Low blood sugar in newborn after delivery

[momuveight2B]

I am hoping someone can help me understand what went wrong with my last birth and how I can prepare for my baby due in August.

We had a hospital birth at 42 weeks and I agreed to induction because my blood pressure was high and afraid of preeclampsia. I was on an IV most of the day (2pm until 2 am, baby born at 2236) but did not have hard labor until the last two hours, easy vaginal delivery but placenta was retained and had to be manually removed. I only had morphine for the removal of the placenta once baby was born, no other drugs. I was not supposed to eat or drink but my doula snuck me a fruit smoothee in the middle of the day.

The morphine made me so loopy I could not get baby on the breast right away and the nurse and doula would not do it. My husband said he was trying but I don't recall him still being there. Not to be crude but when I had my first baby 27 years ago the nurses would grab your tit and put the baby on it. Being a new mom and not knowing how to do it this worked. Nowadays it seems they have a "handsoff" policy.

So a few hours later I have a nurse waking me up saying baby has low blood sugar and my husband is in the nursery refusing a bottle of formula. I asked her is she could give glucouse water and she did by gavage but not enough protein and metabolized too quickly, so I agreed to formula by gavage. She refused to give me the baby or to let me nurse until blood sugar was stable and that took until 7am. I had my IV removed and refused further meds around 2am. So the doctor finally comes in and threatens to put her in NICU if I don't agree to formula feeding by bottle and tells me I can't nurse this baby because she is too sick. I'm sorry I don't remember the numbers but they were always in the low normal range.

At this time since I agreed to the formula feeding they gave me my baby and I promptly began nursing her, she did great, on the breast for a good twenty minutes per side and I woke her every two hours. They would then attempt to top her off with formula. My goal at this time was discharge home and I was scared they were going to get social services because we were so pro breastfeeding.

So we went home threw out the bottles and formula and four and a half years later we still have a great nursing relationship. I did have some early nipple confusion with her but we got through it.

I do not have gestational diabetes and never have, I do get the one hour test and pass without any problems each time. My last few pregnancies I have been overweight.

Sorry this is so long but we are afraid we will encounter the same with this next baby and we want to be prepared. The same hospital. They were very resistant to alternative methods of giving the baby formula, their protocol is to bottle feed and not allow nursing if the baby has low blood sugar. LC are not available nights or weekends. I don't have any milk myself right now and do not have anyone who could donate some, I'm not sure that would even be acceptable to the hospital if I showed up with frozen donor milk.

We are thinking : that this time we will just agree to the bottle of formula and get it over with so that we can get our baby right away. I hate this idea but last time it was very traumatic for us to fight the nursery staff all night and then our baby was poked and prodded more than she should have been.

I am a high risk pregnancy seeing a peri group so giving birth outside the hospital is not going to happen. There is a chance I may even have to have a scheduled c-section this time. I have a thin area in my uterus that puts me at risk of rupture. I will do anything to have my baby safely delivered and staying at home seventy miles from the hospital is not an option. We can not have a midwife attended birth legally in our state either.

If I can't get baby to the breast myself then I am hoping my husband will get it together for me. He is a great guy but is one to stand by passively and let doctors and nurses have their way. We have talked about this but I don't feel like I am getting anywhere with him.

I would appreciate any ideas of how we could handle this better if it comes up again.

[JunipersMom]

Tell your doctors and ask them what they suggest. Talk to your doula about your wishes and add in your birth plan that you want the baby on your boob right away even if someone else has to do it. That way everyone will know your wishes before birth and you might have a chance.

[pamamidwife]

The whole range of what is "too low" for a newborn is extremely controversial. We know that even large babies have enough stores to last them with very little intake over the first couple days.

I'm sorry for your experience and have nothing really to add other than what JunipersMom has said.

[2much2luv]

Can you not refuse blood sugar tests for baby?

[channelofpeace]

My baby was born at 37wks 3d and at 7lb 12oz, was "large for gestational age" I wasn't horribly concerned because all the babies in my family are large. That is just how we grow 'em I refused the blood sugar test based on this fact. I told the nurse that we would check it if the baby started showing any symptoms (she listed them for me, but i don't remember what they were). She didn't bat an eyelash. And the my boy remained perfectly healthy

Good luck on your decisions!

[momuveight2B]

Thanks for the input. I am talking to a doula, the last one has moved away, and we are making a plan on how to handle this if it comes up again. As I get closer to delivery date I am starting to freak out a little. I want to have more control but not be in conflict with the medical professionals either.

[ellebelle]

Get Jack Newman's book, The Ultimate Breastfeeding Book of Answers. There is information about low blood sugar and the improper ways hospitals manage it. I give this book out in my childbirth classes and instruct the moms to pack it in their hospital bag.

Also, check out this Kelly Mom website page. It has a ton of links on hypoglycemia in the newborn. Basically, your colostrum would be much better than formula. Glucose water is not good because it may temporarily raise blood sugar, but then a crash may follow because of the spike in insulin production. http://www.kellymom.com/babyconcerns/bfhelp-hypoglycemia.html

hth,
Ellen
wife to G., homeschooling mom to ds13, ds11, dd7
Bradley® certified childbirth educator

[prothyraia]

My son went through a similar, awful, experience (multiple heel sticks, bottle of formula, IV). I'm kicking myself now because I KNEW he was going to be big, and I didn't think to find out if there would be anything 'routine' associated with that. No GD here, either.

Long story short, next time we're declining any routine blood sugar testing. If the babe's symptomatic that's another story, but my son never was.


http://www.who.int/reproductive-heal...ia_newborn.htm

"9. For newborns at risk, breastmilk is the safest and nutritionally most appropriate food. However it may need to be supplemented with specific nutrients for some very low birth weight infants."

And more importantly:

"Large for gestational age (LGA) term infants. Rare infants with organic hyperinsulinism are typically large at birth, and this association has led to screening of infants whose birth weight exceeds the 90th percentile for gestational age. Occasionally LGA is associated with hitherto undetected maternal gestational diabetes. But the majority of LGA infants are simply large, normal healthy infants (see Section 2.4.4). As in AGA infants (Hawdon et al, 1992), blood glucose concentrations may fall below 2 mmol l-1 in this group, usually within the first 8 hours of life (Holtrop, 1993). There is no evidence that transient hypoglycaemia in this group is detrimental to outcome. Consequently, reagent-strip screening, supplementary feeding and treatment of transient, mild hypoglycaemia in the absence of symptoms are inappropriate."

Edited to add: And even though the screening and treatment were obnoxious, at least the docs and nurses at the hospital I was at actively encouraged me to breastfeed, frequently, especially before the tests!

[bryonyvaughn]

I'm not a birth professional and only feel qualified to comment on one part of your post from personal experience.

Originally Posted by momuveight2B

...We are thinking : that this time we will just agree to the bottle of formula and get it over with so that we can get our baby right away. I hate this idea but last time it was very traumatic for us to fight the nursery staff all night and then our baby was poked and prodded more than she should have been...

I normally am not fond of lying to HCPs but their ignorantly and mulishly insisting on actions clearly contrary to a patient's best medical interest is where my truth telling morals defer to my protecting the vulnerable morals.

If I weren't up for a nursing at the breast vs. bottle feeding battle, I'd bring in frozen donor milk and pass it off as my own. I was in a similar situation and passed off organic free-range goat milk as pumped and frozen breastmilk for my hospitalized and cows milk allergic 9mo.

I think if you got word of your situation out in LLL, API, NFL, circles and especially at finding your tribe on MDC *someone* will have a frozen milk stash from which they'd be willing to donate a bottle or two. As you have no milk now you could insinuate as your milk was drying up during this pregnancy you wanted to pump enough of a stash to avoid a repeat of your previous experience there.

Your situation with the hospital sounds very daunting. I wish for you brilliant bursts of creativity to dream up ways you can control your outcome and wish you peace and strength in them.

Take gentle care,
BV

[Jane]

I heard of giving diabetic mothers needle-less syringes to express colostrum into during pregnancy. The syringe make it easier to grab those drops that well up after a shower. In a month, the hope is to have a syringe full to give to the baby in the first minutes after birth. Just that tiny amount of colostrum helps stabilize their blood sugar so their first check of glucose is okay, the baby stays alert, and breastfeeding goes swimingly, hopefully.

[momuveight2B]

Originally Posted by ellebelle

Get Jack Newman's book, The Ultimate Breastfeeding Book of Answers. There is information about low blood sugar and the improper ways hospitals manage it. I give this book out in my childbirth classes and instruct the moms to pack it in their hospital bag.

cator

Thank you for the link it ws really helpful.

Last time I knew I was right and that my baby needed immediate and frequent nursing BUT how do you go up against hospital protocol and a nurse at 2 am threatening that if you don't give formula she is going to transfer your baby to NICU and then you won't get her for a few days and no chance to room in or nurse? It was scary! We really thought it was going to lead to a social service referral.

[jen and her girls]

I am so glad you posted this, I'm a nervous wreck about this issue myself. I have GD with this pregnancy, and they are estimating that our son will be large for gestational age when I deliver, and is likely to be hypoglycemic. I have been told that they are likely to whisk him directly off to the NICU for a bottle of formula as soon as he's delivered.

I want to do everything I can to avoid this, so I have printed out the articles that ellebelle posted, and I have started storing colostrum in syringes per the advice of Apricot. I have 3ml now, and am hoping to have at least an ounce by the time he is born. I am hoping that if I go in armed with information then they won't be able to force me into things I don't want.

I will be discussing this with my OB on Friday. I will let you know if I get any good information.

[Ruthe]

OP... I'm not a birth professional, so this is unprofessional advice... take it for what it's worth!
Can you make sure your IV (if you must have one) is saline and not glucose solution during labor? Well-meaning OB staff like to give you glucose in your IV to "keep your strength up" but the response to sudden input of glucose directly into your blood is that you will secrete high levels of insulin to process it. The baby gets high blood sugar too(through the placenta) and also secretes high levels of insulin to precess it. Then he's born and abruptly cut off from the sugar source, (unlike you, who are still hooked up to your IV, and can also eat a sandwich or something as soon as you feel like it) and what does he do with all that insulin? Oh yeah, his blood sugar crashes, and he gets tired and doesn't feel like nursing. Breastfeeding can be too much work when you have very low blood sugar. So avoiding the problem is the first line of defense.