Post New]02/11/2008 23:45
Anonymous
Just adding another experience -- no one suggested supplementation to me when I delivered my son. The night nurse asked whether I wanted to nurse him for all of his feedings or if I wanted to sleep and have him have formula for any of them. I said I wanted to nurse, and that was it. But no one ever suggested supplementing for nutrition (and I had an early baby -- 36.5 weeks -- who was 6 lbs). I'm about to have my second there in a few weeks and will post if my experience is different -- if nothing else, I'll be on watch for this!
[Post New]02/12/2008 08:10
Anonymous
Yes, Sibley is great for getting you your baby immediately after delivery so that you can get the baby latched on. However, they also find many many reasons to get you to supplement. Supplementation is no good for a newborn baby. Their belly is only as big as a marble, and supplementation creates a situation where they get more food than they need, and thus makes the baby dissatisfied with just colostrum. Not to mention the potential for nipple confusion/preference which can indeed be a problem for some babies. Not to mention the fact that your breasts need to be generously stimulated throughout the first few days in order to build a healthy milk supply. Not to mention how formula irritates the babies new intestines....and on and on. It's a bad idea to supplement a brand new breastfed baby, and Sibley often seems dead set on doing it, unless of course you willingly do it first! Anyway, it's just something to be very aware of.


I completely agree with this poster. There's another thread here about large babies and supplementation that you ought to read. While many mothers are not pressured to supplement, I was pressured to supplement, and a good friend of mine left Sibley with a pacifier that nearly sabotaged her efforts at breastfeeding. She did end up going to see Pat Shelly and was able to catch up with her milk supply. My advice to you is to go to the breastfeeding center for a consultation if you end up having issues at Sibley. The main reason I was able to continue to breastfeed my son was because I breastfed my daughter and know that my body can make food for a little human.

[Post New]02/12/2008 18:56
sgoga
Member Offline
Sibley will make you supplement if the baby looses more than 10% of weight. However, you can supplement with breast milk (you pump and feed) and you do not have to bottle feed. The nurse taught us how to cup-feed my baby so we never used a bottle or formula.
[Post New]02/12/2008 20:27
cmkeough
Member Location: Arlington, VA
Offline
To the doula - I just delivered my baby at Sibley last Monday (2.4.08) and never once experienced that the nurses wanted me to supplement with formula. Rather I felt that it was quite the opposite. I didn't feel as though my DD was getting enough nourishment and was concerned and asked about supplementing. They told me to continue to try and nurse. One of the nurses (we called her nurse Ratched) brought in a pump and told me to use that after each attempt to stimulate my breasts to produce.

So maybe it depends on what nurses are on duty. But I honestly felt as though everyone was all about the BF rather than formula feeding.

Just my two cents.
[Post New]02/21/2008 15:30
Anonymous
I read this thread with great interest. I delivered at Sibley last August, 3 wks early. My babe was 5lb 15oz and apparently had low blood sugar levels. I told the nurses before delivery that i wanted to BF exclusively. My daughter was with me immediately after delivery and everyone i encountered was very supportive of BFing. HOWEVER, they did (strongly?) suggest that we supplement with formula to get her blood sugar levels up to a certaiin threshold. I nursed her on demand during our stay in the hospital, but we also supplemented for 2 days until we got the "all clear" on the blood sugar levels. She has been exclusively BF since then (now 6 mo). Now, reading this post makes me wonder if we really needed the formula for those first 2 days???
[Post New]02/21/2008 18:18
Anonymous
In a baby that small, I'm sure you did.
[Post New]02/22/2008 02:33
Anonymous
In a baby that small, I'm sure you did.


Well, not really. The size of the baby does not automatically mean anything. "Too small", "too big" -- those are both (misguided) constructs of the obstetric community. The truth is that you will probably never know what the situation really was with your baby, although I have to say CONGRATULATIONS for the great breastfeeding relationship you've wound up having! Try not to stress about the past, as you can see that "alls well that ends well."

What you can do to prepare for the next baby is to have made contact with a great lactation consultant, preferably one who is not hospital-based and who is an IBCLC, so that you have someone to call and get advice from should this situation arise again.

[Post New]02/22/2008 18:46
Anonymous
I had my first baby at Sibley, who arrived at 9lb. 12 oz., and not surprisingly, he lost that sacred 10% of his birth weight within the first two days, and the nurses wanted me to supplement. The worst part was that they discovered he fell below the 10% at their 11pm weighing so when they brought him back to me, I was sleeping and they woke me up demanding that I supplement. It wasn't a good moment. By holding to my guns, I finally got the nurse to allow me to get a pump and pump some milk (well, colustrum, really) for him rather than formula. So remember you can always ask to pump if you would prefer to exclusively breastfeed. Also, you can ask the nurses to put a note on the baby's bassinet requesting no bottles (and/or no pacifiers) as a reminder when the baby is in the nursery. Not sure the nurses always respect it, but I'm sure many do.
[Post New]02/28/2008 11:28
Anonymous
I am a Neonatal Intensive Care Unit RN cross-trained in Family Care (also known as Postpartum). I wanted to reply to the string of comments regarding hospitals and the use of supplementation.
First and foremost I want to address the fact that everyone will have a completely different experience. Labor experiences, birth outcomes, your staff etc all contribute to your experience. Although it is regrettable that some patients will leave unsatisfied with their experience, I would not conclude that their experience is 'typical'.
So, I would like to share a nurses viewpoint when it comes to breastfeeding and bottlefeeding and give you an inside look as to why supplementing may be neccessary. There are only a handful of scenarios in which it would be deemed neccessary to supplement oppose to breastfeed a newborn. These include an excess weight loss, jaundice, hypoglycemia, maternal disease where breastfeeding is contraindicated or maternal disease that separates mom and baby in the initial postpartum period, and prematurity. I will address these briefly so that there is a general understanding as to why a baby must be supplemented in these situations.
Excess weight loss- Yes! All babies lose weight in the first 10 days of life. Normally up to 10% weight loss is acceptable and expected. However, some babies lose weight incredibly quickly, their output is more than their input and consequently they become dehydrated and for some babies, especially those who are starting at small weights, are put at risk.
Jaundice- Jaundice is an accumulation of bilirubin (byproduct of red blood cells) which turns the skin yellow. Your baby will be monitored for jaundice as nearly 80% of babies despite age or weight will develop it. The primary mechanism for eliminating bili is through urine/stool excretion. To accelerate this process, supplementation is often used sometimes accompanied with phototherapy. Dehydration is also of concern when babies are receiving phototherapy due to the continual heat source.
Hypoglycemia- babies who are extremely low and extremely high in birth weight, babies born to moms with gestational diabetes and occassionally the healthy, term baby of appropriate weight can be at risk for hypoglycemia (low sugars). Those at risk will be monitored periodically to ensure their sugars are regulated. Others will be tested on if they are symptomatic (jitteriness etc). There are protocols and it is dependent on the sugar levels. If babies are borderline, we may encourage mom to breastfeed and than 30 mins later we will repeat the test to see if they sugar levels increased. In cases where the babys sugars stay low despite feeds, supplementing them is utilized to prevent persistent hypoglycemia which can lead to seizures etc. In other cases where the babies sugars are at a very low level, supplement is given not breastfeeding because the colustrum provides an insufficient level of glucose and volume in the first hours of life. And for babies with critical lows, IVs are started.
Maternal disease- Some diseases such as HIV breastfeeding is contraindicated. Sometimes moms have complications with their pregnancy/delivery and end up on medications that are contraindicated for breastfeeding. And in other instances, moms are so ill they remain in the labor/delivery unit or even Intensive Care for observation. Naturally these babies remain with the NICU as 'border' babies and are often supplemented because mom is not well enough to breastfeed and may not be well for a few days.
Prematurity- Babies born prematurely are often low in birth weight, have feeding difficulties, require additional calories for growth and support and have an increased need for stable glucose for proper development, temperature regulation etc.
In these scenarios, nurses alert neonatologists or pediatricians regarding the babies status and often it is the MD who orders supplementation. Only per protocol would a nurse directly request supplementing a child (ie in the case of a hypoglycemic baby). Only if a parent requests supplement is it provided without an order.
It is important that new moms realize that as much as we respect your wishes to breastfeed, there are situations that render a different careplan. This is NOT the hospitals or nurses or doctors desire to thwart you from breastfeeding. Our primary interest is to ensure you go home with a healthy baby. The lasting effects of untreated hypoglycemia, jaundice, weight loss etc are delayed development, neuro damage, even death. We must remember that the initial period after birth is quite tramatic and requires alot of transition for the newborn. It is not uncommon for babies to struggle in the first day of life regarding breathing, temperature regulation, sugar regulation etc. It is the role of your nurse and other providers to continously monitor the infant for any signs of distress, and consequently treat them if needed.
It is unsafe to presume every baby is healthy and will not have complications. Although most of us moms walk in the door with our birthplans and feeding plans in pocket, it is very common for those plans to be modified because of unpredictable circumstances. Unfortunately very little is published to educate and prepare parents for the "what if's" and we are misguided into believing that we can control every detail of our hospitalization. Remember mentality is everything. I experience a wide range of attitudes from parents who come with open minds and flexibility and do not stress about neccessary interventions to those who want to justify why their plans are sufficient and refuse to acknowledge their babys health can be put at risk.
The best you can do is to communicate. Let everyone know what your hopes are. If you find yourself in a situation where plans change, understand the rationale. Ask how you can support your baby in the process (ie breastpumping etc). And although it might be annoying to have to repeat yourself every shift, understand that parents change their plans just as frequently and our role is to support those decisions by knowing how we can best care for you and your newborn while we are on duty.

Thank you for listening. Best wishes to all the moms to be!











[Post New]02/28/2008 11:51
Anonymous
What a great post! Thank you so much for giving an informed medical opinion as to the reasons why supplementation may be recommended. Since I haven't been to medical or nursing school -- nor, would I venture to guess have most of the people on this Board -- it's great to hear input from someone who has.
[Post New]02/28/2008 14:42
Anonymous
Thank you so much for giving an informed medical opinion as to the reasons why supplementation may be recommended. Since I haven't been to medical or nursing school -- nor, would I venture to guess have most of the people on this Board -- it's great to hear input from someone who has.


I, too, appreciate the input of the NICU nurse, although I will say that medical opinion is often formed despite lack of training in human lactation. The problem is that the very people who are in a position of power do not necessarily have the most accurate information. Your obstetrician, hospital nurse, pediatrician -- it is likely that none of them have had formal breastfeeding training. Maybe there was one day of class where it was mentioned. That is the big problem I have with the trust that is given to these medical professionals with regard to breastfeeding, and why it bothers me that so many parents feel forced to supplement their babies in hospitals.

There are only a handful of scenarios in which it would be deemed necessary to supplement oppose to breastfeed a newborn. These include an excess weight loss, jaundice, hypoglycemia, maternal disease where breastfeeding is contraindicated or maternal disease that separates mom and baby in the initial postpartum period, and prematurity.


Except this is not a list of rare and unusual circumstances. You go on to say that 80% of all newborns have some degree of jaundice! People who are true experts in lactation (like IBCLC's) will tell you that breastfeeding is actually better for most babies with jaundice. They will also tell you that breastfeeding is better in a number of these other situations as well. Or, if supplementation needs to happen, that there are very specific ways that it should be done. For example, why are bottles EVER being given to breastfed babies in the hospital? Unfortunately there seems to be a wide gulf between the lactation experts, and what happens day-to-day in our hospitals and newborn nurseries. In fact, for almost every single issue that was mentioned above, there is legitimate debate about the correct way to handle it with regard to breastfeeding. For example, high or low birth weight babies DO NOT automatically need supplementation. No, no, no! And premature babies need breastmilk even more than full term babies. Another thing is that many doctors do not have accurate information regarding which medications are contraindicated for breastfeeding, and either tell the mom (incorrectly) that she may not breastfeed while using a medication, or fail to prescribe something that she *can* safely use. Unfortunately many doctors still use the PDR for this type of information, instead of the other, vastly more reliable, guides which are available.

Basically we've gotten an excellent explanation of what typical hospital protocols include. So, if you are a parent or parent to be and breastfeeding is very important to you, and you are concerned about any of these issues, my advice is to make sure to thoroughly do your own research and consult with an IBCLC.

It is unsafe to presume every baby is healthy and will not have complications.


I don't think anyone believes that every baby is perfectly healthy; however it does seem that hospitals seem to find illness and problems when there aren't any. Hospitals don't seem to recognize the "wide range of normal" that can naturally occur -- not in labor and delivery wards, and not in their newborn nurseries. Instead, it seems that most babies are treated agressively, and nurses (who don't necessarily know anything about breastfeeding) continually implement policies that are not breastfeeding-friendly.
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