[thebee321]

I am wondering what others would have done in my situation last week. Please note I am *very* committed to breastfeeding, and did not want to give this baby *any* formula at all. DS1 had a little bit because I had an awful time latching him after having a c-section and discovering I had flat nipples.

DS2 was born last Monday (June 11). He was born by VBAC and latched on within 30 minutes of birth and was gulping down colostrum. He continued to gulp down much colostrum the next 24 hours. At about 14 hours old, my ped examined him for the first time (came to my hospital room, he was full rooming-in) and thought he was "a little yellow". She ordered a test to be done at exactly 24 hours old. The nurse came to my room shortly after that test to tell me the ped on duty (from my ped's office) and my ped both wanted to start him on the light treatment and start giving him formula at the end of each nursing session. He had scored an 11 on the bilirubin levels. Bloodwork shortly thereafter determined his level was actually between 8 and 9 (the thing they used for the first test was something they just pressed on his forehead). Both numbers were in the "high risk zone" for that age.

I told them I did not want to give formula. They told me all the reasons I needed to. Then I started getting scared because they said at that time, they could do the light treatment in my room, with this bili-blanket thing, and he didn't have to go to the nursery and be in the "blue box". I wanted more than *anything* to keep him with me and not have him be in the nursery where they would not be able to respond to his cries. More than I didn't want to give formula. Also, I knew I was scheduled to go home Wednesday, and there had been no compications that would keep me there longer, and I knew they could discharge me and keep him. They said that the formula would help hydrate him and flush the bilirubin out of his body. I had plenty of colostrum, but I could see their point how the formula would be more hydrating than the colostrum.

So I gave the formula. He hated it for the first 4 feedings and took very, very little. The nurse who helped us formula feed during the night was kind of exaggerating (as were we) how much formula he actually took in, because the real amount was really so pitiful. He just did not want it.

We were able to take him home Wednesday night (I was approved to be discharged Wed morning, but they can't make you leave until midnight) as long as we had this bili-light paddle thing at home, which finally arrived from the medical supply place at 7:30 pm. My ped was not going to let him go home with us if the light did not come. While in the hospital, he stayed in my room on the bili-blanket, which wasn't bad at all, he actually seemed to like it.

I continued to offer formula after nursing until Thursday morning, when we took him to the ped and she looked at him and asked if he appeared unsatisfied after nursing and I said no, that I actually was ending his feedings a little prematurely so he would take some formula. My milk had come in Wednesday afternoon, so I had plenty.

So I am very disappointed with myself for not fighting harder against the formula. I would guess he had no more than 8 oz. over a period of about 36 hours. But I was so much more opposed to the other things (him needing to go to the nursery or stay overnight without me in the nursery) that I decided to give in. I tried arguing with the ped that just because the formula would work faster didn't mean the end result couldn't be the same if I just kept nursing, albeit a little slower. They also said breastfed babies naturally have higher bilirubin levels, to which I said why can't we factor that in and know that is part of why his level is so high. No dice.

I am convinced the formula was absolutely unnecessary.

Anyone know what they would have done?

 

[quirkylayne]

Yes, I know what I would have done. But that isn't what matters. Now if you need pointers on how to handle this situation if it occurs again I'm willing to give suggestions. The first one is to find a breastfeeding supportive ped who has up to date education. For now I would like to suggest that you forgive yourself, hold your baby, love him, and nurse him. You can't change the past. You are a good mom - you love your babies and want what is best for him. Sometimes we have to make decisions in stressful sitation and we have regrets. It is okay. Good luck with your continued nursing.

 

[RootSnort]

I'm so sorry that you were strong-armed like that! It was wrong of them, but I am sure that no lasting harm was done, except to you! Keep up the good work, and when you have the time and energy, you might write a letter to the hospital about your experience. But for right now, just focus on having a good start at home!

 

[djoy]

First of all congratulations on the birth of your beautiful baby!

Yes, I know what I would have done, because I was in a very similar situation with my ds in October! It wasn't the ped who tried to push formula, it was the nurses. My ds was under the light and on the blanket in our room and it was not working as well as they would have liked after 24 hours- probably because I kept taking him out to nurse! They too kicked me out at midnight on the day I was discharged, but I had to leave ds in the nursery--in the big box. Well, despite my refusal of the formula, since my milk had not come in yet, between midnight and 7am, when we arrived back at the hospital, I know he had at least 1 formula feeding. I was sad and felt like maybe I was not pushy enough. Now I have a healthy, strong, 8 mos old who is very attached and a wonderful nurser!! So, my point is that we do what we have to do, and it does not have any bearing on what kind of breastfeeding mom you are/will be. You did what you felt was the right thing for your baby- and that is what makes a good mom.

 

[MCatLvrMom2A&X]

Same thing happened with my dd only within a hour of birth she was going yellow. Her level at 12 hours old was in the teens and was rising fast.

I did allow the formula but I never gave it to her the nurses did after she had nursed off me. She did end up in the nursery under the lights for 3 days and every 2 hours when they brought her to me she was wrapped in a bili blanket.

I dont know if I would do things different. I did the best I could at the time and that is all anyone can do.

 

[alegna]

If you honestly want to know what I would have done, I would have refused. BUT I would not have birthed in the hospital in the first place as I don't want to be held hostage.

-Angela

 

[mclisa]

Quote:

Originally Posted by alegna If you honestly want to know what I would have done, I would have refused. BUT I would not have birthed in the hospital in the first place as I don't want to be held hostage. -Angela

gee, there's a supportive comment

I've had all of mine at hospitals. The first 3 at the same and I switched for #4. I do think I'm a little smarter this time around.

I was told by the overly aggressive nursery nurses with #3 that she hadn't had enough wet diapers and so I needed to supplement her with formula. I regret that. Can I say for sure that is what triggered her to have her extensive food allergies and asthma? No, but I wasn't going to let it happen again.

So this time, I had a written out nursery plan that detailed that absolutely no formula was to be given. I was OK with sugar water which can be an option. I was even willing to consider transferring to the NICU to have an IV placed if it came to that. That's what comes from being informed about what I wanted to have done. The nursery nurses had no problems with that and were very good at helping me to nurse so #4 wouldn't have the same issues.

 

[RachelGS]

I got strongarmed like that. I didn't give formula, but that's because I had an IBCLC showing up every other minute backing me up emotionally. It's a very, very vulnerable time, those first hours and days with a new baby. You're right-- the formula was unnecessary, but what's shameful is not that you gave it, but that your doctors scared you into doing so by feeding you incorrect information. Their actions are outrageous. You're a new mama. Be gentle with yourself.

 

[eclipse]

Because I had a good ped when my dd was jaundiced, I know that the numbers they gave you were NOT particularly high. She was concerned about my DD and had her tested - she came in around 19, significantly higher than your baby. She had her tested the next day and, since levels weregoing down, the only recommended treatment was to breastfeed frequently. My youngest son was quite yellow when he went in for his first post hospital check up, but my even better ped didn't even bother to test him because he was breastfed and my milk had come in.

It pisses me off to hear you strong armed like that

.

 

[blsilva]

Oh, mama, you were given so much misinformation!

Honestly, with my first baby, I probably would have done the same thing you did-given the formula. I knew nothing about babies/jaundice, or anything else. In fact, when, in the hospital ds1 did not want to nurse and the nurses insisted that he be given formula, I allowed them to give him a few drops in a tube-type set up that attached to my breast. I had no idea that what he was doing was normal, or that I had the option of saying no.
Since then I have learned a lot and can honestly say that if that had happened with my second babe, I would have told the nurses to shove the formula.
Don't let something like that get you down. You are learning. For now, enjoy your little one!

 

[alegna]

Quote:

Originally Posted by mclisa gee, there's a supportive comment

She asked. I answered.

-Angela

 

[thebee321]

Quote:

Originally Posted by mclisa gee, there's a supportive comment

That's OK. I asked!

 

[alegna]

Quote:

Originally Posted by thebee321 That's OK. I asked!

-Angela

 

[thebee321]

Quote:

Originally Posted by blsilva Oh, mama, you were given so much misinformation!

Actually, I looked up some of the info in the Nursing Mother's Companion that I brought with me to the hospital and the book agreed what they were saying on some parts. At least the part about breastfed babies having higher levels of bilirubin. I don't think that book went so far as to say supplementing with formula was the only solution, though. But honestly, if it was going to come down to him going to the nursery and being in the blue box and out from under my care, I would much rather give him formula. It just sucks that I had to make the choice.

But anyway, it's very hard to deal with this stuff when you are so tired and so worried about your tiny baby! My DH was very worried and would have been really reluctant to go against their advice. He just wanted those levels to go down no matter how we did it.

I didn't anticipate these kinds of problems with this baby, because I've had this ped now for 4 years and I didn't think we would have that kind of situation with her. I'm not sure how to feel about her now.

Thanks for the opinions, they are interesting to read. For the record, despite the rough start with DS1, I ended up nursing him for 3 years! And this little guy has gotten a much stronger start, so I imagine we will go about the same amount of time. I just went into this hoping to not do any formula, after reading some stuff about the "pure gut" and not messing with the intestinal flora.

 

[eclipse]

Deb, what I remember reading in. . . I think it was the breastfeeding answer book was that breastfed babies who are supplemented with formula have bili levels that drop sooner than babies who don't get the formula (because breastfed babies don't get much volume of fluid in the first few days, and fluid is what helps push the billi through them). However, it also said that there is no evidence that the babies who receive formula (and therefore have their levels drop quickly) have any better outcomes than babies who are exclusively breastfed.

 

[RootSnort]

Quote:

Originally Posted by eclipse Deb, what I remember reading in. . . I think it was the breastfeeding answer book was that breastfed babies who are supplemented with formula have bili levels that drop sooner than babies who don't get the formula (because breastfed babies don't get much volume of fluid in the first few days, and fluid is what helps push the billi through them). However, it also said that there is no evidence that the babies who receive formula (and therefore have their levels drop quickly) have any better outcomes than babies who are exclusively breastfed.

Fascinating!
So what we have here is a problem where docs want to "treat the level instead of the patient." Since in the end, there's no difference, there's no point in treating - leave Mom and Baby alone! But in the hospital, you're rarely able to take the baby out of the unit where you could get some sun together and help clear up that bilirubin naturally! ARGH.

:

 

[mothragirl]

if i HAD to supplement i would have called every mama i've ever met til i got some breastmilk and used that.

 

[TovahNeryse]

NAK
I never had this problem, but
i've read and heard that supplementing w/ formula for jaundiced babies is standard practice and better for the babies, ONLY as far as getting the babies better. It isn't an anti-BFing move, it's just meant to get the babies better so they can go homme. I completely understand everyone's POV though, I would probably fight it too.

 

[RachelGS]

It IS anti-breastfeeding, because it uses formula as the norm for measuring a human condition. Formula is not the norm, an 11 is not an alarming bili level.

 

[thebee321]

Quote:

Originally Posted by RachelGS It IS anti-breastfeeding, because it uses formula as the norm for measuring a human condition. Formula is not the norm, an 11 is not an alarming bili level.

Yes, I think that's what is bothering me about it, now that I am learning more. They are using the formula standard to establish the appropriate levels of my breastfed baby. And I did try to address that with my ped in the hospital, but my argument was not good enough. I mean, I knew what I was trying to say but I wasn't conveying it well.

I also had no idea whether 11 was alarmingly high or not. I know DS1 was at about 9 when he was about 5 days old, and they didn't do phototherapy. But what they convinced us with was the fact that 11 was high for a 1 day old. There was this chart they gave us that very clearly showed 11 in the range of "high risk" at that age, whereas if he was at 11 on say day 4, it would not have been high risk. And over the next several days his levels kept going up, with the phototherapy and with the very small amount of formula he got. It didn't start to go down til about days 5 and 6, with our almost constant use of the phototherapy at home for all those days.