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"large" babies, glucose tests, and formula supplementation for newborns at Sibley and other hospital
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Anonymous
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This issue was mentioned on another thread, and I didn't want to hijack, but I have lots of questions...
I delivered #1 and #2 at Sibley. I'm now pregant with # 3. Both times, the nurses were "supportive" of BF, but also pushed very hard to get me to supplement with formula almost right away. With my first child, I gave in rather easily. With my second, I pushed back and said no, and then no, and then told them I wanted to speak to the pediatrician before they did that. I got a very scary lecture from the ped about how low glucose rates are a primary cause of mental retardation, etc. etc... needless to say, I gave him the formula. I'm trying to determine how much of this is real, and how much is a scare tactic used by hospitals to cover their butts. I am petite, my family has no history of diabetes, and I was never close to having high blood sugar during my pregnancies. My weight stayed well withing the normal range of pregnancy weight gain, and overall I felt like I was in pretty good shape for someone who was 9 months pregnant! With both babies, they were big healthy boys (8lbs 11 oz, and 8lbs 12 oz respectively). In the overall scheme of things, I was glad they were big and healthy, ... but they seemed in no way "giant" to me. Both boys had their glucose levels drop after birth. I was told, that 9lbs, is the official cut-off for "big" (i.e. higher risk) babies, and since mine were so close "we should really be watching their glucose levels." I was also know that its perfectly normal for an infant's glucose levels to drop after birth. Can anyone give me more information on this? When do I really need to worry? My suspicion is that the glucose levels would've self-corrected given a bit more time... but what do I know? |
Anonymous
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WTF???
I've never heard of this. My DD was 8lbs 9oz... The only reason I've heard to supplement in the first few days is if the baby has lost too much weight and there is a risk of dehydration. The best thing is to keep the baby at your breast - baby gets colostrum and helps your milk come in. |
Anonymous
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PP - did you deliver at Sibley?
Certainly there is an issue with weight loss too (which is related, but not the exact same issue). What makes the baby's blood sugar levels balance out? Is it the colostrum? Because clearly a BF baby isn't going to get any milk for at least 2-3 days. |
Anonymous
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My experience at Sibley isn't related to glucose levels by is on topic for supplementation pressure.
I delivered at Sibley and was pushed to supplement with formula by my day nurse. This was my second child, and so I questioned why I should have to supplement at all - she treated me like a bad mother for not wanting to supplement, and pressured me to get the 20 ccs in him at each feeding (I was in the hospital for four days due to a c-section and my son's meconium aspiration). My night nurse was wonderful and helped me through my breakdown one night where I was sure that due to all of this pressure to feed my son formula, I was sabotaging my breastfeeding. She got me on a schedule where I would pump before she brought me the baby, and then add whatever formula was needed to bring that up to the 20 ccs. She explained the reasoning for the supplementing pressure (slight jaundice) and arranged for the lactation consultant to come by and give me a pep talk in the morning. I think that the hospitals are covering their butts by forcing supplementation on all babies who might have a slight risk of something - they want to be able to document how much babies are getting, which they can't do with a BF baby. I really disliked just about all of the pediatricians at Sibley, including Dr. Cohen, who I had previously encountered at Pullman and Ariza, where she briefly worked before joining the staff at Sibley. She always made me feel like a bad parent - and doesn't like anybody to question her judgement. |
Anonymous
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I'm the 10:27 poster. I delivered at the Maternity Center (now closed) and then saw my regular pediatrician the next day.
Many, many women don't give any formula ever, including plenty who deliver at hospitals (like a friend of mine in Richmond who delivered via emergency c-section). I've never heard about pressure to supplement, unless the baby has lost too much weight (more than 10% of birth weight). |
Anonymous
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OP, your hunch is right that Sibley, while "supportive" of breastfeeding, often finds reasons to scare moms into supplementing. The truth is that they are NOT supportive of breastfeeding. Being supportive of breastfeeding means helping moms *breastfeed*, even if there is a borderline issue of some sort. Supplementing in the first few days of birth can do all sorts of things to damage the breastfeeding relationship, not to mention what it does to the newborn baby's gut. Sibley has yet to figure out how to offer supplementation only when it is truly medically urgent; as a PP mentioned, they do it at the very first signal that a potential problem might possibly be brewing. Which is basically all the time! (uh, which is unsurprisingly similar to how they do c/sections...but that's another post alltogether!)
To your specific problem an 8 pound baby is hardly "big." It is good and sturdy. Even a 9 pound baby is NOT risky. It's also good and sturdy, and many women who have taken good care of themselves during pregancy and who do not have GD, deliver perfectly healthy 9 pound babies. My first baby was born at a local birth center and was 8lbs 8 oz, and no one batted an eyelash. His glucose was not even tested. No one even thought to call him "big." He was just a healthy baby. If you want accurate information, my recommendation would be to schedule a consultation with Pat Shelley at the Breastfeeding Center (www.breastfeedingcenter.org). The scale for hospital born babies is incredibly skewed due to all the early inductions, so they see an 8 pound 1 ounce baby and start going on about how huge it is. Or, if a baby loses 8 or 9% of its body weight, which is COMPLETELY normal, they start encouraging supplementation because it is "too close" to 10%. The reality is that when a mom has been artificially filled with iv fluids during labor (which most moms are) the baby also takes on additional fluids and it's weight at birth is often inflated. Then, when it loses some of that water weight in addition to the normal weight loss, it's easy to hit the 10% weight loss. Yet, instead of taking this into consideration and instead of relying on other signs that the baby is getting enough breastmilk, Sibley instantly forces supplementation. Gah. Like I said, consult with the awesome lactation consultants at the breastfeeding center before you deliver. Stand firm. Ignore their scare tactics. The reality is that it is very very rare that a baby truly needs supplementation in its first few days of life, and the ONLY person I would trust to tell me if it was really necessary would be an IBCLC (that's an Internationally Board Certified Lactation Consultant.) Not a hospital-employed "lactation consultant", not my peditrician (peds do NOT have lactation training!!!!), not my OB, and certainly not any of the nurses at the hospital. |
Anonymous
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I had my second and third at Sibley. My second was under 9 pounds, although not by much. My third was almost 12 pounds, yes, I am a sideshow, and no, I did not have GD.
In neither case did the nurses push me to supplement. With Sideshow Baby, the discharging pediatrician said that once I was home, I might want to supplement with 1 oz after each nursing, just for a day or two, until my supply caught up. But he was very clear that that was because a hungry, screaming baby might make his brothers slower to warm up to their new sibling (and stress me right the heck out), not because there was any risk to the baby's wellbeing. |
Anonymous
| OP, I don't understand the push on "glucose" as a reason to supplement. Are you saying they tested your kids specifically for glucose levels? I recently had a 8 lb, 11 oz baby at VHC and I never even heard the word glucose while there. |
Anonymous
| My baby was born at Sibley a little over a year ago and she was just over 10 pounds. I never put up a fight about formula and I never felt pressure about this. I'm pretty close to delivering #2 now who will be over 10 pounds too. I don't get this glucose business. They did check my daughter's levels at birth but there was no issue. She was just a big girl. |
Anonymous
| I totally disagree with the poster who said that Sibley isn't supportive of breastfeeding. I had my first two babies there and found them to be pragmatic: try as hard as possible to feed the baby but top-up if the baby is really hungry. Seems sensible - who would want to start life with an empty tummy if it's not necessary. My third baby was born in a country that is on board with the WHO baby-friendly hospital thing. This essentially means that you are made to feel incredibly guilty if you want to give your baby formula, you're made to sign a form each time just to rub it in and people look at you like you're some kind a failure just because you want to bridge the gap between birth/colostrum and milk coming in. My obst said that several babies have had to be re-admitted to hospital because of dehydration/glucose issues. Talk about the perfect being the enemy of the good. I know all the arguments about a baby not needing top-ups etc but my kids have all been so much happier with a bit extra - and I was totally committed to breasfeedign them. So new-mom-to-be - do what you want but don't let anyone tell you one way of the other about how you should feed your child. You know best. It's your responsibility. My personal view is that, in the interests of trying to promote breastfeeding (a very good goal in my books) this whole debate had become nuts. I have b-fed my babies for different lengths of time according to their needs, my work etc and how much they liked nursing. The only problem I've encountered with formula feeding is the judgement of others. If you don't want any top up[s at Sibley then tell them. The only downside is that they might not want the baby in the nursery (because the yowling wakes up the others) but if it's what you want then just be clear. |
Anonymous
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Go deliver at Alexandria, I don't think they even mentioned formula to me...
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Anonymous
I am the PP who felt pressure to formula feed due to jaundice and I respectfully disagree with you. Perhaps you had a different experience but my nurse would come in at each feeding with the formula and was very irritated with me trying to nurse the baby first, and then top off after. If he wouldn't take the 20 ccs of formula, she made it clear that I was hurting my baby with my insistence on breastfeeding instead of formula feeding. He wasn't yowling, and the nurse was extremely unsupportive of my breastfeeding, which she insinuated was harmful to my baby. I understand that she was under pressure to document his fluid intake, and that if he was breastfeeding, she couldn't document it - it wasn't about what my baby needed, it was about what the chart demanded. |
Anonymous
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Although I generally think "nature is best"... I'm not one of those strident anti-formula moms.
However... I question why Sibley seems to push the formula supplementation so much. Nature made it so that our milk doesn't come in until the 3rd or 4th day. I can't believe this is a design flaw. And its not just as easy as saying "no thanks". The OP DID push back and was basically told she risked making her baby mentally retarded if she didn't supplement. Whether that was good advice or scare tactics is anyone's guess. But I think she's trying to find out the facts for herself. It does sound like many nurses at Sibley try to push some formula. Maybe it has to do with the number of wet/soiled diapers they want to see? I vividly remember the chart they asked me to fill out. |
Anonymous
| I just responded to a similar post. I was also encouraged to supplement my 5lb 15oz daughter with formula due to low glucose levels and a slight case of jaundice (she needed to wear the blanket for several days). I wonder if it was really necessary? I can't remember who suggested it now, but they also got me a rental pump immediately and i pumped the colostrum & fed to the baby (while also nursing her). Once her sugar levels were high enough (2 days) we stopped formula and have never looked back. she's now 6 mo old & still BFing exclusively. |
NICURN
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Member Offline
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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! |