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The Supplementation Trap

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In over 2.5 years I have counseled over 3,000 breastfeeding mothers as part of my paid work as a WIC Breastfeeding Peer Counselor and as a volunteer La Leche League Leader.  As a supporter and volunteer for Best for Babes Foundation, I am very aware of the many “Booby Traps” to breastfeeding because sadly, I have encountered many of them myself.

 

 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”.

 

Jaundice did not interfere with exclusive breastfeeding but only because I fought for it.
Jaundice did not interfere with exclusive breastfeeding but only because I fought for it.
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.
I believe that breastfeeding support is important for pediatric practice and which that all pediatrician offices either have a CLC/IBCLC on site or were quick to refer a mother to one as needed.
doctor1

The Supplementation Trap

, , , , , 0

In over 2.5 years I have counseled over 3,000 breastfeeding mothers as part of my paid work as a WIC Breastfeeding Peer Counselor and as a volunteer La Leche League Leader.  As a supporter and volunteer for Best for Babes Foundation, I am very aware of the many “Booby Traps” to breastfeeding because sadly, I have encountered many of them myself.

 

 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”.

 

Jaundice did not interfere with exclusive breastfeeding but only because I fought for it.
Jaundice did not interfere with exclusive breastfeeding but only because I fought for it.
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.
I believe that breastfeeding support is important for pediatric practice and which that all pediatrician offices either have a CLC/IBCLC on site or were quick to refer a mother to one as needed.
doctor1

Zen’s 1st week… 4 months later

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Zen will be 4 months tomorrow and I finally had the chance to finish the recap of his 1st week.  That is how busy things are over here!

 

I was delighted to see Zen do the newborn crawl that I had heard so much about.  He was very sleepy and had a very shallow latch which we later learned was from being tongue tied in addition to having an upper lip tie but it was still awesome.  I had requested to postpone the first bath until after nursing and later found that the nurses treated giving Zen’s bath like a hot potato, they were all too busy/nobody wanted to do it.  He finally got his first bath on the 3rd day in the middle of the night.
A few hours after birth we learned that Zen was Coombs Positive.  What this means is that he got his father’s blood type which is incompatible with my blood type and it can lead to jaundice if unchecked until his body got rid of my blood cells.  The nurses were super strict with the bili lights as a result and tried to limit breastfeeding to only 20 minutes every 3 hours, this is contrary to normal advice for jaundice which lots of feeding is encouraged to help baby have lots of dirty diapers, it was also contrary to my mothering instinct of having skin to skin and bonding with him.  Thankfully I was able to get permission from the doctor to put myself under the lights so Zen could have unlimited skin to skin and nurse on demand.  Due to the bili lights ordeal we missed out on Zen having pictures taken by the hospital and that made me sad but I try to not dwell on it.
Unlimited skin to skin and nursing despite the bili lights. It CAN be done!
He was having lots of dirty diapers which was great but since he was so sleepy and had an ineffective latch he still managed to lose a lot of weight.  I knew this was coming and I was prepared, I would express colostrum and feed it to him and would practically hand express in his mouth to get something in him.  Thankfully the pediatrician understood my desire for a virgin gut and didn’t push supplementation and instead told me to “nurse him a million times a day” which I was glad to do.   I am glad that despite them having an option of invoking a “medically necessary” excuse they didn’t push formula and I didn’t receive a “Breastfeeding Success Kit” aka formula gift bag on discharge.
Zen looking fashionable under the lights
My recovery was much harder this time.  I lost a lot of blood and some of the nurses would forget about my request for pain relief until I was in agony.  I snapped at one nurse that was 45 minutes late giving me painkillers and then had the nerve to tell me to not cough because it would hurt.  Does it look like I want to cough?!
Overall the hospital experience was better than with Shammy with it being a different hospital.  The only truly bad experience was a fiasco where an immature food service employee spilled my husband’s coffee while delivering my dinner and didn’t apologize nor try to help clean it up.  The coffee spilled over lots of important papers, pictures and gifts.  I made a scene about it because I was furious that she refused to at least apologize.  The rest of the staff were great at trying to salvage what they could and replace the rest and the person’s supervisor paid me a visit right before discharge to apologize.
Discharge at Martin Memorial is different than at St Lucie Medical.  With Shammy I was required to carry Shammy out while sitting in a wheelchair.  At Martin Memorial they required Zen to be strapped to the carseat and carried out and I had to walk myself out while being escorted by a nurse that verified the carseat installation.
I went home knowing that it is normal for his bili levels to rise before falling so I planned to nurse often and make sure he got sunlight several times a day.  He was a very sleepy baby compared to Shammy.  I was blessed that Dr. Punger was kind enough to work with us and fit us into her schedule quickly to get Zen’s tongue tie situation addressed.  Over that weekend that we had to wait my nipples started to suffer from nursing so often with a bad latch and my milk supply was suffering.  I don’t think we would have lasted longer than another day without supplementing.  Dr. Punger clipped Zen’s tongue tie AND upper lip tie.  He looked like a vampire baby and I couldn’t help but giggle while refraining from taking a photo.  His latch immediately improved and although it took him a couple of days to figure out how to work his tongue things only got better and my milk production increased.
By this point Zen had gotten a little orange due to breastmilk jaundice/Coombs + but with lots of nursing and sunlight we were able to avoid the hospital and he gradually went back to a normal color.
Zen only got better from there.  Shammy has grown to love Zen and Zen really looks up to his big brother, I look forward to lots of playing together and bickering in the future.  Shammy didn’t develop any jealousy over Zen nursing and I am proud to be a tandem nursing mama.
First of MANY tandem nursing sessions
My anemia got very bad with a hemoglobin level of 7.3, thankfully thanks to being able to have my placenta encapsulated I was able to get my hemoglobin up to 12.1 in just 5 weeks without taking any other supplements or paying any attention to my diet.   The rest of my recovery however has been a long and painful road.  My incision bled from any physical exertion for up to a month.  Even though I weaned myself from painkillers after 10 days, I sometimes have to pop a Motrin to recover from carrying Shammy or cleaning something.  Almost 4 months later I still experience residual pain and I sleep in a recliner because it’s too painful to lie down to sleep.  I hope to be able to feel normal again… someday.

Zen’s 1st week… 4 months later

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Zen will be 4 months tomorrow and I finally had the chance to finish the recap of his 1st week.  That is how busy things are over here!

 

I was delighted to see Zen do the newborn crawl that I had heard so much about.  He was very sleepy and had a very shallow latch which we later learned was from being tongue tied in addition to having an upper lip tie but it was still awesome.  I had requested to postpone the first bath until after nursing and later found that the nurses treated giving Zen’s bath like a hot potato, they were all too busy/nobody wanted to do it.  He finally got his first bath on the 3rd day in the middle of the night.
A few hours after birth we learned that Zen was Coombs Positive.  What this means is that he got his father’s blood type which is incompatible with my blood type and it can lead to jaundice if unchecked until his body got rid of my blood cells.  The nurses were super strict with the bili lights as a result and tried to limit breastfeeding to only 20 minutes every 3 hours, this is contrary to normal advice for jaundice which lots of feeding is encouraged to help baby have lots of dirty diapers, it was also contrary to my mothering instinct of having skin to skin and bonding with him.  Thankfully I was able to get permission from the doctor to put myself under the lights so Zen could have unlimited skin to skin and nurse on demand.  Due to the bili lights ordeal we missed out on Zen having pictures taken by the hospital and that made me sad but I try to not dwell on it.
Unlimited skin to skin and nursing despite the bili lights. It CAN be done!
He was having lots of dirty diapers which was great but since he was so sleepy and had an ineffective latch he still managed to lose a lot of weight.  I knew this was coming and I was prepared, I would express colostrum and feed it to him and would practically hand express in his mouth to get something in him.  Thankfully the pediatrician understood my desire for a virgin gut and didn’t push supplementation and instead told me to “nurse him a million times a day” which I was glad to do.   I am glad that despite them having an option of invoking a “medically necessary” excuse they didn’t push formula and I didn’t receive a “Breastfeeding Success Kit” aka formula gift bag on discharge.
Zen looking fashionable under the lights
My recovery was much harder this time.  I lost a lot of blood and some of the nurses would forget about my request for pain relief until I was in agony.  I snapped at one nurse that was 45 minutes late giving me painkillers and then had the nerve to tell me to not cough because it would hurt.  Does it look like I want to cough?!
Overall the hospital experience was better than with Shammy with it being a different hospital.  The only truly bad experience was a fiasco where an immature food service employee spilled my husband’s coffee while delivering my dinner and didn’t apologize nor try to help clean it up.  The coffee spilled over lots of important papers, pictures and gifts.  I made a scene about it because I was furious that she refused to at least apologize.  The rest of the staff were great at trying to salvage what they could and replace the rest and the person’s supervisor paid me a visit right before discharge to apologize.
Discharge at Martin Memorial is different than at St Lucie Medical.  With Shammy I was required to carry Shammy out while sitting in a wheelchair.  At Martin Memorial they required Zen to be strapped to the carseat and carried out and I had to walk myself out while being escorted by a nurse that verified the carseat installation.
I went home knowing that it is normal for his bili levels to rise before falling so I planned to nurse often and make sure he got sunlight several times a day.  He was a very sleepy baby compared to Shammy.  I was blessed that Dr. Punger was kind enough to work with us and fit us into her schedule quickly to get Zen’s tongue tie situation addressed.  Over that weekend that we had to wait my nipples started to suffer from nursing so often with a bad latch and my milk supply was suffering.  I don’t think we would have lasted longer than another day without supplementing.  Dr. Punger clipped Zen’s tongue tie AND upper lip tie.  He looked like a vampire baby and I couldn’t help but giggle while refraining from taking a photo.  His latch immediately improved and although it took him a couple of days to figure out how to work his tongue things only got better and my milk production increased.
By this point Zen had gotten a little orange due to breastmilk jaundice/Coombs + but with lots of nursing and sunlight we were able to avoid the hospital and he gradually went back to a normal color.
Zen only got better from there.  Shammy has grown to love Zen and Zen really looks up to his big brother, I look forward to lots of playing together and bickering in the future.  Shammy didn’t develop any jealousy over Zen nursing and I am proud to be a tandem nursing mama.
First of MANY tandem nursing sessions
My anemia got very bad with a hemoglobin level of 7.3, thankfully thanks to being able to have my placenta encapsulated I was able to get my hemoglobin up to 12.1 in just 5 weeks without taking any other supplements or paying any attention to my diet.   The rest of my recovery however has been a long and painful road.  My incision bled from any physical exertion for up to a month.  Even though I weaned myself from painkillers after 10 days, I sometimes have to pop a Motrin to recover from carrying Shammy or cleaning something.  Almost 4 months later I still experience residual pain and I sleep in a recliner because it’s too painful to lie down to sleep.  I hope to be able to feel normal again… someday.

Zen’s Birth Story

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Zen’s birth story is not as dramatic as Shammy’s but it’s still special so I want to document it.

The c-section was scheduled for Tuesday July 17th. I was hoping to go into labor on my own before then but aside from some false alarms I walked into the hospital at 6am with no contractions. While in the process of getting prepped for surgery the contractions started to come to the point of the doctor seeing them on the monitor when he walked in to say hi and said “we won’t let those go on much longer”. By the time I was being prepped for anesthesia I was entering active labor with contractions 90 seconds apart that forced the anesthesiologist to work around them.

The anesthesiologist had trouble getting the spinal block in place because my belly was in the way of me leaning forward enough to allow my back to stick out so instead I had to endure through contractions AND the anesthesiologist moving the needle around my back, sometimes the needle would leave the numbed area while trying to find the space to inject which was very painful, it felt like an eternity before they finally found the spot and things started to move again.  Ahh, the relief…

While we waited for them to bring my husband in I started to feel dizzy and about to pass out, it turns out that my blood pressure was dropping very fast. They injected something in my IV to bring it back up but I could see the worry in the anesthesiologists eyes as it wasn’t working fast enough and I feared that they would just knock me out completely and hubby wouldn’t be able to be there. Thankfully my blood pressure started to recover at the last minute and they were able to proceed.

This experience was vastly different than my first c-section. The first time it was an emergency and everything moved super fast. This time nobody was rushing and it felt like it took a very long time. I noticed that last time they were in such a rush to get baby out that they started before the anesthesia had fully taken effect. This time I was nice and numb and barely felt a thing. Because it was taking so long it was too easy for my mind to run away in anxiety so I forced my husband to talk to me and distract me during the whole time so when Baby Zen was being pulled out we were talking about what Shammy was probably having for breakfast with grandma.  This meant that I didn’t get to listen to the Dr’s conversation which may have been a good thing as with Shammy I had the pleasure of listening to the Dr curse in Spanish because he didn’t know I spoke the language.

The doctor was not used to having to announce the gender and forgot so the nurse had to remember that we were waiting to find out if it was a boy or a girl. I was surprised that they didn’t let my husband cut the cord like last time or be there while they wiped and wrapped the baby, we both got to meet him at the same time. He looked so much like his brother!

In hindsight, it’s a good thing that I followed my gut and didn’t ask them to delay cord clamping. It turns out that Zen has his father’s blood type which is incompatible with mine and delaying on the cord would have allowed our bloods to mix more which would have not been good, more on that in a future post.

Daddy and baby went off to the nursery for weighing and other basics while I was being closed up. During that time the anesthesiologist says “listen!  they’re playing that for your baby” as I heard the lullaby playing in the background which can be heard throughout most of the hospital every time a baby is born ::waterworks::.

Once again the closing part felt like it took forever and it turns out that it did because I had a lot of scar tissue from my first c-section and massive blood loss. I also learned that the doctor made a huge mess and the OR looked like a crime scene with a huge pool of blood on the floor, I’m sure that the custodial staff was thrilled, just a funny detail to tell Zen a few years from now.

This time I made it back to the recovery room before daddy and baby but the nurses were nice enough to keep me informed on the delay. My placenta made it to the room before they did. Yes, I was able to get my placenta! The OB had made it seem like mission impossible when I asked prenatally and I had braced myself for a war over it but it was as simple as telling the admitting nurse that I wanted to take it and signing a form, no resistance.

Since I had some “spare” time I got to update my Facebook status announcing the birth before daddy did, straight out of surgery. A few minutes later Zen and daddy arrived and I got to enjoy much relaxing skin to skin time with my new son.

 

 

Coming soon, Zen’s first few days….

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