When a supplement is truly needed

[MarcyC]

I think we can all agree that there are times when a supplement is truly needed? I'll never forget sitting at a LLL meeting and two leaders looked at my two week old, sleepy, lethargic baby who was 5 lbs. (down from 6 lbs., 3 oz. at birth) and told me, "she needs to eat, you need to follow the drs. orders and supplement." I was sobbing! I gave one of them my baby so I could go outside and cry. I called DH and said, "even LLL is telling me to supplement." I was so sad.

Which brings me to a question and commentary.

When a supplement is needed, most doctors say, "put baby to the breast first, then after the baby is finished, offer a bottle, and then pump." That's typical of what most doctors advise.

So a feeding/schedule might look like this:

6:00 am - let baby nurse and a newborn might nurse for 30-60 min.)
6:30 am - offer bottle
7:00 am - pump
7:45 am - change the baby, eat something, do laundry take a shower

8:00 am - start routine all over again

Doing that just seems like it would lead to total 100% exhaustion. Especially if you have other kids and are homeschooling .

I remember when the doctors told me to supplement and suggested the nurse/bottle/pump routine and I told them I had an SNS - I would probably use that and their eyes lit up. Oh, by all means, use the SNS - that's way better than a bottle - she won't get nipple confusion and it will keep you stimulated better than a pump. Um....okay......then why didn't you suggest that in the first place?

So....

I'm just thinking out loud here....

How can we get more doctors to recommend an SNS? I asked our pedi why he didn't recommend an SNS at first and he said quite honestly most women aren't willing to put an effort into BF'ing and some are looking for a way out.


How can we make more women aware of alternative ways to supplement (SNS, finger-feeding, etc.)?

Knowing what women must go through when they are told to supplement (above routine)...how can we have more compassion for bottle feeding women who said they struggled? How can we factor this into "lactivism."

[mighty-mama]

I don't know why they don't push SNS. Maybe due to liability? Maybe they're concerned you truly won't feed your baby with a SNS. I don't know, I"m just rambling myself. I mean if you think about it your babe would get the same amount of milk/ formula in a SNS then what you'd put in a bottle.

Gee could you imagine the numbers of babies who would still be breastfeeding if their mama's were encouraged to supplement w/ a SNS, instead of a bottle..

You have a really good point!!

[courtenay_e]

In general why don't they suggest the SNS? Really? I think it's laziness. Both, as your pedi said, on the part of the mother looking for a way out, AND of the docs. For, if they suggest them, they're going to either have to offer to show them how to use it, or give them a referral to somebody who will...and then follow up to be sure that it's being done properly. Gasp. What is that, a whole 'nother five minutes of providing care? But, time is money. That's what I think. I'm a little cynical, but that's what I think.

[Shell_Ell]

I have a pretty long story and I'll spare you the details, but I will post what I think about this topic.

My experience with the SNS is that it was a pain. On top of the exhaustion of a new baby and the mental breakdown I was having because I didn't have enough milk for him, I couldn't get the tube to stay in his mouth. We didn't even have a latch perfected at that time, so getting the tube in there while having a perfect latch was nearly impossible.

I had birth center midwives and no bottles in the house. One of them actually brought the disposable version of the SNS to me at a home visit on day 5 PP. There was no question that he needed it- he'd lost tons of weight, had a hoarse cry and dry mucus membranes, and when weighed/fed /weighed, only got a half ounce from me. This was with a half hour feed. (And this continued until about 2 months old, when the Domperidone and pumping finally kicked in)

I think the reason more mainstream medical professionals don't push them is because some feel they are alot of work compared to giving a bottle. I agree that it is the better choice, but for me, some sort of sanity was more important. We did syringe feeding, and then I finally broke down at about 2 weeks PP and had DH go buy a bottle. I did try to use the SNS again when DS was a few months old, but by then he was old enough that it he knew something was "off" and didn't want to nurse with it. I didn't want to nurse with it either. It was simply easier to nurse him and then give a bottle afterward.

Even at a LLL meeting a couple of months ago when I suggested an SNS to someone, I got a sort of blown off, as if it wasn't even an option. I was suprised that the leaders or other members didn't pipe up and praise them.

edited for grammar

[MaryJaneLouise]

ITA that SNSs / Lactaids should be recommended and used more often. I think it's just a part of how our society doesn't value BFing and just sees it as a "pain."

As a PP said, the doc would have to refer to a LC, which often times aren't available. And most people's insurance won't cover them.

I don't know how to get the info out there .

[Shell_Ell]

Originally Posted by MaryJaneLouise

I think it's just a part of how our society doesn't value BFing and just sees it as a "pain."

I think I'm being sensitive because this is a touchy subject for me. But since I used the word "pain" I'm wondering if that was directed at me or if you were just using the same word. For me, breastfeeding has been the hardest uphill battle of my life. I wouldn't say it's been a "pain" but that for me, the added stress of using an SNS wasn't worth it. It doesn't mean that I haven't put every once of myself into making nursing work. Alot of low supply moms don't use an SNS for the same reason. I applaud those that use them long term, because I'm sure it's WAY harder than just giving bottles. It has nothing to do with valuing breastfeeding. I don't think that's what you meant, though. I think you meant that society as a whole doesn't put emphasis on the SNS system because no one cares enough to.

I also think that alot of Drs don't even know what an SNS is. Alot of pediatricians don't know jack about breastfeeding. If more mothers knew that, maybe they would seek out an LC rather than a Dr. And if more insurance companies knew that, maybe they would cover LC visits. I think the root of the problem may lie in the fact that most people trust what their Dr's say, not realizing Drs aren't breastfeeding experts.

[Sustainer]

I think the problem is that doctors, on the whole, are simply not very bf-friendly. I am constantly hearing about doctors advising people to supplement with a bottle of formula even when it isn't indicated. Keep in mind that they accept gifts from formula companies.

The description of the doctor who failed to recommend an SNS, but then when the patient brought up the idea, he then supported it, reminds me of many descriptions I've heard of doctors failing to recommend breastfeeding, and waiting for the patient to volunteer the fact that she's going to breastfeed, and only then does the doctor show his support for breastfeeding. When asked why they didn't recommend breastfeeding in the first place, they say that they don't want to make mothers who intend to formula-feed feel guilty. It has been remarked that doctors would not use that excuse for other health issues, like smoking. They don't hesitate to ask people if they're smoking. They don't fail to recommend that people quit smoking for fear that they will make the patient feel guilty.

[MaryJaneLouise]

Originally Posted by Shell_Ell

I think I'm being sensitive because this is a touchy subject for me. But since I used the word "pain" I'm wondering if that was directed at me or if you were just using the same word.

No, I'm so sorry. I wasn't aiming that at you. I must have just used in advertently since I just read the word :

[MaryJaneLouise]

Originally Posted by Sustainer

It has been remarked that doctors would not use that excuse for other health issues, like smoking. They don't hesitate to ask people if they're smoking. They don't fail to recommend that people quit smoking for fear that they will make the patient feel guilty.

"Customer relations"

[elanorh]

Originally Posted by MarcyC

How can we get more doctors to recommend an SNS? I asked our pedi why he didn't recommend an SNS at first and he said quite honestly most women aren't willing to put an effort into BF'ing and some are looking for a way out.


How can we make more women aware of alternative ways to supplement (SNS, finger-feeding, etc.)?

Knowing what women must go through when they are told to supplement (above routine)...how can we have more compassion for bottle feeding women who said they struggled? How can we factor this into "lactivism."

I went through the above routine (for a long time actually) -- my doctor was very supportive and relatively well-informed about lactation, and I was working with an LC too. It is exhausting, though! My doctor offered me the option of either an SNS or the above routine. When I said that the above sounded more manageable, she said, "Good, the SNS is hard for babies" and mentioned something about tubes in their noses??

Having never used one, I don't know how they work and have no idea whether her assessment was truthful or not. I do think that the educational lectures which OBs and Peds attend need to continue/increase providing good breastfeeding information lectures/conferences. And as patients, we should encourage our doctors to go (or thank them for going)? That doesn't factor in, of course, the docs who attend and spend the conference in the back organizing their daytimers.

**
I think a big part of increasing awareness is simply to support the women we know in our own lives, suggesting good books about bfing when they are pregnant, offering help/assistance if they are struggling - then we ourselves can suggest SNS to them if it looks like they need them, etc.

**
Honestly, I think (or would like to hope) that most women who are "lactivists" are well aware of the obstacles that many women face in re: breastfeeding - especially those with less informed/less supportive doctors and families. And that we feel compassion for them (at the same time that we may feel angry on their behalf for the lack of good support they received).

For those women who ultimately decided that the struggle was too much, and resorted to formula feeding, I'm not sure what route is most effective. If I were one of those women, I would like to know that it's fine to try again, things might be different the next time 'round, that I may have been given poor information and support and that there are educational and supportive options (books, LCs, LLL) out there who might be able to see me through another rough spot. But, I think some women really become very upset about the situation, internalize things and blame themselves and rather than recognizing that, lash out at those who they perceive as either "attacking" their situation/choice, or as "pushing" a bf agenda on them. I really don't know how those walls are broken down.

[mama-a-llama]

Originally Posted by elanorh

she said, "Good, the SNS is hard for babies" and mentioned something about tubes in their noses??

I can't comment on whether the SNS is hard for babies because all the drs said they were for younger babies, not my 10 mo old, and I didn't know to go to a LC. Don't know what that dr meant about tubes in noses--my daughter did end up with a tube in her nose (a feeding tube) because she completely refused a bottle, and I had no milk left. I wish that someone had encouraged it, as I don't think it could have been more of a pain than tube feeding her.
I don't know how we can get drs to suggest it. Or better yet, have LC's be covered by insurance, and be referred to like any other specialist. Sort of OT, but I think that could help a lot, if it was easier for women to get help when they need it.

[sapphire_chan]

Originally Posted by Sustainer

It has been remarked that doctors would not use that excuse for other health issues, like smoking. They don't hesitate to ask people if they're smoking. They don't fail to recommend that people quit smoking for fear that they will make the patient feel guilty.

And yet many doctors also have no problems telling women to stop breastfeeding. Maybe they're just good at saying "no"?

Re: Difficulty with SNS,

Couldn't doctors introduce mamas to cup/syringe/finger feeding as a way to supplement the baby while learning to use the SNS?

[BensMom]

My friend in Fl is struggling to BF her 3w old baby, doing the nurse, supp (with her milk at least), pump routine. I have asked her to ask for a SNS several times - at the hosp she gave birth in and at the hosp they ended up at with the babe for almost a week (long story, but the babe is fine). Both times she was told BS like "the ped has to write a prescription for the SNS" or that the LCs dont have any. WTF?? I am going down there to visit next week and was thinking about getting one for her and bringing it with me just in case. I wonder the same thing - why add all the extra work to an otherwise tired and struggling new mama?