Why do jaundiced babies have to be given bottles? Sorry long post :(

[Fredfred]

This is a difficult subject to write about for me as I have many feelings of guilt and anger still associated with it, but I really want some answers so I hope that you can help me. Sorry this is going to be long.

I am one of 6 children and we were all ebf until at least 6 months and some of us until the age of 2 years. Therefore it seemed only natural to me that when I had my own children I would ebf. So much so that when I was pregnant with DD1 I didn't buy any bottles or formula in preparation as I just assumed I would ebf.

Well, DD1 was born over 2 years ago following an extremely traumatic labour from which I suffered PTSD. Among other things I had a pph and had 2 blood transfusions (4 units). As a result my milk was extremely slow to come in. DD1 latched on fine and bf was going well, or so I thought. Within hours she developed extremely severe jaundice (probably as a result of the ventouse that was used to get her out on 7 separate attempts- NICE guidelines are 3 attempts I think, but that is another story). Anyway, she was put in an incubator and I was told that as she had jaundice she would have to have top up feeds. I was told that she could have donated breast milk as I didn't want her to have formula (we have lots of allergies in my family). I told the midwife that I had read and been told that giving a baby a bottle if bf was not established could lead to confusion and difficulty with bf. She said 'there is absolutely no evidence of this'. I was too exhausted and drained to argue, so they gave her a top up bottle after every feed. I was told to express every 2 hours which was completely soul destroying as absolutely nothing came out, not once in the week that I was in hospital did I manage to get a single drop from expressing and all I got from the midwives were looks of disbelief when they saw nothing was coming out. :( I did know that DD1 was getting milk though as I could see it round her mouth when she was feeding, but because nothing came out when I was expressing the midwives wouldn't believe me and continued to give her top up bottles.

Well done if you have read this far!

Well, to cut a long story short when we finally got home bf was a nightmare. DD1's appetite had been artificially increased by all the top ups. As well as this I wasn't producing enough milk because of the blood transfusions. She would scream in hunger and I was left sore and bleeding from letting her suck even when there was nothing there. Plus when I tried to feed her she would arch her back and pull away- she didn't want me, she wanted a bottle. This carried on for a week and I saw breastfeeding counsellors and went to a support group before I just couldn't take it anymore and gave her a bottle for one feed. Well, it was amazing, she stopped crying and fell asleep for the first time. From then on, trying to bf was so hard as each time she just wanted a bottle, so I used to trick her by getting her to suck a dummy and then pull it out and put her to the breast quickly which was the only way I could get her to feed. My milk supply dwindled and I had to feed more bottles. I mixed fed for four months like this. By four months I was only BFing at night and by five months my supply just stopped. I had continued to express to try to keep my supply going, but it just didn't work. To add insult to injury, the formula feeds caused her to reflux and she continued to have reflux until she was 11 months old (including with solids- yuk).

Now that I have had DD2 (born 5 months ago) who had no problems and is ebf, I keep thinking of what could've been with DD1 :( It seems to me that so many of our problems were because she was given a bottle so early on. My mother used to be a nurse and told me that jaundiced babies that were going to be bf used to be given sugared water and this could be given from a cup. I mentioned this to the midwives at the time, who said they had never heard of such a thing. I am racked with sadness and guilt over the fact that I couldn't ebf DD1, especially as she has bad eczema. So my question is why do they have to give jaundiced babies bottles? I just don't understand :( I know they have to have extra fluids, but why from bottles?

Sorry for the long post, but I have found it very hard to get past this. :(

I knew what you mean FredFred.

DS was in an incubator on the postnatal ward and we even had a private room. we were very lucky :)

Sorry kittya I didn't mean to mislead you, I am not good with the proper terms, I thought that was the name of an enclosed box thing. Sorry.

It is!!! unless the baby had a plastic cot cover on.
Incubators in private rooms?? good lord, thats a posh hospital!

Kittya - I agree it is upsetting when mums have had an awful time. But I do think we need to accept that sometimes this is because they've had shit advice, either due to a crap hospital policy or due to someone not been up to speed on best practice. There really is no need to give a breastfed baby a bottle and to be honest I would say never in any circumstance and the research backs that up.

At the hospital where I work even the sickest baby in SCBU wouldn't be given a bottle if they were b/f. They'd either be deemed well enough for cupfeeds if they weren't getting enough via breastfeeds or if they couldn't manage cupfeeds then an NG tube is a better alternative for breastfeeding success than a bottle. Energy requirements to feed from a bottle are very similar to feed from a cup so if a baby can't manage a cup feed I doubt they'd manage a bottle and would need an NG tube anyway.

But the important thing here is that this wasn't the case - they didn't even try a cupfeed. So its not like they could even say that they tried it and baby wasn't taking the cupfeed very well. Even then that would still be a crap reason.

Kittya, I wouldn't say "posh" :) but yes I had a very good experience at ERI

Also Viva, midwives are really stretched and maybe they just dont have the time to get stuck in and help with the breastfeeding? In an ideal world we would have numerous breast feeding counsellors.

It is horrible to hear of mums having bad experiences especially when most staff really do try with limited resources.

Some types of hot cots, especially the ones with inbuilt phototherapy look like incubators but they're not. They're enclosed perspex boxes but are not incubators. Not a SCBU incubator which is where they would have oxygen, etc.

Kittya - I'm a midwife and while I'm horribly overworked and may not always have time to give good b/f support it doesn't mean I give out crap advice instead.

I think you worked somewhere with loads of dosh!

I actually didn't want help with bf as such, DD1 at the time seemed to be latching on and feeding fine-although I had to wake her to feed her. It was once she had been given a bottle things seemed to go down hill. Maybe coincidence what with the reflux etc, but maybe not.

I wanted to add as another midwife, that it sounds like you had really terrible care (and you should complain if you feel able to)

There are at least 4 alternatives to using a bottle to feed a baby that they could have considered, a) syringe (probably not appropriate for you) b) cup c) finger feeding which is using a tube taped to your finger and works well for the occasional baby who can't/won't cup feed and d) an NG tube (but often need to go to special care for that, so may be why they didn't do that)

It also sounds like you had poor care once you were discharged from hospital, there were lots of things that could have been done to help you breastfeed. Things like using a supplementor at the breast to try to replicate the fast flow of a bottle, trying medication to increase your milk supply and simpler things like checking the baby was going on the breast well (if you were sore and bleeding she may not have been) and checking she didn't have a tongue tie.

I am really pleased to hear you had a better experience with your second daughter though. Was it the same hospital?

Mine was in an enclosed heated box with a control panel on the front - the phototherapy light was separate and was pushed over the top of it. I thought that was an incubator but maybe not?

Fredfred - have you had some help and support to help you deal with all the issues you have had to deal with? I'm sure you must have done, at least with the ptsd, if it was over 2 years ago? It sounds like you did everything you could and made an amazing effort under the circumstances and I can't see how anyone could have done any better.

Thank you for the replies.

sandberry I'm not sure I can complain now as it has been so long since DD1 was born. Also they were very kind to me when I had DD2 because of the problems I'd had with DD1, so I think I would feel bad complaining. None of those options that you mention were offered to me either in the hospital or when I went home, although I saw a breastfeeding counsellor to help me to try to get DD1 latching on. Problem was that as I had to trick her to feed from me it became quite difficult to sort out the latch and I was just grateful that I was managing to get her to feed from me at all. It was a very difficult, exhausting and stressful time. I don't think she had tongue tie. No one ever checked, but I surely someone would have if they thought she did? It was the same hospital. DD2 had mild jaundice. She wasn't given light therapy, but I had to give her 3 top up bottles. She had no problems with BF after this, so I know this problem doesn't always happen, but I was put on a drip for 2 hours after I had her and didn't have blood transfusions this time, so my milk supply was fine and DD1 had to have top up bottles for 6 days, so different circumstances.

naturalbaby I have had some support from the health visitors before DD2 was born and my consultant was great, even offering me a C-sec (which I didn't have), but I wasn't diagnosed with PTSD until my 2nd pregnancy. Following my diagnosis I was referred to the perinatal service, but DD2 was 2 weeks early and my referral took so long to come through they rung me 2 days after she was born to ask if I wanted to discuss my birth options in relation to what happened the first time. They were very apologetic once they realized that I'd had DD2, but only seemed concerned with whether I had PND and that I had bonded with DD2 (had bonding issues with DD1). So no, I haven't had much support with regards to what happened with DD1. I hoped that I would forget it all and be able to move on, but I can't seem able to. It won't go out of my head, none of it, which seems ridiculous as I am so lucky and have 2 healthy children. :( I was actually thinking of contacting the perinatal service again and asking whether I should talk to them, I just feel a bit foolish as it is all in relation to DD1's birth and postnatal period and I have had another child since then which was all fine.

Im sorry for your hospital experience and Im glad to see that you had really good support during and after your second pregnancy.

Have you been to your gp to get referred for counselling as I dont think your feelings re the first one is simply going to go away as it has been two years? I really think you should push to see someone.

No, I haven't, maybe I should.

I honestly think you should. You are getting mixed messages on here and it would be better to speak to a proffessional in rl. Good luck with everything!!

Thank you.

All the replies on here have been so helpful, thank you. The reason that I posted was because I just thought that it might help me come to terms with some of what happened if I could see that there was a real need for DD1 to have been fed top ups from a bottle, but from what people have said on here, she did not need to be given top ups from a bottle, the top ups could've been given another way which may or may not have made BF easier.

Does anyone know what criteria they use when deciding whether a baby needs formula or lightbox treatment (or both)?

Rita - for phototherapy, the decision is made whether they need it or not from the results of a blood test which looks at how much Serun Billirubin they have in their blood. There's no one cut off figure as it depends how many days old they are. So the hospital will have a chart with a curved line on it and they'll plot the baby's result on the chart and see if its above or below the treatment line.

Where I work any baby that needs phototherapy will be put onto Transitional Care and have a Feed Plan. So its worked out how many mls of feed they should be getting over a 24hr period - again this depends on how many days old they are and also birth weight. We work it out on a case by case basis of how many mls per kilogram (of baby) in a 24 hour period and then divide by 8 to get the mls per feed (3hourly feeds). Now with a breastfed baby its hard to see how many mls they're gettting so we'd go on feed length. If a baby was having a 20min b/f each feed then its unlikely they'd be given any extra - as long as its a good feed, good sucking pattern, good attachment and we weren't worried about milk supply. The baby would be weighed every other day as well and if there were concerns about weight gain then extra milk would be given by a cup feed or if baby was lethagic and not feeding well then would be given extra milk by a cup. But where I work its all planned very much on an individual basis.

Fredfred - It really sounds like you have been through the mill with your first baby. I had a similar experience with my first.

DD1 was born by ventouse 10 days early after a 4 day induction. She was 'swarthy' (as per my mum) on day 1 and she stopped bfing and started screaming when she was about 18 hours old. I eventually begged for formula because well she was obviously starving @@ We were then allowed home (born early hours Tuesday went home on Wednesday) but jaundice was noticed by the CMW and 2oz of formula every 2 hours was the prescribed course of action (along with sunlight). There was no mention of cup feeding or any other alternative to bottle feeding.

By Thursday DD1 had stopped opening her mouth so DH had to prise her mouth open and I would milk the teat and stroke her throat to encourage her to swallow (bfing had stopped totally). She had blood tests that day and was admitted to PN ward for double bili-bed therapy for about 2 days. I was pumping with a Hospital grade pump at home (every two hours) but was obviously not getting 2oz of colostrum.

Eventually my milk came in and I was able to provide more milk for DD1 but she was predominately bottle fed formula, with some EBM and the occasional bf until she was 8 weeks old when we managed to get her to ebf from the breast. I was so lucky that DH was so supportive as I wouldn't have been able to express 2 hourly for 8 weeks with out him to help look after DD1 when he was home from work.

DD1 had reflux and has eczema, asthma and allergies now at 5y/o though DD2 & DD3 also have eczema and DD3 will almost certainly develop asthma when she is old enough for her lung problems to be classified as such.

I do think that forcing 2oz of formula (or colostrum if I managed to express enough) every 2 hours in a days old baby will stretch their stomach and might even loosen the sphincter more than it is normally in a young baby. I can also see that stretching the stomach/sphincter could lead to reflux in a susceptible baby.

Thanks truthsweet. I'm sorry to hear about your experience. Thank you for sharing it though, its nice to know I am not on my own having gone through this.

OP, I am so sorry you had a dreadful experience. I did too, but it was very different.

Dd1 was 36weeks when delivered by emerg Csection under GA. I had pre-eclampsia. I was induced, but she became distressed & we needed to get her out. No time for epidural etc.

She spent 2 days in SCBU. During which time I got to see her for 10minutes. That was it, for 48 hours. It was gut wrenching!

I was unable to bf. I had no help to get her to latch on, I didn't know that premmies found latching on difficult & no one had time to help. I ended up giving her bottles as she just needed food!

I really suffered in the year after her birth. Suffered because I wasn't the first to hold her, to feed her, to dress her. I had no idea if she cried when she was born. It really does mess with your head.

After a while I sent a huge email to a friend to tell her all about it. I told her how I felt, how horrible I felt about missing her first days etc. How I felt I had failed because she was early & she had to be pulled from me, not delivered by me.

She said, amoung other things
"While I have no idea of how important those things are you mentioned [she had no children at that time] you have years ahead of you now with dd, I am sure that there are many more important things that will come your way & you will be involved in. You have a whole lifetime together.

As for your scar, that is your daughter's door into this world, be proud of it, it is you & it is her, a vital part of her life.

You gave life, you gave birth. Which ever way you see it, you are the most important person in her life, no one gave her what you could, what you did. Let them have the first nappy change, you have all the rest"

It was those words that turned me around, made me realise that some things, whilest very important to me, couldn't be fixed/changed.

Living under that cloud stopped me from enjoying my baby & I really had to decide to let that part of our lives go, so I could enjoy the rest.

I do know it is hard, and I do know it is important, but are you going to let it overshadow the rest of your life?

What I am trying to say, hopefully in the nicest way, is that sometimes, you just have to let it go.

Good Luck!