Pediatrician recommends supplementing - should I?

Notchalk wrote:


I seriously find that 36 and 37 weekers have MUCH more trouble
breastfeeding than 35 and 38+ weekers do. I have no idea why, but it's
something I've noticed from when I first started my Midwifery training
in 2001. There are rarely any exceptions, but of course I only see them
for the first 5 days.

Wow. I'd be wondering if there was some difference in how the cases are
handled, if they get different levels of nursing care or whatever (but
I suppose you aren't talking about just one hospital?). I know there
was one woman here years ago who had a baby at (I think) 36 weeks, who
was big and healthy and got treated essentially as a full-term baby, so
that she didn't get at all the kind of support she would usually have
done with a premie. I think that may well have had something to do with
the problems her baby had breastfeeding. Of course this is all my
interpretation in hindsight, and I can't be sure of having the story
quite straight any longer.

--Helen

"LubsyB" wrote in message
ups.com...
Thanks for all the advice! In answer to some of your questions,
breastfeeding is going much better now (I've had my mom, who
successfully bf'd 3 babies, sit with me many times to watch her latch,
etc.), and I let Sara feed on each side until she gets too sleepy
(10-15 mins per side). If she still acts hungry, I let her go back on
the first breast for a few more minues.

I also have been pumping some, and offering her that after a couple of
feedings a day, and she always takes 1-2 more oz when I offer, so that
makes me think she leaves hungry sometimes -- even after 45 minutes.
One thing of note is that she doesn't eat 10-12 times a day, maybe more
like 8. She typically sleeps for 2-3 hours every time before waking up
to eat. Her diapers are definitely good, and she has long alert
periods where she's perfectly content, so it's not like she's crying
all the time or anything.

Then I'd ignore the pedi. If she's happy and growing, try not to stress too
much.

Jess

On 2007-01-07 03:55:45 +0800, "
said:


Notchalk wrote:


I seriously find that 36 and 37 weekers have MUCH more trouble
breastfeeding than 35 and 38+ weekers do. I have no idea why, but it's
something I've noticed from when I first started my Midwifery training
in 2001. There are rarely any exceptions, but of course I only see them
for the first 5 days.

Wow. I'd be wondering if there was some difference in how the cases are
handled, if they get different levels of nursing care or whatever (but
I suppose you aren't talking about just one hospital?). I know there
was one woman here years ago who had a baby at (I think) 36 weeks, who
was big and healthy and got treated essentially as a full-term baby, so
that she didn't get at all the kind of support she would usually have
done with a premie. I think that may well have had something to do with
the problems her baby had breastfeeding. Of course this is all my
interpretation in hindsight, and I can't be sure of having the story
quite straight any longer.

--Helen

Yes, this is from the 3 different hospitals I have worked at. I think
if a 36 weeker is of a normal size, they are left to demand feed, but
all feeds are watched (with mother's permission) regardless of
gestation. If the 36 weeker is on the small size, they are on 3 hourly
feeds, usually. If they are not feeding well, then they would get EBM
via syringe, cup or finger feed. If they are not able to do even this,
they would be in SCN getting tube fed. I guess all infants are treated
the same from birth, breastfeeding-wise, and just observed for any
problems and go from there.

Jo
--
Woman, Wife, Mother, Midwife

Wow. I'd be wondering if there was some difference in how the cases are
handled, if they get different levels of nursing care or whatever (but
I suppose you aren't talking about just one hospital?). I know there
was one woman here years ago who had a baby at (I think) 36 weeks, who
was big and healthy and got treated essentially as a full-term baby, so
that she didn't get at all the kind of support she would usually have
done with a premie. I think that may well have had something to do with
the problems her baby had breastfeeding. Of course this is all my
interpretation in hindsight, and I can't be sure of having the story
quite straight any longer.

some hospitals will automatically treat 36 weeks as a preemie, others will
do if under a certain weight and a few actually look at what they are seeing
and treat accordingly.

For me, this came up in the context of planning a homebirth, I felt that
once past the stage where there was a high chance of immediate help needed
with breathing, I would continue with homebirth plans, I didn't discuss this
with my midwife until around 35 weeks and she felt that if I had the baby in
week 35, I would have a good chance of remaining at home through the first
week or so after the birth, but with a 36 weeker that would actually be
harder. I seem to recall that Donna Metler's little girl was quite big and
treated as term, though was somewhere in week 35, but ended up losing a lot
of weight and probably wasn't being observed closely enough for her
gestation. My particular reasons for avoiding the hospital was not so much
that I felt there was no need, but that I felt that routine interventions,
such as insisting feeds be of a certain volume were potentially harmful and
that they might have insisted on tube feeds rather than waiting and seeing
if tube feeds were necessary. I feel that a lot of hospitals are not
treating near term babies as they deserve, for example, they won't be
priorites for receiving donor breast milk, yet they often won't give mum the
chance to express some and will supplement with formula too soon.

Anne

Yes, this is from the 3 different hospitals I have worked at. I think
if a 36 weeker is of a normal size, they are left to demand feed, but all
feeds are watched (with mother's permission) regardless of gestation. If
the 36 weeker is on the small size, they are on 3 hourly feeds, usually.
If they are not feeding well, then they would get EBM via syringe, cup or
finger feed. If they are not able to do even this, they would be in SCN
getting tube fed. I guess all infants are treated the same from birth,
breastfeeding-wise, and just observed for any problems and go from there.

obviously my observations in my other post relate to British hospitals
mainly and this would not be normal standard in a British hospital, at 36
weeks, a bottle would almost certainly be offered before using a tube and in
many cases even before other methods. I feel that in the UK we are getting
there when it comes to well full term babies and breastfeeding, for more
premature infants it's also generally good though I suspect that more donor
breastmilk is needed and there is always need for extra lactation
specialists to help the mums with pumping, but for near term and sick full
term babies breastfeeding is seen as a bonus and the importance of making
care decisions right from the start that support it is diminished. I once
visited a friend about 16hrs after a c-section (after early attempts at
induction had stressed the baby) for obstetric choestasis, so the baby was
just on 37 weeks, she'd had a couple of dusky episodes early on and had been
whipped into scbu, complete monitoring, etc (I don't know whether that was
warranted or not, but no reason was ever found and she's been fine since),
when I spoke to the mum, she was obviously quite distressed, she'd had a
PPH, but she said no one had even mentioned breastfeeding to her and she had
no idea how the baby was being fed (I'm pretty sure it turned out to be
bottle not tube, and definitely formula). It's entirely possible that being
a less needy baby, they wouldn't have made it through without some formula
in those first few days, but equally things could have been handled so much
better. There also seemed to be significant delay in mum being allowed to
offer the breast, again for no strong reason, of course when it came to it
after, the bottles, baby had no idea what to do and the ended up using
nipple shields, discharged without any advice on how to continue, so she
continued using nipple shields, each feed took a long time and she felt she
couldn't breastfeed with nipple shields anywhere but home and stopped
feeding within a month. Baby had a very sickly first year, with multiple
colds etc. absolute classic for a formula fed baby attending daycare, mum's
postnatal depression worsened after stopping feeding, which is a known
connection, yet doctors etc. advised her that stopping breastfeeding would
help. All in all, not a good outcome, but it was pretty much clear that
something like that would happen with the first 16hrs of the babies life.
The sad thing is that that kind of story is not a one off where things went
wrong or guidelines were not followed, it's a normal story.

Cheers

Anne

In article .com,
"betsy" wrote:

Chookie wrote:
Switching breasts while feeding isn't necessary, btw. My elder boy always
fell asleep within 10-15 mins of latching on, so we never got to the second
breast. This was probably a good thing as I had oversupply.


Switching breasts isn't necessary if you have oversupply and your baby
is growing well. If you want to increase your baby's milk intake and
increase your milk supply, then switching breasts is a very good idea.

I'm not sure it will increase supply. From what I understand, more frequent
feeds are a way to increase supply. In some cases, switching breasts might
act like an additional feed, but I am not sure it's clear-cut.

--
Chookie -- Sydney, Australia
(Replace "foulspambegone" with "optushome" to reply)

"Parenthood is like the modern stone washing process for denim jeans. You may
start out crisp, neat and tough, but you end up pale, limp and wrinkled."
Kerry Cue

Switching breasts isn't necessary if you have oversupply and your baby
is growing well. If you want to increase your baby's milk intake and
increase your milk supply, then switching breasts is a very good idea.

I'm not sure it will increase supply. From what I understand, more
frequent
feeds are a way to increase supply. In some cases, switching breasts
might
act like an additional feed, but I am not sure it's clear-cut.

switch nursing is a well known method of increasing supply, basically the
opposite of the keeping the baby on a single breast for x hrs trick for
decreasing supply. If you are well tuned in to your baby and are responding
to feeding clues, it may not be possible to feed more often, which then
leaves switch nursing, you need to be careful to avoid foremilk hindmilk
inbalance, but if you are in a position of needing to increase supply, you
probably aren't going to have that problem!

Anne

In article ,
"Anne Rogers" wrote:

Switching breasts isn't necessary if you have oversupply and your baby
is growing well. If you want to increase your baby's milk intake and
increase your milk supply, then switching breasts is a very good idea.

I'm not sure it will increase supply. From what I understand, more
frequent
feeds are a way to increase supply. In some cases, switching breasts
might
act like an additional feed, but I am not sure it's clear-cut.

switch nursing is a well known method of increasing supply, basically the
opposite of the keeping the baby on a single breast for x hrs trick for
decreasing supply.

I see!

--
Chookie -- Sydney, Australia
(Replace "foulspambegone" with "optushome" to reply)

"Parenthood is like the modern stone washing process for denim jeans. You may
start out crisp, neat and tough, but you end up pale, limp and wrinkled."
Kerry Cue

Anne Rogers wrote:
Switching breasts isn't necessary if you have oversupply and your baby
is growing well. If you want to increase your baby's milk intake and
increase your milk supply, then switching breasts is a very good idea.

I'm not sure it will increase supply. From what I understand, more
frequent
feeds are a way to increase supply. In some cases, switching breasts
might
act like an additional feed, but I am not sure it's clear-cut.

switch nursing is a well known method of increasing supply, basically the
opposite of the keeping the baby on a single breast for x hrs trick for
decreasing supply.

That's interesting. Now I'm wondering if we'll face a problem of
dwindling supply. At night, DD often likes to latch on and nurse for
HOURS. Sometimes she gets a second let down, sometimes it's just
sucking to suck.

That's interesting. Now I'm wondering if we'll face a problem of
dwindling supply. At night, DD often likes to latch on and nurse for
HOURS. Sometimes she gets a second let down, sometimes it's just
sucking to suck.

probably not, your supply is hopefully well established, but if you do
notice any decrease you might want to flip over before you go back to sleep

Cheers

Anne