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Monday
Jun112012

Why Don't Moms Meet Their Own Breastfeeding Goals?

Last week, Pediatrics released a new study led by Cria G. Perrine, PhD on Baby-Friendly Hospital Practices and Meeting Exclusive Breastfeeding Intention.  The study looked at 1457 women who intended to breastfeed exclusively for some period of time (85% f them intended to do so for 3 months or more) and examined the relationship between characteristics of the mother and hospital practices and the success rate in achieving breastfeeding goals.

Characteristics of the Mother


The study found that certain characteristics of the mother were related to greater success at exclusive breastfeeding. Mothers who were married and who had more than one child were more likely to meet their breastfeeding goals. Mothers who were obese or smoked were less likely to meet their breastfeeding goals.  Some of this makes sense, when looked at in context, of course. If you have support from a partner, and possibly even the opportunity to stay at home with the children while your partner works, meeting your breastfeeding goals will be easier. If you can learn from the mistakes you made the first time with breastfeeding and apply your knowledge and practice from the first baby, you can often be more successful with your second child. Women with polycystic ovary syndrome (PCOS) are more likely to be obese and also more likely have trouble producing enough milk. In any case, while these factors are important to understand, they are not always easy to change.

One weakness of the study is that almost all of the participants were white (88.2%). Another 2.9% were black, 4.5% were Hispanic, and 4.4% were in a category called "Asian/Pacific Islander/Other".  Given the historically low breastfeeding rates among black women, if this study had been more representative, it could have provided some answers and helped the black breastfeeding community in its efforts to improve breastfeeding rates.

Baby-Friendly Hospital Practices


The study looked at a series of  Baby-Friendly hospital practices and examined their link to meeting breastfeeding goals. The practices examined include:

  • initiating breastfeeding within one hour of birth

  • no food/drink other than breast milk

  • baby rooming-in with mother

  • breastfeeding on demand

  • not giving a pacifier

  • providing information on breastfeeding support


Overall, the study found that only "no food/drink other than breastmilk" had a statistically significant bearing on whether a woman met her own breastfeeding goals. The following chart breaks down the numbers.


Are In-Hospital Formula Supplements Necessary?


The numbers from the study show that in-hospital formula supplements are certainly not the only thing keeping women from meeting their own breastfeeding goals, but they are a significant factor. What the numbers from the study don't say, however, is how many of the women who received supplements in the hospital actually needed them. Forty percent of babies whose mothers intended to breastfeed exclusively received a non-breastmilk supplement in the hospital. Forty percent is a very high number.

I asked two International Board Certified Lactation Consultants, Kelly Bonyata from Kellymom and Fleur Bickford from Nurtured Child, what the circumstances are where a baby would need to be supplemented within the first 48 hours (the time usually spent in hospital after a vaginal birth). They both referred to the Academy of Breastfeeding Medicine Clinical Procedure #3: Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate.

Fleur explained the very limited circumstances under which a healthy term breastfed infant would need to receive supplements:
There are only 4 circumstances where supplementation is definitely indicated: maternal illness resulting in separation of mother and child (ex. shock), a baby with a metabolic disorder such as galactosemia, a mother who is taking medication that is incompatible with breastfeeding or a baby who is unable to breastfeed due to congenital malformation or illness (in this case baby can usually be supplemented with mother's own colostrum).  There are some other circumstances where supplementation may be indicated, such as low blood sugar, excessive weight loss, jaundice and dehydration  however it is only indicated if baby does not respond to skin-to-skin contact and skilled help with breastfeeding.

Kelly further noted that the first choice, of course, for supplementation is "expressed human milk". This can often be the mom's own colustrum if she is producing enough, which can be obtained through hand expression or using a hospital grade mechanical breast pump. In my opinion, hospitals should all have easy access to banked human milk, not just for premature babies, but for all newborns that truly need supplements. If nurses were working with human milk instead of formula, perhaps they would be more careful about pushing it on moms in questionable circumstances.

"Just Say No" to Formula Supplements in the Hospital


When I asked people on twitter, what reasons (i.e. MYTHS) they were given for providing formula supplements, they included:

  • Your baby is hungry

  • You were sleeping and I didn't want to wake you, so I just gave him a bit of formula.

  • Your milk hasn't come in yet. We'd better get him on a bottle.

  • Your baby has low blood sugar.

  • Your baby is crying a lot.

  • Colustrum has no nutritional value.

  • It will cure jaundice.

  • Maybe if he has a bit of formula, he'll know what it feels like to have a full tummy and that will make him interested in nursing.

  • Your baby's blood sugar is too low.

  • Since English isn't your mother tongue, you should really just formula feed.


None of these, on their own, is a reason to give formula. Some of them are plain ridiculous and others are only an issue if combined with other problems (e.g. low blood sugar and the baby isn't responding to skin-to-skin contact and skilled help with breastfeeding and mom isn't producing sufficient colustrum).

But so many moms, wanting the best for their baby and trusting the "experts" at the hospital, fall prey to flimsy excuses that can end up sabotaging their entire breastfeeding relationship.

Can We Get Rid of Unnecessary Formula Supplements?


I've written before about the wide variety of reasons why women may quit breastfeeding and the many societal barriers to breastfeeding. This study shows once again, the importance of reducing the very routine supplementation of newborns in the hospital, increasing the education of staff on breastfeeding and supplementation, and ensuring that human milk is available in the event that supplementation is necessary.

Breastfeeding advocate and Human Milk 4 Human Babies founder Emma Kwasnica told me:



Right here in my own city (Vancouver, BC) two hospital-based IBCLCs (Int'l Board Certified Lactation Consultants) walked off the job due to the continuing undermining of breastfeeding that occurs in hospital by the unnecessary, harmful and clearly politically-motivated supplementation of powdered infant formula to newborn babies. The formula lobby is huge, while supporting breastfeeding is not financially lucrative. This is a question of money and resources, and breastfeeding simply cannot compete with formula marketing.


She went on to look at what moms can do to protect themselves and meet their own breastfeeding goals:
So what can mothers who want to exclusively breastfeed for more than a few days or weeks do? Until hospitals realise that their practice of supplementing the newborn is what is most detrimental to women trying to achieve their own exclusive breastfeeding goals, it seems most pertinent that women enlist the support of their partner or a doula in order to ensure that hospital staff give nothing by mouth to their infant while in hospital. Another excellent option, and one which more and more women in the USA are choosing in order to ensure the health and well-being of themselves and their baby, as well as to ensure breastfeeding success, is to stay the heck out of hospital and plan a midwife-attended homebirth instead.

Fleur also had some ideas on this topic. She wrote:
The best way to avoid unnecessary formula supplementation in hospital is to keep your baby skin-to-skin as much as possible. This way your baby is close and you are able to respond quickly to early feeding cues. If your baby is not nursing well, then frequent hand expression and spoon feeding of colostrum is the best approach to protect your milk production while ensuring your baby is getting what he needs.

Moms need to keep increasing their own knowledge about breastfeeding and have a qualified circle of support around them and breastfeeding advocates need to keep fighting for an environment where moms who want to exclusively breastfeed are given every opportunity to do so instead of being sabotaged at every turn.

 
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Reader Comments (42)

It really is sad how nurses who are not experts in this area end up influencing so many of our lives so severely with this - supplementing our babies with formula. I had one nurse talk me into using a pacifier - my baby should have been on my breast, not a pacifier, the first 24 hours.

Thanks for sharing

June 12, 2012 | Unregistered CommenterMissy @ marketing mama

I had my first baby in Australia and the hospital had no formula/no pacifier rule. Breastfeeding help was amazing, my tongue tied little one and I figured it out by the time we left the hospital after a few days.
My second one was born in the UK. The midwife had never seen a tongue tied baby before (how is that possible??? :) and yes, both of my boys were tongue tied) and kept telling me I was breastfeeding wrong when I knew exactly how to help a tongue tied baby latch. If this had been my first breastfeeding experience, I probably would have given up...

June 12, 2012 | Unregistered CommenterMrsB

I'm going to say that one of the reasons new mothers don't succeed with their goals beginning in the hospital is lack of education regarding breastfeeding. I know that it's touted as "natural" and "instinctive" and while that may be kinda sorta true, I think it's a bugaboo for new moms to get their heads around when in the hospital - after dealing with the birth of a child, which, again, is a huge event that may leave minds reeling (at a psychological level, there's just no way to completely prepare for "what it's like" to give birth and hold your child for the first time) - and if things didn't go exactly as expected then doubt begins to creep in.

Doubt that your body knows what it's doing, doubt that you know what you're doing. And now here comes breastfeeding - again, natural, instinctive, what women *do* - and if things aren't picture perfect right away, more doubt.

I think that lots and lots of education beforehand on what breastfeeding is - all the ins and outs - will better prepare women to know that even though natural, it's not always easy or pain free or without it's trials - and That Is Okay. It can still work. But I know that's not what a lot of women want to hear. I know that's not how we approach parenthood with media photos of sleeping, round-cheeked cherubs and celebrity moms who lose all their "baby weight" in five weeks, and women in general who do it all. Western women are surrounded by convenience and doing what they do while looking good and being competitively successful in all they attempt. That's not parenthood and that's not breastfeeding.

It's a catch-22 because with that message that breastfeeding can take time and work and a lot of support to "get it right", some are going to say "why bother". But I think we have to be honest - even if just with the women who start out gung-ho and motivated, and get that 68% number down.

June 12, 2012 | Unregistered CommenterJosette Plank

I'm contemplating a hospital birth for baby #2 because we now live in a remote area. My first was born at home and we were able to establish a successful breastfeeding relationship quickly with the help of my midwives. I also received help from Renee Hefti-Graham, one of the lactation consultants that walked off the job in Vancouver. She is fantastic, BTW. You would not believe how many mothers I have met who almost gave up on breastfeeding and Renee saved the day for them.
This article has me concerned. There aren't the same resources here for breastfeeding as there are in Vancouver. Subsequently the breastfeeding rates here are abysmal.
Sigh.
I guess it's on my shoulders, right? I'll have to search high and low for a good LC, I'll have to get my husband and, hopefully, doula, keeping a vigilant watch once the baby is born to see that no one is giving the baby formula.
I feel tired and stressed out just thinking about it.

June 12, 2012 | Unregistered CommenterRachel

The hospital attempted to supplement my daughter because she went 24 hours without producing urine. Because they refused to count the fact that she had peed all over the OB as he delivered her (C-section)!
After getting my doula (also LLL and IBCLC) on the phone with the hospital pediatrician, my husband finger fed her a small amount of glucose. It must have been satisfactory to them. Luckily I was educated enough to know that she wasn't "starving," that colustrum was "enough," and that it was ok that my milk didn't come in for a full 72 hours after the birth.

I was really paranoid about supplementing and pacifiers--probably justifiably so, based on the amount of formula that was in this hospital.

June 12, 2012 | Unregistered CommenterKate

With my first, I had problems during labor (don't get me started) that resulted in an epidural (I wasn't progressing and couldn't relax enough to let my body do its job; the epidural worked, I was pushing within 15 minutes of receiving it). But no one told me that it could cause problems with breastfeeding. My son wasn't able to latch properly, so I didn't produce anything--not even colostrum. The LC was horrible. She just kept telling me that I was doing it wrong and that my physiology (inverted nipples) would make it "impossible" to bf properly without nursing shells (lies #1&2). My son was dehydrated, so I asked them to give him a cup feed--but they used a bottle & didn't make that clear (lie #3). I told them to bring him back exactly 2 hrs after his feeding so I could try again to bf when he was more relaxed & not starving. They waited 4.5 (!) hrs and told me they hadn't wanted to wake me (lie #4) and this resulted in a second bottle feeding. I was sent home with no ability to bf at all--no one made sure I could do it before I left. We had a terrible first day home, with me crying, baby crying, he not able to eat right and me feeling like a horrible mother. I called his ped first thing the next day. He had me come right in, & he & his nurse spent an hour teaching me to bf properly. My son was dehydrated, so the ped told me to rent a pump, pump between every feeding to encourage my milk, & feed what I pumped to the baby. We did have to give him some formula until I could pump enough, but it wasn't much. The ped told me we would have my son exclusively bf by his 2-week check. But his help was so good, it only took 3 days until I was exclusively bf and not pumping at all.

I was still bf my son when my daughter was born, so I tandem nursed (which is the most wonderful thing ever--seriously, tandem bf and a group nap? Yes please!). Believe me, I took my horrible experience the first time and made sure that never happened again. I had no trouble at all.

June 12, 2012 | Unregistered CommenterAmy

I was pretty lucky, I picked a hospital where they let you keep the baby with you in the room (unless there are some serious problems). They took her away only once for shots and she came back with a pacifier - the nurse oppologized profusely for the paci. Fortunately, it didn't cause any problems (my little girl is exclusively breastfed and now loves her pacifier when she's going to sleep at night - funny thing, she loves only the one they gave her at the hospital, she won't take anything else).
I did have an issue with the LC there, well, one of them. The first one was very helpful, showed me different positions, brought me Lanolin creme, offered advice. Actually, she was just a nurse, not an LC. My little girl was doind pretty well, it was me who had trouble with holding her in position. But then the LC came - horrible experience! She shoved my little girls face on my breast saying that's how it's done - baby was crying and crying, she was shoving some more. Finally I said enough, I will try on my own. As soon as the LC left the room, my baby latched on and was sucking happily.
I also had an issue with one of the delivery nurses - I asked for my baby to be put on my chest immediately for skin on skin and a try to breastfeed as soon as possible - I basically had to fight for it! I remember laying there watching her taking away my baby and telling her to please bring me my baby back. Her response? You will get dirty!!!! After some persuasion from my husband, she brought her back. Then after some time she took her again to wash her and perform all the "necessary" tests. I specifically asked to bring her back naked...I look over there and she is puting clothes on her! Again, pleading, begging, almost shouting from both me and my husband...she brought her back. She was looking at me like I was doing the most horrible thing!!! She kept on saying my baby would get cold....

Breastfeeding has been an amazing experience!
I would add to all the reasons why women don't meet they goals - LACK OF MATERNITY LEAVE!

June 12, 2012 | Unregistered CommenterAndrea

I am a RN in labour and delivery in Vancouver and I'm so sad by this post. The root cause of ALL of these issues is education on the part of the health care professional. Where I work we were lucky enough that management thought it was necessary that all nurses (LPN, RN) had the 18 hour breastfeeding course. Then they collected enough DONATIONS to send a bunch of staff to become LC's. In our health care system education for continuing practice is not funded. We relied on monetary donations from past parents for all of this very beneficial education.

Also, we would love to have a freezer stocked with donated human milk. Again it is a cost issue and also a donor issue. We have a milk bank just up the street (Basically) but the supply can waiver and the cost of the milk is an issue. Once in a blue moon a patient will be given a prescription, drive to get the milk and bring it back for their baby. What a hub bub!

PS. In residency, doctors education on breastfeeding is extremely minimum to nil. So when a doctor gives you 'advice' on breastfeeding they are either using their own experiences or making stuff up. A good doctor will go and look up the information or refer appropriately.

June 12, 2012 | Unregistered CommenterAndrea Firmani

This is so interesting. When I had my second child in a hospital in Houston, he nursed almost constantly the first 48 hours, but I had to beg and plead to get him brought back to me after my c-section. I told him they couldn't do the eye drops until after I nursed him, and they needed to do the eye drops within the first 3 hours to meet their regulations, so that is why I got him back to me after 2 hours in the nursery. So, first crazy thing, I had to fight to get to hold my newborn!

Then even after nursing a ton, he lost a good bit of weight between his birth and day 2 (my husband thinks his initial weight wasn't accurate because he was watching the weighing and the scale wasn't zeroed out or something...). That didn't make sense to me since he nursed all night long. The pediatrician walked in with a case of formula, and I immediately said that I was not giving my baby formula. She said since he lost weight, he needed formula. I told her no, and she stormed out and SLAMMED the door!

Only then did she send the LC to me, and then I was playing a game of nursing my baby and weighing him to prove he was getting something from nursing for the rest of my stay. It was insanely stressful and I left the hospital as soon as I could. My baby quickly grew to be a very big baby boy. I'm so glad I fought the pediatrician on giving him formula, but I think it is so sad that we have to fight our doctors to do what is right for our babies.

June 12, 2012 | Unregistered CommenterKristine

A homebirth didn't stop them from giving my baby formula. I transferred to the hospital after baby was born due to a retained placenta. She was admitted and got a horrible "pediatrician". They had her hooked up to all sorts of stuff(she was stuck in the box, they didn't want her skin to skin with me, wouldn't let me breastfeed her the first day, and kept her in the nursery, we visited every two hours), had her on an IV and then gave her formula without my permission, because she had jaundice and low blood sugar at birth. The horrible doctor told me that donated milk was a biohazard when I suggest that instead of formula. I wish I had lied and told them it was my milk.

June 12, 2012 | Unregistered CommenterMel

"But so many moms, wanting the best for their baby and trusting the "experts" at the hospital..."

This, in my opinion, is the crux of the problem. What we need is for hospital staff to STOP purporting to be experts in infant nutrition because they categorically are not. And we need to make sure that mothers are aware ahead of time that hospital staff are not experts and that we are not required to follow recommendations if we know them to be incorrect or inadequate.

June 12, 2012 | Unregistered CommenterKrissyFair

"when a doctor gives you ‘advice’ on breastfeeding they are either using their own experiences or making stuff up."

This is so true and SO infuriating. How do we get the message across to physicians that working outside the bounds of their competencies is completely unprofessional and unethical?

June 12, 2012 | Unregistered CommenterKrissyFair

[...] Why Don’t Moms Meet Their Own Breastfeeding Goals? | PhD in Parenting. Share this:Like this:LikeBe the first to like this post. Posted in Breast Feeding [...]

With my first two, it was a none issue. With my third he was in the NICU and a couple nurses seemed hell bent to give him a bottle. I stood firm on my ground and told the old hags where to go. By day two, my milk was fully in and he was gaining weight rapidly (he was 15 lbs by 6 weeks, 10.5 at birth: he was in NICU for hospital born amnio-infection and thus required IV antibiotics for a week). I am shocked in this day in age, despite hospital policy that states how important kangaroo care and breastfeeding is, that there is so much formula use in hospital. Makes me angry:(

June 12, 2012 | Unregistered CommenterKelly

I nursed and supplemented both my babies with formula for 6 months (baby #1) and 9 months (baby #2). I'd had breast surgery when I was 20 so milk supply was always going to be an issue.

With my first, I'm sure that premature supplementation influenced how we chose to feed him. But he was tongue-tied and the nurse who gave it to him assured me that I could still exclusively breastfeed. I'm glad that I nursed him as long as I did anyway; I didn't want to give it up entirely, but it became very easy to rely on the bottle.

So when I had my second, I vowed to be more dedicated. I had professionals around me (both doctors and LCs) who were supportive of my decision to exclusively breastfeed. Unfortunately, despite my best efforts I could not produce enough milk. My daughter ended up back in the hospital when she was over a month old with jaundice - which she'd had when she was a few days old - and we were just lucky that she didn't end up with any permanent damage. Even though I'd asked everyone about her yellow colour and her diapers, I was told to keep doing what I was doing. Obviously, I had to adjust my goals in order to feed my child.

I feel like health professionals' lack of knowledge about breastfeeding, etc. compromised the care of my child each time. Better education in this area for both doctors and nurses is needed.

June 12, 2012 | Unregistered CommenterErin

I am so happy to have had excellent support after the birth of my daughter. She would not latch after she was born (med-free, and immediate skin to skin) so the LC taught me how to hand express into a spoon to feed her. After I got home I pumped and put her to the breast all the time. She finally got the hang of it around the second day, and after battling with oversupply and overactive letdown, we are still nursing at 23 months.
I really, really believe it was the support of the LC and staff at the birthing center that helped the first day, and the support of my husband that helped me in the weeks after. A good support system is vital.

June 12, 2012 | Unregistered CommenterJulie

Annie, this post was really enlightening for me. You and I have talked before about how frustrated I am with how my breastfeeding experience turned out, but the information you've added here about myths they tell you in the hospital makes it even worse. Three - THREE - of those were used on me. I trusted them to help me do what was best for my baby. I'm not sure the trust was deserved, though I can't help but take responsibility too. I really didn't do enough research ahead of time and that's no one's fault but mine.

My story is long and starts before Brandon was born, so http://karenschronicles.ca/blog/2012/6/12/why-this-mom-didnt-meet-her-breastfeeding-goals.html#.T9ejetVYvEU" rel="nofollow">I wrote it up on my blog. I hope you don't mind me linking to it here. I didn't want to hijack your comments with such a long story.

Thank you for writing this. I hope I've told you this before, but if not, I appreciate all you do here. I have learned so much from you that I wish I'd known 4.5 years ago. Perhaps one day I'll have a chance to put some of this knowledge into practice. :)

June 12, 2012 | Unregistered CommenterKaren

I am fond of saying I was able to breastfeed my daughter successfully in spite of the professionals at the hospital where she was born, rather than because of them. The worst was actually the lactation consultant on staff at the hospital. To this day, my husband becomes livid when he thinks of how she treated me and our daughter. There was a nurse there who thankfully was very helpful, and knew more about helping a new mom breastfeed than the lactation consultant.

I did everything I could to educate myself about breastfeeding before my baby was born, and still I felt lost when the time came. Fortunately I had good friends I could rely on for support and advice. The majority of the "professionals" I dealt with gave that word a bad name.

June 12, 2012 | Unregistered CommenterElizabeth

Unfortunately, this is also true of "trained" lactation consultants. La Leche and the lactation consultants I was put in touch with were absolutely cruel and made me feel like I was a complete failure for ruining their "this is how is *always* works" by-the-book Rules Of Breastfeeding. It was actually two very compassionate and patient doctors - my OB and my pediatrician - who helped me most.

Lactation consultants need to put aside politics at times and meet moms where they are, so to speak. Telling women they aren't doing it good enough for their gold starts has turned off just as many women I know as hospitals bungling things.

June 12, 2012 | Unregistered CommenterJosette Plank

Hi Rachel. It sounds awful! Are you able to keep the baby in the room with you? In New Zealand, where it is a normal birth and the baby is fine we practice "rooming in", so the baby is in a bassinet in the room the entire time. If the baby has to go to NICU that's different of course.

June 12, 2012 | Unregistered CommenterTamara in NZ

How much weight did he lose? The practice here is that it is normal for babies to lose weight during the first few days. Anything up to 10% is fine and in that case they only worry if the baby doesn't regain its birth weight at the end of two weeks. Both my babies lost under the 10% but once my milk came in (by which time they were starving I tell you!) they put it all back on and them some.

June 12, 2012 | Unregistered CommenterTamara in NZ

I fully agree! I think painting this perfect image and not addressing common trials in the beginning can be misleading in a way. Mom's deserve some honesty and understanding about what to expect. Possibly encouraging more expectant moms to attend local Breastfeeding support groups or LLL meetings may help. Even if they hear moms talking about struggles they see them continuing to breastfeed and gain an understanding of ways to push through those struggles.

June 12, 2012 | Unregistered CommenterNatalie

I gave birth to my first three at the absolutely wonderful Stanton Territorial Hospital in Yellowknife, Northwest Territories. They were working towards Baby-Friendly Hospital status; a male Australian midwife was the head of their entire obstetrical unit. (See, awesomeness.)

I had very good BF support at Stanton. I nursed all of my older three right after my sections (congenital hip defect) -- N. was latched for the first time right on the OR table as they stiched me up! Stanton also was not afraid to use experienced mothers on the ward to teach new moms. I was stuck in the hospital five days after my third, and was bored to tears, so the nurses would bring in new moms to watch me latch, ask questions, and get tips.

Then we moved south, where I had my last child. And I was SHOCKED by the way the OB ward nurses treated me. The one who took care of me after my section in the recovery room refused to let me nurse E., and kept putting it off and off, until we finally ignored her and latched him.

The ward nurses were pushy and obnoxious, demanding to see my nipples and "fix" my latch. None of them were LCs. I promptly told them I was nursing my 4th and would ask if I needed help -- because I frankly knew more about BFing my kids than they did. One of them replied with, "well, I can leave some bottles for when you need them." She also complained about how much E. cried (we later found out he had GERD) and kept saying a pacifier would "fix him up!" They also constantly harped about my co-sleeping.

I told them I would throw out any formula given to me, and would call the patient care quality office if anyone touched my baby without my permission or mentioned co-sleeping again. I was fed up.

This was also the hospital where I complained about the heat in my room for 24 hours, and the nurses just made sympathetic sounds (I was in pressure boots due to edema and couldn't get up, and they blamed the boots for the heat). When my DH came back in after going home to sleep a few hours, he remarked on how hot the room was and checked the temperature. It was 26C!! He turned down the heat and chewed out the nurses.

June 12, 2012 | Unregistered CommenterCin

How about this reason for supplementing- my dd was born at 37 weeks and weighed little less than 5 lbs. She was in the NICU as she could not hold her body temperature. The doctor tells me that they are giving formula because she does not have the energy to suckle at the breast. When I protested and told the doctor just how much I wanted to exclusively breast feed, she said- we need to make sure that the baby is eating well. Only then can we discharge her! And that had the desired effect (desired by doctor of course!) on me. I so badly wanted to go home and take dd with me, that in my mind it was a small sacrifice I was going to make. And how much I regret this even now. I wish I knew or someone told me about kangaroo care. DD is 2 yrs now and still breastfeeding. And that's the good part- we did not give up!

June 12, 2012 | Unregistered CommenterChetana Kulkarni

Obviously in cases where a baby cannot suckle at the breast, because the baby was born small or because of tongue tie or cleft lip, then the baby does need nourishment. The question is, does it need to be formula? In most cases, the answer should be no. The mom should be pumping right away and providing the colustrum and later breastmilk to the baby. If she doesn't have enough, the hospital should ideally have access to donor milk.

June 13, 2012 | Unregistered Commenterphdinparenting

I was given this exact same reason for supplementing my daughter, also born via c-section.

June 13, 2012 | Unregistered CommenterOlivia

It was almost 10%, so they said he needed formula. And they were worried on the second day! They didn't give him a chance to regain. My pediatrician wasn't at all worried - just the hospital pediatrician.

June 13, 2012 | Unregistered CommenterKristine

I was determined that my baby receive no formula, so what that meant was to make sure that the baby never ended up the nursery without me or my husband. We "roomed in" and *never* let the baby go unattended with a nurse. They tried to take the baby several times for tests and bathing, and every time we either refused or my husband went with them, and I didn't care if it was 3 AM. I had a good friend who was going to need a C section and I warned her about the nurses sabotaging breastfeeding and absolutely not to trust that they'd listen to instructions. She made sure that her husband was always with the baby and didn't let them take the baby away from them, and she was grateful for my advice because she said she never would have believed how many times they tried to give the baby formula and pacifier against their express wishes. These were are conventional American hospitals (ie, not mother-baby friendly). So if you can, have your husband (or another support person) with you and your baby in your room 24-7, so that even if the baby "needs" to go to the nursery, someone is with the baby advocating for him/her. Rooming in alone isn't a guarantee; there really needs to be an adult besides the mom in the room at all times. But all that said, I didn't find it stressful it all - I wanted my husband there 24-7 anyway (my parents were watching my older child the second time).

June 13, 2012 | Unregistered CommenterErin

I feel like I had good support in the hospital but we still ended up with supplemental formula by day 3 or 4 after our c-section (breech).
The nurses & LCs were pretty good about helping with getting bfing started, they showed me a variety of ways to hold the baby, hand express some milk onto the nipple to get her started (she didn't want to suck, although positioning was perfect & she'd suck on a finger if it was put in her mouth) One nurse tried sugar water on my nipple, which I wasn't okay with, but it was the middle of the night, I was overwhelmed and frustrated, and baby blues had set in. That didn't work either.
Eventually they recommended a nipple shield and a pump, and that got some colostrum into her. At the same time, they weighed her once every 24 hours, and it kept dropping, more than 10% of her birth weight. So by the third morning, the pedi, midwife, & LC were all pushing formula in addition to nursing and eyedroppers full of pumped colostrum. I gave in (tearfully - so much for ebf!) and took home some formula.
7 months later, we're still bfing (with the help of LLL we lost the shield at 11 weeks) but use formula when I'm touched out, want/ need to be away for a few hours, etc. I stopped pumping at maybe 4 or 5 months? I'm happy with the situation, but I AM wondering if the early supplementation was necessary, and if things would be different if we hadn't had it.

June 13, 2012 | Unregistered CommenterJuliet

My friend's first baby was 5 weeks early and had to go to NICU. She pumped for weeks until he was well enough to breastfeed. The hospital provided a hospital grade pump for this period. She said it was very upsetting but then NICU would be upsetting either way.

June 13, 2012 | Unregistered CommenterTamara in NZ

I also was asked to give formula after she produced no urine in 24 hours. They clef the pediatrician and I have in. Such a huge mistake. No have to supplement once or twice a day now or my lo is still hungry.

June 13, 2012 | Unregistered CommenterDebbi

I'm with whoever said LACK OF MATERNITY LEAVE. Coupled with husband going back to work when baby is 1 week old, lack of sleep, lack of support from those around you, etc. I bet if you asked these moms why they didn't meet their goals, a lot of them would say something like that. (Did they even ask them? Or did they just assume they could fix their problems without knowing what the problems even were?)

June 15, 2012 | Unregistered CommenterElaine

How do you make sure your baby is not supplemented at hospital? You stay with your baby ALL THE TIME and watch and lobby and be an advocate for your baby and yourself. This was the difficult truth I found when my 3rd child was admitted to the CHEO NICU 3 hours after a wonderful home birth, and we stayed for 10 days. I pumped around the clock and repeatedly told nurses to make note in his file for no formula and no bottles, clearly stating I intended to breastfeed exclusively. And yet, and yet!, nurses repeatedly recommended I go home to rest (and leave my baby alone?!?!), asked if I wanted 'to bottle' the baby, asked if I wanted formula, did not let me hold my baby for 2 whole days (terrifying). I did not feel certain that my baby would not be given formula if I wasn't around. It is perhaps no surprise that under all this stress I was having trouble pumping enough milk. Had I not already breastfed two children to 2y2m and 2y7m (without any formula whatsoever - my personal goal), I would have probably given up in despair. But I knew this could work, so I tapped my networks (thank you LLL! Love LLL!) and with help I ramped the milk supply thing, advocated and got incrementally got more skin-to-skin time with baby, slowly moved from feeding tube on crib to feeding tube while holding him, to feeding tube while he suckled and then boob only! and eventually convinced the doctors to let us go (although the option of just walking out seemed pretty attractive too). Once the feeding tube was off on day 7th, baby took breast like a pro and on we continue now at 13 months until, well? who knows. I think one of the hardest parts of the experience was knowing that the nurses wanted to help in their own way, but were not well informed enough to know that their comments and recommendations were in fact having an opposite effect on me. I think it is important to remember that medical staff do want the best for the baby, I don't believe they are malicious, but are following the establishment view that formula=ok and baby needs to be alone, lots of things that are not conducive to establishing breastfeeding and promoting bonding.

I sent a letter to the hospital's CEO which led to some discussions and I'm told some changes have been implemented as a result of my letter, and that it is being used to help educate staff and to discuss on these issues. Although not soon enough, it is some solace to at least lobby the hospital so that practices change and hopefully one day soon acquires baby friendly designation.

June 15, 2012 | Unregistered CommenterCarla

If you have a normal birth, the best way to avoid supplementing at the hospital is to leave as soon as possible after giving birth. I left within 24 hours after each of my births. Most of the problems that hospitals use as excuses to supplement - jaundice, weigh loss, lack of urine etc - come up on the second day or later. By getting out so quickly, I never even had to refuse a bottle for my babies.

June 18, 2012 | Unregistered CommenterChanna

This is exactly why I fight EVER having another hospital birth. I was with a midwife in a birth center with my firstborn son and we had to transport to a hospital with my midwife's back up O/B (my son was malpositioned and, after almost 25 or so hours of intense labor we kept going from 2cm to 4cm and back)... anyway, I have hypoglycemia and told the hospital staff my blood sugar was dropping - they gave me a popsicle - which later my midwife told that, with as far along as I was in labor, my body could not process a simple sugar well enough to raise blood sugar and keep it raised consistently - ANYWAY, when they checked my son's blood sugar levels (he had only breastfed for a short time - maybe 30 minutes), it was, of course, low... they insisted it was SO low he could have a seizure and the pediatrician on call (who was VERY antagonistic against us because we were midwife patients) refused to do any care of my son in my room... so they kept him for 2 hours and I KNOW they supplemented with formula - I was FURIOUS and had to finally ask they bring him to me... he ended up being an amazing breastfeeder and he breastfed for 12 1/2 months, but the trauma of how rude and unfriendly and antagonistic the staff was towards us and breastfeeding lead to some PPD and I was so stressed I spent the rest of the time fighting to get us out of the hospital as soon as possible. It was later I learned the "myth" of the low blood sugar reasoning: http://bruffeyfamily.blogspot.com/2011/06/medical-un-necessity.html

It is frustrating as a mother who wants to do what is best by her children to have medical personnel be so contrary to the success of things like breastfeeding, healthy births, etc.

June 21, 2012 | Unregistered CommenterElizabeth

[...] meet their own breastfeeding goals (see coverage of study here, and an in-depth review by blogger PhD in Parenting).  There are several influences that effect a mother’s breastfeeding, including hospital [...]

As a nurse, it makes me really sad to see some of these comments here about the poor experience you had with your nurses. I also see first-hand the mothers of the babies who are admitted to our unit for jaundice, whose mothers haven't the first inkling on how to nurse their newborns. Fortunately, I have hands-on experience, but I am not a Lactation consultant, and always end up placing an order for these mothers to see one first thing in the morning (I work nights). I didn't personally meet my own goal of nursing (I wanted to do it for one year, and barely made 9 months) because of the hours I worked - 3 12-hour shifts in a row, meaning I rarely had an opportunity to nurse my son for those days and nights, and he was getting pumped milk from a bottle. I'll not go into the politics of the importance to let a mother stay home with her child at least the first 6 months, because this is not the forum for it...

July 1, 2012 | Unregistered CommenterCarmen

Carmen,- that sucks :( I work at a hospital as well, and today is day 2 of a 3 in a row. It's brutal, and I think you did awesome to get to 9 months. I want to make it to a year as well, but I don't want to think about the stretch goal. I actually pump in the bathroom at work because the lactaction room is too far away (I can't get the breaks to go pump, I have to use my 15 min breaks and 30 min lunch).

I really hope I can make it to at least a year though, I literally can't afford formula.

July 4, 2012 | Unregistered CommenterDanielle

I think women don't meet their own BFeeding goal because of a perceived lack of support and because of conflicting information.

"Lack of support" can take many forms- if your partner isn't invested in bfeeding as much as you are, he will be quicker to tell you that its okay to use formula. No partner wants to see their other in distress. Most women in my circle go to work after 6 weeks. That's lack of societal and work support. I took 8 weeks FMLA (I was told I needed the remaining 4 weeks for breastfeeding breaks to keep my job) and my job wanted me to work right until I delivered (I work at a hospital). Now that I'm back to work, it's an issue to get pumping breaks- they don't mind me going of course, just not when it's busy which is my entire shift...

Incorrect information: bleh you can write so much on that- but suffice to say I think that is CRIMINAL for a health care provider to not know about breast feeding, the way that human babies get human milk. My baby's first ped (before I switched) wanted us to supplement because she wasnt gaining enough weight. She was 6 lbs 12 oz at birth, and 6 lbs 6 oz when we left the hospital, her first appt was the day after we left the hospital, and the doc said that she wasn't gaining enough. At that time my baby was cluster feeding, and the ped said that meant she wasnt getting enough. My MIL told 15 mins on each side so that's what I was doing, so when baby was crying cause she wasn't getting enough, I figured I wasn't making enough milk. Now I know I needed to follow my babies cues. Couple that with The Internet, and you can see how it's easy for a mom to get information overload with conflicting information.

I thought I needed to increase my supply, and lo and behold when I did, I got plugged ducts and had oversupply lol. Now I know to feed on demand only.

On the plus side my experiences and the help I received from ppl (LLL and others) demonstrates that breastfeeding needs to a (supportive and properly informed) village.

Sorry for this super long post about my experience. I meant to only type a couple sentences!

July 4, 2012 | Unregistered CommenterDanielle

[...] Research PROVES that giving formula in the first few hours and days after birth can significantly compromise [...]

Hurrah! After all I got a webpage from where I know how to really get
useful facts concerning my study and knowledge.

August 11, 2012 | Unregistered Commentermaking a boy

[...] The program staff seemed almost bewildered when we persisted on asking over and over again what happens when a mother is unable to breastfeed or when a baby is unable to latch on. The mother would be transferred to a medical facility, where the breastfeeding problem would be assessed and corrected, they said. But this is so rare, that it didn’t really register on their radar as a major issue to be dealt with, like it is in North America where so few women meet their own breastfeeding goals. [...]

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