The Supplementation Trap

 While I don’t get tired of talking about breastfeeding, it can be very hard to not take things personally and feel defeated when a mom doesn’t reach her breastfeeding goal.  It saddens me to see so much unnecessary supplementation and premature weaning that could have been easily avoided if mom had more confidence in herself and learned to listen to her gut.  Oftentimes I can’t blame the mom as the bad advice comes from a health authority figure that they mistakenly assume to be an expert even if their lactation knowledge is minimal at best.

I hear it all of the time, a nurse says “your baby lost weight, you are not making enough so you have to supplement” or “your baby has jaundice so you will have to stop breastfeeding for 24/48 hours and give formula”.  That could have been me…

When Shammy was 2 days old a nurse woke me up at 2am to say that he had lost weight and had to be given formula right now, I must have been the first mother in her career to question that order.  In my groggy state I had to attempt to engage my brain because the nurse was pushing all of my emotional buttons to get me to agree.  To her it was just standard protocol of infant weight loss= give formula.  She didn’t know about breastfeeding and adamant that I couldn’t wait until I asked the doctor in the morning about the formula, she insisted that my sleeping newborn had to have formula RIGHT NOW.

So I told her that if it’s truly such an emergency that he needs to supplemented that she will then wake up the doctor and have me tell him himself.  Obviously that wasn’t an option so I insisted that if he had to be supplemented he would be supplemented with my breastmilk so please get my a breast pump.

 
After almost 15 minutes of arguing she finally gave up and came back with a breastpump.  My milk wasn’t in so I pump some colostrum and she complained about how that wasn’t enough but put it in the fridge anyway.  Shammy never got that milk.  The next morning I asked the doctor and he agreed that while supplementing with formula would help, it wasn’t necessary and I did NOT have to do it.

The next day my milk came in and Shammy gained all of the weight loss plus some.  But how many new mothers know to question a nurse?  They think the nurse knows it all, oftentimes they mistakenly assume that the nurse is acting on doctor’s orders.  How much supplementation could be avoided?  Also a lot of mothers think that supplementation = formula.  It doesn’t occur to them that their baby can be supplemented with their own breastmilk.

A lot of people say “it’s just one bottle, what harm can it do?”.   If you spend 1 day with me at the WIC office and you’ll be surprised at how much damage just one bottle can do to breastfeeding.  Not counting the fact that a lot of nurses and doctors tell a mother to supplement but don’t tell her for how long so mom thinks she will always have to supplement when in reality they could have stopped days ago and by the time they get to me we are faced with the problem of dropping milk supply, lazy latch, nipple confusion, etc.

Jaundice does not equal formula supplementation.  Zen was born Coombs +, what this means is that his blood type is different from mine so he gets jaundice while his blood clears out the leftovers from mine so he had to be under bili lights as a preventative and still got mild jaundice. On top of that he had (at the moment undiagnosed) posterior tongue tie and upper lip tie so his latch was not good and he was losing weight due to improper milk transfer.  The first nurse said that I could only nurse for 20 mins every 3 hours due to the lights.  The second nurse said that I had to supplement because he was losing weight and his bili levels were rising.

I saw another argument like the one with Shammy’s nurse brewing but thankfully this time it was daytime and my demand for a doctors order wasn’t so unreasonable.  I knew that limiting nursing would only make his jaundice and weight loss worse but the nurse was set in her ways.  The doctor agreed with me and I got permission to nurse on demand by getting under the lights with baby as long as I wore sunglasses.  The doctor had no trouble discharging us from the hospital despite still rising bilirubin levels and weight loss because she knew that I would “nurse him a million times a day”.

As soon as we were discharged I made an appointment with Dr. Punger to get Zen’s tongue tie and upper lip tie diagnosed and fixed and while his jaundice took a while to fully clear, we never had to supplement, we never had to go back to the hospital and he gained all of the weight loss plus some.

The moral of the story is:

• Always ask questions if you are told that your baby has to be supplemented.  If a nurse tells you to supplement, demand to hear it straight from the doctor.
• Know that you can supplement with your own breastmilk.
• Pediatricians can still be quick to recommend supplementation when it’s not truly needed so it’s ok to get a second opinion and talk to an IBCLC
• If you are told to pump and dump or stop breastfeeding due to medication, contact an IBCLC or LLL that can look up the drug on Hale’s Medication’s and Mother’s Milk.  Doctors and pharmacists play it safe and tell you not to breastfeed because they don’t know better when in reality it’s perfectly safe.  Most drugs are compatible with breastfeeding.  Lactmed and the Infant Risk Centers are also good resources for this. (You can use the Lactnet search widget on the right column of this page to research a medication).
• If you are told to supplement “until your milk supply increases” know that your milk supply will go further down because production is supply and demand and every ounce of formula that baby drinks is one less ounce that baby will drain from the breast sending a signal to your body that it’s not needed.  While pumping can help, a breastpump is not as efficient as baby to increase milk supply.
• If you must supplement it doesn’t have to be with a bottle (anything but a bottle is preferred; SNS, syringe, cup, spoon or finger feeding are options) and get clear instructions on exactly how long that is necessary while getting counseling on how to protect your milk supply and baby’s latch.