hospital wanting to give formula to newborn

[Zerub]

I'm thinking about baby number 2, and starting to wonder about all the things that went wrong with dd. When she was born she was fed formula through a tube in her nose, for a week until she started bf'ing properly. My question is, was it necessary? Actually, since that is irrelevant now, the real question is, if I'm in that situation again, what should I do?

She was born by elective cs at 38.5 weeks - diagnosed as footling breech the day before. She weighed 5lbs 9 - they were worried about her weight and said she couldn't afford to lose any, but she was on the 2nd centile and has remained there (she's 22mo now) - so I think her weight was fine! DH & I are both small. She was also slightly jaundiced.

She fed in the recovery room at midday and again a couple of hours later. Then wasn't interested. Woke a couple of times in the night, had 2 sucks, went back to sleep. They made me express at 1am and she had 15mls off a spoon (I've got my notes so I've looked it up). At 5am they tested her blood sugar and said it was ok. At 11am she still didn't want to feed and we gave in to pressure and agreed to give her formula (I couldn't express any). So she had that off a spoon every 3 hours. That night I agreed to them putting a tube in her nose. After that I attempted to bf every 3 hours and topped up with formula via the tube. Milk came in on day 5. By day 6 she was feeding ok and we stopped the formula.

It was all quite stressful, we had to stay in hospital longer than I wanted, and I wish she'd had colustrum instead of formula (didn't want her to have any formula). And I wonder if she would have started bf'ing earlier if she wasn't full on formula? And if my milk would have come earlier if she'd been sucking more?

So should I have just said, no leave her alone, she'll feed when she's ready? Or what?

It's interesting about the skin to skin. I honestly can't remember how much skin to skin I got with either of mine straightaway - with dd1 she was plonked on my tummy but then whisked away (and I was so knackered and horrified by the whole thing I didn't even look at her when she was on me - just remember this gelatinous blob on me) and with dd2 I did hold her against me (and I was naked in the pool at the time) but then her dad took her while I was stitched and suchlike.

Yet both of them tucked in ravenously. And while I found breastfeeding a bit of a nuisance at the moment I never, ever, had any major problems and I'm still feeding dd2 nine months on.

GeorginaA - the guidelines I am talking about should be in every accredited Babyfriendly hospital.
The link to their site is
babyfriendly

The guidelines I have talked about are the ones in our hospital. Can I say though, they are not followed properly half of the time because paediatricians insist on blood sugars being done unnecessarily. Midwives who lack confidence in feeding managemnt will do them too. They are not the answer. A normal healthy baby can have a blood sugar less than 2 because it is using it's own ketone bodies as fuel. Baby friendly hospitals have infant feeding advisors so they are the people to access. If there isn't anyone in post, the babyfriendly site will help.

Thank you for the site link. I'm not sure, but I don't think Worcester Royal Infirmary is Babyfriendly accredited, but I shall ask their policies when I do the tour of the ward.

Is it worth while me getting in contact with my local NCT breastfeeding counsellor before I give birth so I have someone to contact and visit me in hospital if I do start feeling pressured?

Ghosty, just want to encourage you to complain. I recently made a complaint about one aspect of my delivery, after nearly nine months of worrying/thinking about it. I really didn't want to let it colour my memories or experience of childbirth. Found the act of writing it all down therapeutic enough. But then when I got the response I was delighted; the hospital had made a very thorough investigation, taken on board all my concerns and (they said) made all the changes I'd called for. Result! As long as they aren't just making it up, I feel really pleased that hopefully no-one else will be put in the same situation I was. And that's partly due to the people on MN who reassured me about this issue (thanks Mears).
So many women have poor experiences of labour and yet never complain for a host of very understandable reasons - I've even known solicitors who never got round to it. But it means whatever went wrong for them isn't rectified and might trip up the next poor woman who goes through the doors.

eddm, my sister didn't complain and she was a solicitor.

Bizarrely, knowing that dd didn't need the formula has made me feel better... I suppose it is because I know I was right to get cross (been wondering if I was being silly). Also will know what to do next time.

It didn't mess up bf'ing, it just spoilt my first week with dd (and dd had formula and dh is allergic to cream). But dd seems to be ok. Mostly what it did was to make me completely paranoid about how much dd was eating, she was 18mo before I stopped worrying about food intake/weight.

Next time, I shall be armed with all this info! And, I have Mumsnet. So if I end up in hospital and they hassle me over some completely different issue, dh can come in with laptop, mobile phone, and cunning-connecting-to-internet-with-mobile-phone device, and we will go sit outside the hospital front door with all the smokers and find out what to do!

Fab idea about the laptop Zerub
I think I'd need to anyway, just because of withdrawal symptoms. My mumsnet addiction must be as bad as any smokers.
Remember watching my ward mates amazing ability to go from moaning about post op pain (I had a section too) and getting the midwives/health care assistants to bring more painrelief, cups of tea, meals to bed etc. before hobbling off at high speed to have a fag outside. Can't wait to emulate this in the name of mumsnet

Georgina, it would be fine to contact an NCT bfc before your baby is born.

However, has to be said that volunteer bfcs can't always visit you - they have their own families, and they have to come first. But she would talk to you on the phone.

Might help to have your wish to breastfeed and not to supplement unless there are medical grounds in writing, in your notes.

Sometimes a baby is diagnosed as 'needing' a supplement. If the baby needs more than he is getting, and it is often a big 'if', then most mothers can express, by hand rather than a pump in the early days, and this can then be given to the baby.

Babies should be held closely, skin to skin when possible, so their instinct to feed is stimulated.

This may not be srtimulated very effectively in a crib.

Dear Ghosty and Mears,
for a first-timer like me with all this to come, you've both given some totally usefull advice - thank-you!

Sorry you had such an awful experience Ghosty

This thread is great. I will be much better prepared for the next one, and I have referred a friend who's baby is due in July.

OK, so, just to make sure I'm really well prepared... When would it be ok to agree to them feeding formula? Ever?

They said dd was jittery. Then they did some test and said she had an infection but they didn't know what. Then they said they were worried about her high-pitched cry (which turned out to be her normal cry) and did a lumbar puncture to test for meningitis (which she didn't have). And gave antibiotics whilst waiting for results (and to clear up whatever infection she did have). Not surprised she didn't have the energy to feed actually!

And I couldn't express anything (far too stressed, I think!).

So does that come in the category of babies who need supplementary feeding? (although admittedly they started formula before getting worried about her being ill!)

Sorry to keep asking, but if I'm ever to stand up to a doctor I need to have my facts straight!

not that I'm going to give birth in hospital next time.

Zerub - I am posting our policy for babies at low risk of hypoglycaemia

There is evidence that babies who have none of the risk factors listed below are at little risk of damage from low blood sugar levels as they are able to use other fuels for their cerebral metabolism. Hypoglycaemia is not therefore distinctly defined in these babies and the presence of a low blood sugar in an otherwise alert and asymptomatic infant is of uncertain significance. The aim in these babies is to encourage a feeding pattern with regard to mum's expressed wishes. Treatment of isolated asymptomatic hypoglycaemia may be detrimental if it interferes with the natural progression of breastfeeding.

Low risk criteria:

1. Full term (37 or more completed weeks - in other words more than 36 weeks + 6 days)

2.Normal weight for gestation (37 weeks - 2.5kg, 38 weeks - 2.8kg, 39 weeks or more - 3.0kg)

3. No evidence of asphyxia (the baby does not need resuscitation apart from suction, facial O2 or

Now if you are still awake, the emphasis here is on healthy babies. If there are concerns about a baby's health and well being which was set out in the criteria in the last post, then we have a high risk hypoglycaemia policy.

Now I am not going to copy it all out but basically, early feding is encouraged within the labour suite (within 2 hours) . If the baby won't feed then hand expressed colostrum is given by syringe/cup. There is not set amount - it is whatever the mum can express.

The aim is to feed 3 hourly. The first blood sugar is checked before the second feed (4-6 hours after birth)

If the glucose reading is >=2.6 then the baby is fed 3 hourly with a glucose strip checked before feeds.

If the glucose strip is lower than 2.6 then a proper blood sample should be obtained from the baby's heel (into a glass tube) which is then read by a glucose analysing machine which is more accurate than the strip. That is called a TBG (true blood glucose)

The policy states:

Only supplement with formula when breastfeeding or breastfeeding and expressed breastmilk does not maintain the plasma glucose. Feeding may be encouraged by skin-to-skin contact between mother and baby.

There is also a definition of jitteriness.

Jitteriness implies repetitive movemnets of one or more limbs that is unprovoked. Movements may be of the extremeties only, or may involve the entire linm and are usually relatively fast. It is important to noe that these movements should not be as a response to stimuli, be this either physical, auditory or visual. Any newborn infant will produce some sort of fine movement in response to such stimulation.

I am exhausted typing now. Is that of any help?

Has everyone gone to bed already? Fallen asleep before getting to the end of the longest thread I have ever written?

I'm here mears! Does that mean that my ds didn't need the formula he was given (I've posted about it way down below)?

If his blood sugar was above 2.6, which it seems to have been, then he did not need formula at the point he got it. Only if his blood sugar could not be kept up with either B/F or B/F plus expressed colostrum, should he have got formula. He should have been fed every 3 hours initially to maintain his blood sugar without the need for formula. Thankfully it worked itself out for you but to someone else it could mean the end of B/F.

Yes, I agree. I was lucky though, and had great support from my mum/dp/bfc. Will fight the bossy doctors harder next time .

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mears that is excellent information - thank you for wearing down your fingers typing all that! I'll print that out and staple it to the back of my birth plan I think (won't the midwives be pleased )

robinw: that may or may not be so, but we have allergies in our family and I'm taking NO CHANCES, especially if it's completely unnecessary. Fortunately (so far) ds has shown no allergies - now whether that was down to my "obsession" with no formula past his lips for at least the first four months, I guess I'll never know.

It would be hard to prove that one bottle of formula does harm to one individual baby.

However, there is plenty of evidence to associate exclusive breastfeeding with health benefits, compared to non-exclusive breastfeeding.

For most mothers and babies, the main risk of a bottle in the early days is the link with early weaning from the breast....a baby who is supplemented in hospital is three times more likely (than an unsupplemented baby) to be fully formula fed by the age of two weeks (Infant Feeding 2000). This probably happens for reasons associated with confidence, motivation, support rather than anything related to the bottle itself, like nipple confusion.

Hospitals should only advise supplements for medical reasons. Mothers can choose to have them for whatever reason they like, of course, but they do need the information about the link with early weaning, too.

Also, blood sugars should not be tested with the little sticks. These are not accurate for low blood sugar in babies.

Wow Robib W, I didnt realise that the mafia were regular mumsnetters. I was under the impression that the majority were parents who loved and nurtured their children not criminals who commit gross acts of violence, torture and murder. Or is that just your opinion?

I wasnt going to post this as didnt want a debate but I cant see how it can be justified to refer to mothers who feel strongly about breastfeeding as a bunch of criminals.

Herc, Robin has been asked before to refrain from using this description. She ignores the requests. She is, I think, trolling, so best to ignore it