As a Lactivist, would you ever recommend supplementation and how?

[MarcyC]

Kind of a spin-off from the pediatricians feeding the fear thread...

At what point would say that a baby needs supplementation and how would you recommend mom supplement. I know there are a lot of factors (age/weight/strength of baby), but just try to answer the question in general.

[bandgeek]

If a baby is truly FTT and the mom has seen a LC and determined there is an issue going on with low milk supply. But I wouldn't be all flippant and say, "give him a bottle". I'd recommend an SNS first. If it was an issue with baby having a weak suck, I'd recommend mom pump and put her milk (and formula if needed, or better yet, donor milk) in an SNS so baby doesn't get confused but is still able to get milk until his suck is strong enough to handle it by himself.

In any case, I would try to keep the baby off of bottles and try to work it out so mom's milk supply is stimulated and baby is getting enough.

[alegna]

In *general* if baby isn't gaining/thriving it's time to supplement. Of course donor milk is best- but usually hard to get.

I would suggest non-bottle methods.

SNS/lactaid best in most situations. Or finger feeding, cup feeding, syringe feeding etc depending on the situation.

-Angela

[ccohenou]

No...I'd refer the parent to a knowledgeable medical professional or IBCLC.

If I was giving information about ways to give a necessary supplement, I would include information about paced bottlefeeding/ the Kassing method along with other alternatives. IMO the most important thing is to find the method that works for the family and helps to preserve the breastfeeding relationship. That could be an SNS or it could be something else. I'm not aware of research suggesting that an SNS is unequivocally the best method of supplementing, and some mothers will find it very overwhelming and hard to deal with in addition to frequent pumping and a possibly ill baby.

[MaryJaneLouise]

Originally Posted by ccohenou

No...I'd refer the parent to a knowledgeable medical professional or IBCLC.

: I would not make any "recommendations" unless I were a trained LLL leader or health professional.

As lactivists, we can advocate for a society that treats breastfeeding as normal. We can encourage people to BF to the fullest extent that they can. We can refer people to read good sources of information, such as kellymom. We can support people emotionally during difficult times. I might even go so far as to say to someone, "If I were you this is what I would do...."

But I don't think lactivism has anything to do with making recommedations to individual families.

[Bekka]

Originally Posted by MaryJaneLouise

: I would not make any "recommendations" unless I were a trained LLL leader or health professional.

Actually, LLL Leaders are trained to share information. If a baby is FTT, they would recommend a few professionals (IBCLCs) and they would offer lots of information. They can't offer "advice"--that becomes something like "practicing medicine without a license." Or something like that.

[MaryJaneLouise]

Originally Posted by Bekka

Actually, LLL Leaders are trained to share information. If a baby is FTT, they would recommend a few professionals (IBCLCs) and they would offer lots of information. They can't offer "advice"--that becomes something like "practicing medicine without a license." Or something like that.

Thanks for the info And Marcy, I apologize if I came across as harsh. I just sometimes get irritated with folks who think that lactivism is all about : to people and not to change society as a whole. I know you are not like that

[songbh]

Originally Posted by MaryJaneLouise

: I would not make any "recommendations" unless I were a trained LLL leader or health professional.

As lactivists, we can advocate for a society that treats breastfeeding as normal. We can encourage people to BF to the fullest extent that they can. We can refer people to read good sources of information, such as kellymom. We can support people emotionally during difficult times. I might even go so far as to say to someone, "If I were you this is what I would do...."

But I don't think lactivism has anything to do with making recommedations to individual families.

Excellent post -- ITA.

We need to be careful to distinguish between breastfeeding advocacy (a.k.a. lactivism) and breastfeeding support. Helping/support situations with individual mothers require an entirely separate set of skills.

[momuveight2B]

Before my last baby I would have said no. Just when I thought I had it all figured out I gave birth to a baby who needed an emergency transfer to hospital NICU and was placed on a vent and TPN (central line feeding of supplemental specialized medical formula). He was heavily sedated and when weaned off the vent had already developed oral aversions from the vent and deep suctioning that he had to have after birth. He had had a stroke (brain bleed) in utero and could not coordinate his suck, swallow, breathe. He had hypotonia (low muscle tone) and could not even be positioned at breast properly. Once at the breast he was not able to latch, suck or swallow.
We agreed to bottle feeding in the NICU of breastmilk which I pumped round the clock while caring for seven older children and traveling 140 miles each day to and from the the hospital.
He never learned to bottle feed and never learned to breastfeed either.
He was volume intolerant so I agreed to enrich the milk with formula powder to increase the calorie content.
We finally got him home and his weight was not stable and on an NG tube (through his nostril to his stomach).
Finally we went to surgery and had a g-tube placed directly through his belly and two other procedures done.
Through it all I pumped and gave breastmilk with the formula supplement.
At four months despite nursing another child my milk supply dwindled to a few ounces per day. When my supply in the freezer was gone we had to switch to a medical formula since he could not tolerate anything else.

So I have found that despite all the education and best intentions it is not always possible to nurse. Broke my heart because I fully intended to CLW. I was a leader applicant with LLL so had all the training and support from friends there. I had previous nursing relationships and lactation support in the hospital.

I feel we did all we could for our baby. I never got any postpartum recovery at all. I stayed on the bed for an hour after his birth because they didn't want me to hemorrage and then I had to get up and get to it because of his medical condition. The stress, lack of any rest, and fatigue just wiped me out. He is eight months now and I continue to nurse his sister but unfortunately he still had not had the stregnth to go to breast.

[Inspired007]

Originally Posted by MaryJaneLouise

: I would not make any "recommendations" unless I were a trained LLL leader or health professional.

I agree. It is very difficult for lactivists to make non-biased recommendations to mothers regarding formula, IMO.

[Rhiannon Feimorgan]

I agree that i'm not in any way qualified to know when a baby *needs* supplementation. However I don't belive that bfing is an all or nothing thing so in situations where a mom was considering stopping bfing, such as going back to work in an environment where she can't pump, I would sugest continuing bfing as much as she can and supplementing with formula for the rest of the time over switching to formula full time.

[annettemarie]

I don't think lactivists should be in the business of handing out health advice, unless they are also a trained LLL leader, IBCLC, midwife, someone with training specific in breastfeeding.

That said, any breastfeeding advocate/health professional worth their salt will tell you the first rule always is "Feed the baby." Formula exists to keep babies alive who, for whatever reason, can't get breastmilk.

[RoadWorkAhead]

I will be the first to admit that when I hear a mom talking about longterm TEDs (total elim diets) without success, etc. I will nicely mention medical food. I wish more of my pro-BFing friends had really stopped to listen when I talked about what DD and I went through. I wish I hadn't harmed her and I in the process of trying to BF a child who can not BF and be healthy. So now, I am much more apt to point this out. As for supplementing for low supply, I don't know that I know enough other than what herbs help boost supply.

[Unoppressed MAMA Q]

Um, if the baby is hungry, supplement while working on what, if anything, can be done about supply.

Of course, the supplement ought to be fresh human milk from a local, caring donor. Formula is the last straw, and even then, I'd look into making my own.

[miss_sonja]

Well, sure. That's what formula (and goat's milk, donated milk etc) are for. If a mom has a true physiological reason why her breasts can't make enough milk to sustain an infant, that's a case for supplementation.

What's wrong to recommend is supplementation without a reason--the old "you can't make enough milk" saw said by the ped who hasn't actually had any training in human lactation. Or supplementing with formula rather than suggesting using a pump.

It's all situational, which is why it's so challenging.

[CherryBomb]

I'm an LLL Leader and if I feel a mom needs to supplement, I'll refer her to our Leader who is also an IBCLC.

If mom is already supplementing and wants advice on *how* to supplement, my advice would depend on the situation, and I'd probably still refer her to the IBCLC.

[preemiemamarach]

Originally Posted by Kierdan'sMom

I will be the first to admit that when I hear a mom talking about longterm TEDs (total elim diets) without success, etc. I will nicely mention medical food. I wish more of my pro-BFing friends had really stopped to listen when I talked about what DD and I went through. I wish I hadn't harmed her and I in the process of trying to BF a child who can not BF and be healthy. So now, I am much more apt to point this out. As for supplementing for low supply, I don't know that I know enough other than what herbs help boost supply.

i am so glad you said this. my almost 10 month old is now on a combo of medical formula and ebm (i have ep'ed for him since birth), and i am on a TED until we get more testing done on him (upper and lower scope, more labs, ph probe, ear tubes). since i worked so long to ep for him (tried bf directly daily for six months), it has been a huge blow to resort to medical formula. he's been getting half ebm and half formula because he had a tough time transitioning to the formula. but the bottom line is that he's truly ftt (no growth for 3 months) after growing wonderfully for seven months, and we had little choice, as he's also developmentally delayed now. i hope to go back to eping and get him off the formula once we have a firm dx, but keeping up supply while dealing with it all isn't going well. he may well come out of this with a feeding tube, and i doubt i will be able to ep anymore if we get to that point.

i have been so hellbent on getting my milk in him, but i wonder now if i held out for too long, kwim? in some situations i think it's a tough call.

[hipmummy]

Originally Posted by bandgeek

If a baby is truly FTT and the mom has seen a LC and determined there is an issue going on with low milk supply. But I wouldn't be all flippant and say, "give him a bottle". I'd recommend an SNS first. If it was an issue with baby having a weak suck, I'd recommend mom pump and put her milk (and formula if needed, or better yet, donor milk) in an SNS so baby doesn't get confused but is still able to get milk until his suck is strong enough to handle it by himself.

In any case, I would try to keep the baby off of bottles and try to work it out so mom's milk supply is stimulated and baby is getting enough.

My feelings as well. Use formula a last resort like a prescrip of sorts.

[MilkTrance]

If a baby has FTT or is in a life or death situation, then of course I would be okay with supplementing. For instance, my friend's baby was very premature and was fed gauvage while she pumped (and pumped and pumped and pumped). While I realise that even a preemie can survive and thrive on colostrum, hers wasn't thriving. So she okayed him to be supplemented with formula if necessary (thankfully, he JUST started thriving as her milk came in -- she gave him milk thru his tube). I think it's so easy for us to say "oh, give him/her donor milk" when in reality, that is VERY difficult and not even possible for some people.

[Mama Poot]

Knowing what I do now since my own experience of having to put my first child on formula, I would recommend supplementation through an SNS for the majority, if not all feedings. My focus would be to keep the baby on the breast for as long as possible and less on what was going into the baby. I would mention donor milk but I am very aware that this is not an option for most people who need to supplement.