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

  1. #11
    Join Date
    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
    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.

    Personally, I don't think bottle-feeding has to interfere with breastfeeding. I think the feeding technique and the bottle nipple flow rate make an enormous difference. Research indicates babies suck the same on bottle nipples IF the flow rate does not overwhelm their oral space/airway. Another LC colleague and I tested a bunch of nipples for flow rate; found all disposable hospital types to be too fast, although one seemed better/a bit slower than some others. A few commercial brands appeared to be OK (and parent feedback concurs) but NICUs are likely to be hesitant about bottles/nipples being brought into the hospital. In spite of mother, LC or other health professional opinion/bias, there is NO "perfect" supplementary feeding device...

    For example, there's no evidence that finger-feeding results in better (or worse) long-term BF outcomes -- transition to BF, BF duration, etc. than any other supplementary device. The tissue on the finger is not the same as the tissue of the breast. It can help the feeder notice changes in an infant's ability to "organize" re: sucking, but it can also result in oral "pursing."

    The SNS or Lact-Aid nursing supplementer is not designed to help an infant "learn" to BF; an infant needs to be able to BF fairly effectively already to use it. However, it can be a great way to offer extra nutrition and increase production when an infant is BF fairly well. Negatives reported with this type of device -- can be messy or a pain to use, clean, etc. and some babies get "hooked" on the tube.

    Re: NICU nurse and protocol about teaching 2 different methods of feeding -- request a copy of that protocol and read it closely. Ask for the research report evidence upon which it should be based. If the protocol is as described, it makes NO sense! Penga's learning (or trying) to coordinate breathing with sucking and then swallowing. BF is the biological norm and associated with infant body systems' stability, so should be 1st on any list; bottle-feeding (including flow rate) should simulate BF.

    It would be extremely helpful for the OT's education to have her observe BF. However, it may help to BF before bottle-feeding (or finger-feeding, etc). Or, if Penga's really hungry, give her a little by bottle to decrease hunger, then BF, then can finish by bottle. Lots of moms find the best routine is to be available before a feeding, pump (so let-down isn't too strong), kangaroo, let kangarooing "lead" to BF (with or without a nipple shield based on baby's ability/energy/etc.) for 5-15 minutes, and finish with EBM (fortified or not) via a supplementary method. (Because preterm babies have less mature oral structures and lower endurance, they can't keep up with "organized" suckling as long as term infants, so limiting BF activity to avoid "disorganized" feeding behavior with the supplement is pretty typical in NICUs -- and generally makes sense.)

    Personally, I wouldn't be concerned at this point re: Penga associating you with other kinds of feeding if it means she's in your loving arms instead of a staff person's for feedings.

    Poor Penga with the desats... How scary that must feel for her. Question -- was the number different or her response to desat different with BF vs. the bottle-feed? I'm surprised the kangarooing didn't help her stabilize more quickly.

  2. #12
    Join Date
    Sep 2007
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    59

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

    First I am glad to hear yoru dd is doing well. Sorry I cannot remember how many weeks you said she is now.

    I was an NICU SWker for 9 years and our MD's were very supportive of NICU moms BF. However sometimes they did discourage it. BF takes more work than bottle feeding and preemies do run the risk of burning calories ( which they cant afford to burn).

    However it doesnt seem like that is the perspective of your MD

    Remember that MD's are people...they ( contrary to their belief sometimes) are NOT GOD. You dont agree with something then push the issue and yes go over their head! If there is n RN that seems to be supportive of you , ask that he/she be the primary RN. Work with the RN so you are getting Kanagroo time.

    Mostly just hang in there. The NICU experience is hard enough without MD's being a pain in the rump!! Your social worker is a great asset as he/she can advocate for you and baby


  3. #13
    Join Date
    Oct 2007
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    50

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

    Today, I talked with Penga's doctor briefly and submitted our proposal (for her to continue to learn breastfeeding and that should be the primary focus on her feeding plan) with medical literature (from the links Karen posted). The doctor was not receptive, saying "it is OK for you to read things on the internet, but..." Then he tried to threaten me by saying he did not know whether Penga was going to survive at the time of her birth (implying we should leave it up to the MD because we, the parents have no idea how delicate her condition is - she is stable but requires caffeine and reflux med - but I think it is not uncommon for preemies anyways.) I tried to maintain my smile (I know, I know, because "I" was told on the day she was born that her survival rate was 50% and nobody assured us that she would survive during the first couple of weeks of NICU stay while maintaining that she was in a stable condition.) I just asked him to review our proposal and attached literature (including the Journal of AAP article –breastfeeding is less stressful for ELBW preemies).

    The doctor and I will talk tomorrow (possibly with the head MD). The head MD declined to receive the proposal/articles directly from me, saying he would talk with Penga’s doctor so there is no need for him to read them - he was friendly, though.

    I am considering asking the social worker to be present when I talk with the MD tomorrow (Penga’s doctor tends to interrupt me before I complete my sentence and try to scare me by emphasizing how delicate Penga is.).

    As for Penga’s condition, she had residulas for the first time in a long time - when asked, MD did not recall the time when residula was observed but he said it was probably in the afternoon. She did not desat today during her bottle-feeding, but before and after the feeding session, she needed blow-by O2. Today’s nurse let me Kangaroo Penga about 1 hour after bottle-feeding was over, but we needed to keep giving her blow-by for longer time than yesterday. I suspect that bottle-feeding is causing her not to digest BM well and causing desatting, but it is hard to tell - I plan to bring it up during tomorrow's meeting.

    I plan to visit NICU early tomorrow so I will have a chance to Kangaroo Penga longer to give her the O2 boost. I am afraid though if she tries to BF during Kangaroo, doctor might reason BF as the cause of another desat afterward.

    Although Penga was desatting, she still looked very relaxed during the Kangaroo session – she rested her head on my left chest and enjoyed listening to my heart-beat, looked up at me and smiled. She had sucking motion and putting her hands to her mouth (hunger sign) so I put her on my breast and she gave me little sucks – I moved her up higher because she fell asleep after that….. These are the moment that I would like to try to be optimistic and positive for little Penga.
    Last edited by wakawaka; October 31st, 2007 at 09:41 PM.

  4. #14
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    Oct 2007
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    50

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

    Quote Originally Posted by Karen Gromada View Post

    Poor Penga with the desats... How scary that must feel for her. Question -- was the number different or her response to desat different with BF vs. the bottle-feed? I'm surprised the kangarooing didn't help her stabilize more quickly.
    Just a quick comment on the desat:
    The last BF session with Penga on Monday, when she managed to cause let down and I believe she swallowed some BM- she did NOT desat at all! The day before (Sunday) when the similar thing happened, she de-sat and needed to be suctioned. I was surprised that Kangarooing did not help much both yesterday and today, but it seems that she is having a real hard time now. At least today, she looked peaceful and relieved when I held her.
    Last edited by wakawaka; October 31st, 2007 at 09:41 PM.

  5. #15
    Join Date
    Jan 2006
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    561

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

    Quote Originally Posted by wakawaka View Post
    (Penga’s doctor tends to interrupt me before I complete my sentence and try to scare me by emphasizing how delicate Penga is.)
    Hel-LO! That's why you want to BF instead of giving her a far less appropriate alternative, isn't it?? I really feel for you having to deal with that doctor. If I were in that situation, I would have a hard time keeping my composure. Good luck; you seem to be doing very well so far!

  6. #16
    Join Date
    Oct 2007
    Posts
    50

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

    Quote Originally Posted by mom of teen and baby! View Post
    First I am glad to hear yoru dd is doing well. Sorry I cannot remember how many weeks you said she is now.

    I was an NICU SWker for 9 years and our MD's were very supportive of NICU moms BF. However sometimes they did discourage it. BF takes more work than bottle feeding and preemies do run the risk of burning calories ( which they cant afford to burn).

    However it doesnt seem like that is the perspective of your MD

    Remember that MD's are people...they ( contrary to their belief sometimes) are NOT GOD. You dont agree with something then push the issue and yes go over their head! If there is n RN that seems to be supportive of you , ask that he/she be the primary RN. Work with the RN so you are getting Kanagroo time.

    Mostly just hang in there. The NICU experience is hard enough without MD's being a pain in the rump!! Your social worker is a great asset as he/she can advocate for you and baby

    Thank you, Kelly! BTW, Penga is a 25 weeker, now 36 week gestational (Penga has been in NICU for the last 11 weeks.)

    You social workers are greatest people that are so supportive and resourceful at the same time. Penga has been in 2 different hospital and I have worked with 2 social workers. I love both of them. They always have this great smile and know how to work with people and with the system. My social worker at the current hospital is also a preemie mom, so she REALLY understands many issues that I go through.

    Primary nurse: I have indeed asked for primary nurses. I come to appreciate critical thinking skills and care by these great nureses. Kangaroo care while my favorite nurses are in charge, has been an extremely calm experinece.

    MD....Any profession, there are people like my MD. Just cannot get over with their own bias/belief. He also tends to politicize the issue. I try to take it a great learning experience that will help me to be a great teacher (I am a foreign language teacher) one day. I am also trying to learn how to be a good communicator so I can effectively advocate for Penga.

    It's really nice to hear from people with different perspectives - mom, LC, social worker, etc... Thanks a lot!

  7. #17
    Join Date
    Oct 2007
    Posts
    50

    Talking Re: We reached an agreement

    Today, Penga's MD and I was able to agree on Penga's feeding plan

    The MD was very very pleasant today. As soon as he got to Penga's bedside for rounding her, he was very sociable, which is out of his character, and I appreciated he was trying to be that way. So I did not press the question until he brought up his plan: starting tomorrow, Penga will receive one more bottle-feeding (2 total) and one breastfeeding. He assured that I would get LC, OT, and any other supports for our BF. It was a very clam and friendly conversation. Although there is no mention of BF being the best practice or push for exclusive BF, I can live with the plan, as long as BF is a part of the Penga's feeding plan and that we will get all the resources and supports for BF.

    My Social worker checked with me before meeting the MD, which was very comforting. The head MD talked with me after the meeting, too. I told him that the new plan was a great compromise and he thanked me for good suggestions and said our goal is full BF before discharge.

    I am in shock at how peaceful the meeting went. I feel extremely proud that the agreement was a win-win situation, without anybody being in a bad spot. I learned that what was extremely helpful was having the reliable data to back up my argument, finding out who to talk to through social worker, and not over-reacting until I have a good plan. I thank everyone for cheering for me and Karen for great suggestions and support

    Penga did much better today, too. Since yesterday, she has no residuals. After bottle-feeding, she had a bit of desats, but they were all self-resolved. I kangarooed her before and after feeding. While Penga slept through both sessions, she gave me some sucking before the bottle-session, reminding me that she hasn't forgotten mommy's special milk, too.

  8. #18
    Join Date
    Jan 2006
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    18,063

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

    yeah I'm glad you could come to an agreement with the doctor.
    Once you get her out of the hospial you can do what you want!
    IT will not be that much longer!

  9. #19
    Join Date
    Feb 2006
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    422

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

    Bravo -- for all involved!

    BTW, both you and Penga show incredible resilience, which will serve you well in the weeks to come when she is home and able to breastfeed more and more over time...

  10. #20
    Join Date
    Sep 2007
    Posts
    59

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


    Glad to hear how things are going. Keep up the good work and advocacy for your dd!!
    to all of you!!

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