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Need advice ASAP for friend who just had her baby. Nurses pushing formula. *Update* *Update 2*

Posted by on Aug. 21, 2013 at 6:12 AM
  • 75 Replies
Hey ladies, I don't have too many details and I am waiting for her to call me back. She just had her baby via csection and the nurses are telling her to give the baby formula because his glucose is low. They are telling her he could get brain damage. She said she can only nurse on one side because of everything she is hooked up up and that she is have trouble keeping him awake.

What do you ladies think? I know none of us can give real medical advice, but does this just sound like a nurse scare tactic?

*Update*
I visited my friend in the hospital. I didn't get to stay long because I had to pick my son up from school. She basically said the nurses took him to the nursery right when he was born because of his low blood sugar, and that she thinks the nurses gave him a bottle of formula. She said his blood sugar improves after he has a good latch, but it's not consistent and it keeps going down again. She is having trouble getting him latched properly and it doesn't sound like the hospital staff is supportive at all. After she nurses him she has been giving him a syringe of formula. The nurses also told her not to let him comfort suck.

I told her she was getting bull shit advice. I told her to feed on demand and to let him nurse as long as he wants. I also told her to make sure the latch is right every time even if it takes twenty minutes. I have her a few pointers on how to get him latched. I also brought her my medela pump in style. Maybe she could pump on one side while he is latched to the other, and then she could give him the colostrum in a syringe? Or is pumping a horrible idea?

*Update 2*
I want to thank you ladies for all the advice and support. Unfortunately, it looks like my friend has given up on breastfeeding. I visited her today, and the baby was drinking formula from a bottle, not the syringe. I asked if she was able to get anything from the pump and she said a little. I assured her a little would go a long way.

Both times I held him, he started rooting or sucking on his lips. I encouraged her to try breastfeeding him again and even offered to help her get him latched. The first time she tried for 30 seconds and then gave up and let him fall asleep. The second time she said, " I'm not ready to feed him yet, he just ate." When she said that I knew her heart really wasn't committed. It also made it obvious to me that she hasn't absorbed anything her husband (he has an older child who was breastfed until age 3) and I have told her these past few days.

She started talking about his bad latch and I assured her it took me a while to get the hang of it. She then told me that he hadn't nursed but one time today. I asked of she was at least pumping every two hours and she said she only pumped once last night. I said, "I am not trying to pressure you, but if you don't nurse him or pump your milk won't come in." I could see her eyes get watery so I changed the subject.

She called me when they were on their way home to let me know they were discharged. I asked how the baby was and she said he seemed like he was wanting to eat more. She started talking about how many bottles of those 2 oz premixed formula he was eating. So I guess she doesn't even want to try.

Oh well. I tried to help. It makes me sad, but it's not my baby.
by on Aug. 21, 2013 at 6:12 AM
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Replies (1-10):
Momsthename0609
by Bronze Member on Aug. 21, 2013 at 6:27 AM
Three of my four boys had low glucose at birth due to their size. My first I didn't know that BM could bring glucose up. My third was born and home and only had BM and my BM brought it up. Same with my fourth.

It is normal for babies to be sleepy after even a vaginal birth, so I assume it is normal for a c-section as well.
Yogamom08
by Member on Aug. 21, 2013 at 6:32 AM
Thanks.

Quoting Momsthename0609:

Three of my four boys had low glucose at birth due to their size. My first I didn't know that BM could bring glucose up. My third was born and home and only had BM and my BM brought it up. Same with my fourth.



It is normal for babies to be sleepy after even a vaginal birth, so I assume it is normal for a c-section as well.
Momsthename0609
by Bronze Member on Aug. 21, 2013 at 6:38 AM
I will also say that in order for him to get brain damage his sugar has to be extremely low, there will be signs of it before it happens.

Quoting Yogamom08:

Thanks.



Quoting Momsthename0609:

Three of my four boys had low glucose at birth due to their size. My first I didn't know that BM could bring glucose up. My third was born and home and only had BM and my BM brought it up. Same with my fourth.





It is normal for babies to be sleepy after even a vaginal birth, so I assume it is normal for a c-section as well.
Momsthename0609
by Bronze Member on Aug. 21, 2013 at 6:41 AM
1 mom liked this
http://www.nbci.ca/index.php?option=com_content&id=71:hypoglycaemia-of-the-newborn-low-blood-sugar&Itemid=17

Here is a link.. :)
MomTo3NMW
by on Aug. 21, 2013 at 6:43 AM
1 mom liked this

Honestly, if it was just a few times, I would do it to make sure my baby was getting what he/she needed. If they were just flat out telling me to formula feed and I didn't want to, not giving me the chance to breast feed just because, I'd be walking out of there. I think the nurses are trying to do what's easiest for them here though...

Momsthename0609
by Bronze Member on Aug. 21, 2013 at 7:01 AM
3 moms liked this
There is no need for it though. Colostrum has more sugars in it then formula, so it will bring up baby's sugar better then if he was fed formula.

There are also risks to formula feeding and people often over look those risks because formula is the norm. Even one drop of formula can ruin the healthy flora of baby's gut. Baby could also have an allergic reaction to the dairy in formula.


Quoting MomTo3NMW:

Honestly, if it was just a few times, I would do it to make sure my baby was getting what he/she needed. If they were just flat out telling me to formula feed and I didn't want to, not giving me the chance to breast feed just because, I'd be walking out of there. I think the nurses are trying to do what's easiest for them here though...

littlemonaghan
by Bronze Member on Aug. 21, 2013 at 7:10 AM
5 moms liked this

this is simple...tell her to say this to the nurses...


"shut up. go away. right now"


then have her take a deep breath, and calmly place her newest adorable squish back on her bewb.

to help keep him awake have hre strip him down to just a diaper, stroking his feet & cheeks to stimulate him. and nurse nurse nurse nurse, even if its just on the one side it sbetter than not nursing at all

stupid nurses

mostlymaydays
by Group Mod-Stacy on Aug. 21, 2013 at 7:40 AM
1 mom liked this
Dr Jack Newman recently posted on fb something about this myth. I'm trying feverishly to find it.
Tea4Tas
by on Aug. 21, 2013 at 7:43 AM
2 moms liked this

Every hospital has a lactation department. She needs to call them in now. They will help her and possible shut that nurse up.

 

mostlymaydays
by Group Mod-Stacy on Aug. 21, 2013 at 7:45 AM
6 moms liked this
This is from Dr Newman:



Hypoglycæmia of the Newborn (Low blood sugar)

Introduction
The fear of low blood sugar of the newborn has become the new “acceptable” reason to separate mothers and babies and give babies supplements of formula in the immediate hours and days after the baby’s birth. The reason paediatricians and neonatologists are worried about low blood sugar is that it can cause brain damage, so there truly is a concern. However, there has developed a sort of ‘hyper’-concern about low blood sugar that is simply not warranted. As a matter of fact, most of the babies who are tested for low blood sugar do not need to be tested and most of those who receive formula do not need formula. By giving the formula, especially as it almost always is given by bottle, we interfere with breastfeeding and give the impression that formula is good medicine.

Some truths about hypoglycæmia of the newborn


The best way to prevent low blood sugar is to feed the baby with milk. However, formula and breastmilk (specifically colostrum in these early days) are not equivalent and colostrum is far better to prevent and treat low blood sugar than formula (See point #5 below). A little bit of colostrum maintains the blood sugar better than a lot of formula.1,2,3
Having the baby skin to skin with the mother immediately after birth maintains the baby’s blood sugar higher than if the baby is separated from her. (See the information sheet The Importance of Skin to Skin Contact).
There is no lowest level of blood sugar that is universally accepted as meaning the baby has low blood sugar. Because of this atmosphere of hyper-concern about low blood sugar, the level of sugar keeps being raised to absurd levels. In many hospitals now, 3.4 mmol/L (60 mg %) is now considered the lowest acceptable blood sugar. This is patently aberrant and there is no evidence to back up such a level as the lowest acceptable blood sugar concentration.
There is no reliable method of measuring the blood sugar outside the laboratory. The use of paper strips to measure the blood sugar is not reliable. Paper strips tend to underestimate the true value. Only the laboratory gives a reliable measure of plasma glucose or sugar (plasma is the part of the blood which does not contain red blood cells and which is what we are really interested in, but we’ll leave this aside).
If the baby’s blood sugar is low, it does not mean he will be brain damaged. This is due to the fact that other constituents released by the baby’s body will protect his brain. These include compounds called ketone bodies, as well as lactic acid and free fatty acids. In fact, babies who are receiving colostrum or breastmilk have much higher levels of ketone bodies, for example, than formula fed babies or even breastfed babies with supplements of formula.¹
Babies born of a normal pregnancy and normal birth and who are at term and of a good weight do not need to be tested for low blood sugar. Yet, so pervasive is the anxiety about low blood sugar that more and more postpartum units are testing every baby at birth for low blood sugar. This is painful for the baby, anxiety producing for the staff and parents, costly, useless and contrary to evidence.²
It is normal for the blood sugar to drop in the first hour or two after birth. Yet many babies are tested first at birth then an hour later and given formula because the blood sugar has dropped. Babies are being tested without reason, then given formula for a normal situation! Incidentally, even if the baby is not fed, the blood sugar will rise after the initial (normal) drop.¹,³
A baby is not at risk of low blood sugar just because he weighs a lot at birth, if his mother is not diabetic. Yet many hospitals have protocols that call for automatic testing of a baby, and some even automatic feeding of formula (unbelievable) if the baby weighs more than 4 kg (8lb 12oz); others use 4.5 kg (10 lb). This approach seems to have been started because infants of diabetic mothers tend to be born very large. In fact, large babies whose mothers are not diabetics are not at increased risk of low blood sugar². In fact, they are at less risk because their livers are full of glycogen (glucose molecules connected together in long chains) ready to be called into action by the need for more sugar, and they also have lots of fat ready to be called into action to produce ketone bodies, lactic acid and free fatty acids.
A baby who is born small for the length of the pregnancy (under 2.5 kg or 5lb 8oz if born at term is one definition) maintains his blood sugar just as well if breastfed or formula fed². Of course, it’s important the baby is breastfeeding. Also see the video clips of young babies breastfeeding.
How should we prevent low blood sugar?

Diabetes in the mother, particularly type 1 (insulin dependent, juvenile), is a high risk situation for the baby. This is due to the fact that at birth high insulin levels in the baby (as a result of the baby’s being exposed to high sugars during the pregnancy) not only drop the blood sugar but also prevent his body’s formation of ketone bodies, lactic acid, and free fatty acids. Therefore the baby needs to be watched and may require an intravenous to maintain the blood sugar.

Good control of diabetes during the pregnancy can help prevent low blood sugar.
Good control of diabetes during the labour and birth also is important.
We, and postpartum departments all over the world (particularly in New Zealand and Australia), have suggested to our prenatal patients whose babies are at high risk to express their colostrum before the baby is born, starting at about 35 or 36 weeks gestation. Most can get a few millilitres a day by hand expression and a mother can often get 30 or 40 millilitres saved before the baby is born. If the baby needs to be supplemented to control the blood sugar, the baby is given colostrum, not formula.

Intravenous fluids containing glucose (it is usual) given rapidly to the mother should be avoided. If the mother’s glucose tolerance (her ability to handle glucose) is impaired, a lot of glucose given her may increase her blood sugar and provoke a similar response in the baby with a corresponding rise in the baby’s insulin secretion.
It is best to put the baby skin to skin with the mother immediately after birth. As mentioned above and in the information sheet The Importance of Skin to Skin Contact, the baby maintains his blood sugar better when skin to skin with the mother. The baby should be dried off but not bathed before he is put skin to skin with the mother. It is possible and desirable to put the baby skin to skin with the mother even if she’s had a caesarean section.
The baby should be encouraged to breastfeed as soon as possible after the birth. Having the baby skin to skin with the mother helps a lot as the baby may latch on all by himself. A good latch also helps, so the baby gets the colostrum. Compression while breastfeeding gets more colostrum into the baby. Also see the video clips.

Treating low blood sugar

If there is a concern about the baby’s blood sugar dropping too rapidly or being too low and good breastfeeding doesn’t seem to be correcting the problem, the baby should get an intravenous infusion of glucose rather than formula. Babies often spit up formula in the first few days because they get so much. If there is a real concern, taking formula by mouth does not guarantee the blood sugar will be raised.

Every postpartum unit should have banked breastmilk available on site. Banked breastmilk is preferable to formula as a supplement whenever the supplement is truly necessary. Even if the baby needs treatment for low blood sugar, there is rarely a reason for the baby not to breastfeed as well. A baby can be at the breast even if he has an intravenous. A baby can get supplements (preferably pre-expressed colostrum or banked breastmilk) even while being breastfed.

References:
De Rooy L, Howden J. Nutritional factors that affect the postnatal metabolic adaptation of full-term small and large for gestational age infants: Pediatrics Vol. 109 No. 3 March 2002, pp. e42
Cornblath M, Hawdon JM, Williams AF Aynsley-Green A, Ward-Platt MP, Schwartz R, Kalhan SC. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics 2000;105:1141-5
Hoseth E, Joergensen A, Ebbesen F, Moeller M. Blood glucose levels in a population of healthy, breastfed, term infants of appropriate size for gestational age. Arch Dis Child Fetal Neonatal Ed 2000;83:F117-9

See also the WHO document on hypoglycaemia at
http://www.who.int/child_adolescent_health/documents/chd_97_1/en/index.html

Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.

To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.

Information sheet Hypoglycaemia, Jack Newman MD, FRCPC, IBCLC, 2009©
Revised by Edith Kernerman, IBCLC, 2009©
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