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Thread: Need Support: MD not supporting BF on the breast

  1. #1
    Join Date
    Oct 2007
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    Default Need Support: MD not supporting BF on the breast

    I feel stuck communicating with our MD. I just need lots of supports going forward with BFing Penga.

    GOOD news is: My little Penga UNOFFICIALLY started BF yesterday.

    During Kangaroo-care, she started to root for my breast, latched on it, and gave stronger sucks than before. Yesterday was the first day she managed to cause milk let-down. But yesterday she desat and needed oxygen support (BTW, Penga is off nasal cannula as of yesterday!!). Today, however, she paused frequently after sucking and managed to have a little amount of milk without having desat. Nevertheles, it is a slow process and I know she was getting frustrated that her tummy was not fillilng fast. I was hoping I could work with LC to find the way so Penga will be able to associate BF with filling tummy.

    BAD news is: that MD does not approve of Penga (officially) starting BF nor finger-feeding (which was a suggestion from our LC) and instead ordered bottle-feeding.

    He thinks finger-feeding is too dangerous to my little Penga (now 3lb 12oz and 36 weeks gestational, born at 25 weeks) for the fear of her aspiring BM into lung. He said all the 5 main MDs in our NICU agree with him. Basically what I have found out is that alternative way of supplementation (rather than bottle-feeding) is hardly used in this NICU for the same reason.

    He also said they do not allow BF first then supplement with bottle-feeding method, because Penga won't have energy to complete feeding.

    There was a director of the care in the unit at the scene, and she told me that there is no nipple-confusion - 99% of moms are fine transitioning from bottle-feeding to direct BF w/o problems. However, when I talk with the outpatient LC of the hospital (this breastfeeding -riendly NICU does not even have an inpatient LC,) they laugh at the myth, confirming they do work with NICU graduates' moms to correct nipple-confusion and other problems.

    The MD also downgraded the importance of the Kangaroo-care, saying "it is OK for you to Kangaroo your daughter for bonding." It clearly shows his ignorance about medical benefit of Kangaroo care.

    I have been talking with my allies in the NICU - some nurses and social worker. They agree that our MDs have very narrow scope in what the patient care is about.

    So what came out of all this is that Penga will receive bottle-feeding so they can assess her readiness for nipple-feeding. Once they think she is ready, she can BF gradually, but only after she gains more weight.

    I accepted the above, because Penga is learning to BF on her own. Plus my LC was feeling "in-between" and pulled herself out of the scene today. I have a feeling that she was threatened by the MD for interferring their "medical" care. Without her support, I don't think I can continue the way I envisioned.

    Oh my head hurts and I feel so emotional about not speaking the same language with MD. I am just hoping Penga will not forget what she has learned during the last 4 weeks - that mommy's breast is a welcoming place with a special food for her.
    Last edited by wakawaka; October 30th, 2007 at 05:35 PM.

  2. #2
    Join Date
    Jul 2007
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    960

    Default Re: Need Support: MD not supporting BF on the breast

    big hugs to you mom. Some moms Im sure with similar experiences will be here soon. You seem very determined to bf, if problems do ensue with nipple confusion you can get through it...look what you have already overcome!
    congrats
    kate
    My little May baby just turned THE BIG ONE!
    Formally known as kaykate23

  3. #3
    Join Date
    Feb 2007
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    Default Re: Need Support: MD not supporting BF on the breast

    Wow, I'm so sorry that the doctors are being unsupportive. I can empathize. I went through something akin to this (though I don't want to minimize your experience by comparing directly - mine was just hospitalization for jaundice), with doctors not supporting breastfeeding in the hospital. All I can say is in the end, it is your daughter they are treating. Get all the facts, make your wishes known, and fight for what you determine is the best course of action. You should be very proud of what you and your daughter have accomplished so far.

  4. #4
    Join Date
    Feb 2006
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    Default Re: Need Support: MD not supporting BF on the breast

    Quote Originally Posted by wakawaka View Post
    I feel stuck communicating with our MD. I just need lots of supports going forward with BFing Penga.

    GOOD news is: My little Penga UNOFICIALLY started BF yesterday.

    During Kangaroo-care, she started to root for my breast, latched on it, and gave stronger sucks than before. Yesterday was the first day she managed to cause milk let-down. But yesterday she desat and needed oxygen support (BTW, Penga is off nasal cannula as of yesterday!!). Today, however, she paused frequently after sucking and managed to have a little amount of milk without having desat. Nevertheles, it is a slow process and I know she was getting frustrated that her tummy was not fillilng fast. I was hoping I could work with LC to find the way so Penga will be able to associate BF with filling tummy.

    BAD news is: that MD does not approve of Penga (officially) starting BF nor finger-feeding (which was a suggestion from our LC) and instead ordered bottle-feeding.

    He thinks finger-feeding is too dangerous to my little Penga (now 3lb 12oz and 36 weeks gestational, born at 25 weeks) for the fear of her aspiring BM into lung. He said all the 5 main MDs in our NICU agree with him. Basically what I have found out is that alternative way of supplementation (rather than bottle-feeding) is hardly used in this NICU for the same reason.

    He also said they do not allow BF first then supplement with bottle-feeding method, because Penga won't have energy to complete feeding.

    There was a director of the care in the unit at the scene, and she told me that there is no nipple-confusion - 99% of moms are fine transitioning from bottle-feeding to direct BF w/o problems. However, when I talk with the outpatient LC of the hospital (this breastfeeding -riendly NICU does not even have an inpatient LC,) they laugh at the myth, confirming they do work with NICU graduates' moms to correct nipple-confusion and other problems.

    The MD also downgraded the importance of the Kangaroo-care, saying "it is OK for you to Kangaroo your daughter for bonding." It clearly shows his ignorance about medical benefit of Kangaroo care.

    I have been talking with my allies in the NICU - some nurses and social worker. They agree that our MDs have very narrow scope in what the patient care is about.

    So what came out of all this is that Penga will receive bottle-feeding so they can assess her readiness for nipple-feeding. Once they think she is ready, she can BF gradually, but only after she gains more weight.

    I accepted the above, because Penga is learning to BF on her own. Plus my LC was feeling "in-between" and pulled herself out of the scene today. I have a feeling that she was threatened by the MD for interferring their "medical" care. Without her support, I don't think I can continue the way I envisioned.

    Oh my head hurts and I feel so emotional about not speaking the same language with MD. I am just hoping Penga will now forget what she has learned during the last 4 weeks - that mommy's breast is a wellcoming place with a special food for her.

    Bravo, Penga! She knows what is best for her! BF is actually LESS likely to result in O2 deccreases/desats. At 36 weeks she may still need a bit more time ot coordinate suck, swallow, breathe at breast; however, the flow from the bottles used in most NICUs is more liekly to result in behaviors associated with airway distress.

    While it may not be feasible for all feedings to be at the breast and it may be necessary to limit BF to 10-15 minutes, I'd strongly disagree with the neos -- and, personally, I'd be asking them to come up with research refs to support their position. (It may help to pump completely to a bit as Penga learns to handle let-down before kangarooing or putting her to breast. Pumping to through or to let-down will mean she "works" less hard at breast initially, that she won't have to cope with a stronger let-down, and she'll get more hindmilk when there.)

    I'll be back in another post with a bunch of refs for you to give to your LC, the NICU staff, and the neos. Tell them you're willing to discuss this further AFTER they've read the info.

    Penga is YOUR baby -- not theirs. YOU more than anyone wants her to be healthy. YOU are her advocate and YOU have every right to expect them (neos and NICU staff) to know breastfeeding as well as breast milk. Don't be afraid to challenge them or stand up for yourself and Penga. This usually can be done in a nice way. Neos/physicians/all NICU staff are supposed to be scientists and their clinical practices are supposed to be based on good research evidence. They should be able to explain any/all their recommendations -- until you feel truly comfortable with each of them. Never be afraid to ask for the research reports that support any given recommendation.

    There is a lot we still don't know about "best practices" as they refer to transitional diets for preterm to older/borderline term to former preterm infants. Not all current recommendations or practices are based on good research.

    Off to get some references for you...

  5. #5
    Join Date
    Feb 2006
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    422

    Default Re: Need Support: MD not supporting BF on the breast

    Here's a few references that may be of use.

    Part I: Nutritional Support for VLBW (toolkit): http://www.cpqcc.org/Documents/Nutri...ionToolkit.pdf

    Part II: Nutritional Support for VLBW (toolkit): http://www.cpqcc.org/NutritionIIToolkit.htm

    Academy of Breastfeeding Medicine (ABM) protocols:
    http://www.bfmed.org/ace-files/proto...adProtocol.pdf
    http://www.bfmed.org/ace-files/protocol/near_term.pdf

    Bier JAB, Ferguson AE, Morales Y, Liebling JA, William Oh W & Vohr BR (1997). Breastfeeding infants who were extremely low birth weight. Pediatrics, 100(6), e3. Accessed http://pediatrics.aappublications.or.../full/100/6/e3 on October 29, 2007.

    Henderson G, Fahey T & McGuire W (2007). Multicomponent fortification of human breast milk for preterm infants following hospital discharge. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD004866. DOI: 10.1002/14651858.CD004866. Accessed http://www.cochrane.org/reviews/en/ab004866.html on October 29, 2007.

    http://www.rush.edu/rumc/page-1098987364943.html

    These are for you! http://www.texaschildrenshospital.or...edingguide.pdf

    http://www.kellymom.com/babyconcerns...p-preemie.html


    Don't know if it helps to know that I have some initials -- besides LLL leader -- after my name in auto signature line. (If of use, they're MSN, RN, IBCLC.)

  6. #6
    Join Date
    Oct 2007
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    50

    Default Re: Need Support: MD not supporting BF on the breast



    Thank you everyone! I feel better reading all the postings.

    Having emotional support, empathy from moms with previously hospitalized baby (we all feel same even though our situations are slightly different ), and great research all uplifted my sanken spirit:-)

    Karen, thanks for the links . I've been reading the articles. Especially interesting is Bier et.al's 1997 study and their recommendation to increase opportunities for ELBW babies to breastfeed AND what CPQCC (BTW, I live in California) considers a barrier for best practice: "OUTDATED recommmendations that infants must prove they can feed by bottle, before being allowed to go to the breast."

    I'm thinking about how to approach doctors. The doctor who talked with me yesterday was frankly very agitated. I will talk with my allies and the director first, sharing these data/info first to see their suggestions of how to approach the doctors. At the back of my mind is to bring it to the hospital's bioethical committee if I feel I need an arbitrator.
    Last edited by wakawaka; October 30th, 2007 at 07:58 AM.

  7. #7
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    Feb 2006
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    422

    Default Re: Need Support: MD not supporting BF on the breast

    Quote Originally Posted by wakawaka View Post

    I'm thinking about how to approach doctors. The doctor who talked with me yesterday was frankly very agitated. I will talk with my allies and the director first, sharing these data/info first to see their suggestions of how to approach the doctors. At the back of my mind is to bring it to the hospital's bioethical committee if I feel I need an arbitrator.


    I think your idea to speak with "allies" and the director first is excellent. Definitely a best first step! Good luck -- and keep us all posted on this issue and your baby's progress!

  8. #8
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    Default Re: Need Support: MD not supporting BF on the breast



    Keep us updated!


  9. #9
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    Oct 2006
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    Default Re: Need Support: MD not supporting BF on the breast

    Remember, too, that you are the mom. Whether or not the doctor agrees, you get to have a say. It takes a lot of advocacy, but someone has to start the ball rolling. If you find some good information, take it to the doctors. I'd be tempted to call a NICU that does support breastfeeding and ask them for information.

    30 years ago, one of my friends had a baby with jaundice who ended up hospitalized. At the time, the medical establishment felt that babies with jaundice should not be breastfed and wrote orders to that effect. The nurse walked in to find my friend breastfeeding and told her that bottle feeding was ordered. My friend told her "I'm the parent and this decision is mine."

    I can't say which way is medically better. I've never been in your position. But, I would educate myself and then advocate for my baby.

  10. #10
    Join Date
    Oct 2007
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    Default Re: Need Support: MD not supporting BF on the breast

    Today, I talked with my social worker. She suggested to show data and talk with Penga's doctor first, then his boss, head MD in the NICU. If that is not fruitful, then I can go to a committe for arbitration.

    The social worker already hinted to the head MD that I was thinking about discussing the issue and from what I heard, he was willing to listen.

    I plan to talk with the doctors tomorrow to request for me to BF Penga first, and for them to consider safer ways of supplementing (finger-feeding and SNS).

    Today, I watched Penga drinking the bottled EBM from the OT. I asked her whether she could also assess Penga's ability to breastfeed. OT was delighted but after consulting with the nurse, she came back and said it is the NICU's protocol not to teach two different techniques of feeding because Penga will be confused (and it was the MD who said nipple confusion does not occur), thus she could not assess. OT also mentioned Penga would be too tired.

    Both OT and nurse pressured me to hold Penga to feed, which I repeatedly refused, explaining that I would hold and feed Penga only if it is BF so Penga would associate me with BF only. I told them my husband would be available to learn how to bottle-feed, but until Penga masters BF, I would not.

    OT, though, at the end of the session, with a wink, told me to continue challenging the doctor by asking questions. I will.

    Penga almost got a full feed, but desat and needed oxygen twice. After that session. I tried to Kangaroo Penga in vein, because she continued to desat and needed blow-by O2 and I needed to put her back to incubator. It took an hour for her to calm down, and by the time she was calm, it was time for me to leave the NICU to pick up my other daughter from school......

    Bottle-feeding is already interfaring our Kangaroo relationship

    Please wish me a good luck.
    Last edited by wakawaka; October 31st, 2007 at 07:09 AM.

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