MOTHERS IN MEDICINE
BREAST FEEDING SUPPORT BY MEDICAL PROVIDERS
(NOT JUST PRIMARY CARE):
THE HOW AND WHY IT MATTERS
AUTHOR Claire Cowley, MD
The 1:00 am phone call to the primary
care doctor: “Dr. So-And-
So, baby Gumby has lost 10% of
its birth weight. Do you want to
supplement with some formula?”
What do you say, what do you ask?
How old is this infant? Frequently,
cesarean section infants have an
inflated weight secondary to a fluid bolus in mom prior to delivery,
exaggerating the weight loss. Is the infant nursing well, frequently
every two hours, vigorously? What are the intakes and outputs? One
wet and one dirty diaper per day of age is normal in the first five
days of life. If the baby is vigorous and nursing well, I would say,
“Let’s see how the baby looks at rounds in the morning.”
What are the dangers of unnecessary supplementation? There are
multiple, but for this readership, a principal set would be: undermining
a woman’s confidence at a fragile moment in her ability to do this
task she’s determined to do; the alteration of gut flora; the shorter
duration of, and the exclusivity of breastfeeding. We are trusted as
experts. When we order that supplement (unnecessarily, possibly)
we say that this is the right way, that breastfeeding doesn’t matter.
Baby is jittery and has a marginal glucose: once again there
is a lot of research on this but for simplicity, remember glucose
gel. Nurseries can readily utilize this to get past a brief episode as
breastfeeding is established. Remember that newborns need 10 to
12 feedings per day, initially. That is key.
What else can you do as a primary care provider? If mom and
baby are stable, keep mom and baby together after birth through
the first feeding and room-in afterwards. If there are problems
with lactation, utilize the services of a Lactation Consultant. If a
supplement is needed, use donor human milk, a protein hydrolysate
formula or regular formula, in that order.
Now the why it matters: what if I told you that we could halve
6 LOUISVILLE MEDICINE