Thank you for your unique perspective!! And for letting me know whatās in my rights, and yes degrading indeed but more disturbingly how distraught and hungry he was by 6p from not being able to absorb anything from the 3p formula feed.
Does your hospital ever mix DBM with EBM or formula, or is it standard practice to only do isolated feeds of either of the 3 options exclusively?
@imchad Nurses have to encourage and support moms' pumping and breastfeeding journey. Especially with the prices of formula nowadays.
Yes we frequently do. If say your feed is 30mls and you have only 20mls of ebm, the other 10mls will be either dbm or formula - based on the infants needs and parents consents. So if you've consented to dbm and deny formula use, then they can supplement with dbm for the remaining 10mls. Your milk will come in the more you pump and the more you breastfeed. Keep pumping every 3 hours (even after a breastfeed) to help pump up the supplies!
@patrickmiller Thank you so much for clarifying. I will be sure my consent is documented and to keep using the original EBM/DBM combo we originally requested.
The nurse said she was stressed at the end of her 8 hr shift and didnāt check the fridge well, so thought I didnāt have any breastmilk left. But she also went against doctorās orders and supplemented with formula instead of EBM. My son is no longer in her care and I need to find a diplomatic way to report all this to the charge nurse without blowing my load.
Happily my supply is increasing and Iām staying ahead of his needs. Iām learning to ask before I leave each visit how much of my milk is left so I can know where weāre at.
@imchad Iām a nicu nurse and i donāt really underhand why they would use formula if you have breast milk ready to go. When Iām making milk for my patients I always default to breast milk due to the risk of NEC. Plus all the amazing benefits of breast milk. Switching to formula without good reason is not evidence based
@nathaneharvey Thank you. The nurse claimed she didnāt check the fridge thoroughly and didnāt see that I had plenty of supply. Even still, doctors orders are to default to donor, not formula. My son just turned 33 weeks old. She was telling me to get used to putting him on formula as this was typical at this NICU to ātransitionā him off donor to formula. I guess itās cheaper?
@imchad This sounds really not ok. I would not want the nurses making a decision like this without speaking with the attending and the nutritionist first. There are cases where some amount of formula/special formula/fortification is necessary to an extent but "getting him used to formula in case you end up using it later on" sounds like a nurse with an agenda to me.
@versesvsvices Thank you. Yes ānurse with an agendaā is exactly it! I didnāt even know there was a NICU nutritionist available to chat with. The lactation consultants have been hounding me about breastfeeding so I got more than earful about that, which Iām keeping up with religiously ā¦ so itās just heartbreaking that theyād dump formula on him after all my efforts and all the fuss.
@imchad I felt the same betrayl. They said of his 8 bottles a day they were switching 2 of them to formula so it could be fortified. After we took him home we realized the formula was causing constipation which was reducing his intake (so who cares about extra calories in a bottle if he's not drinking the whole bottle now). After causing a fuss with our GI doctor then all of the sudden the dietician was like well actually you can just add one tsp of formula to every 70ml of breastmilk to get the same calorie fortification.
Are.
You.
Kidding.
Me.
I felt so offended they didn't offer this from the get go. I worked really hard to get a good supply whole my kid was locked up in the nicu for 100 days.
@pattoh Wow. Just wow. And Iām sorry you too felt betrayal. 100 days is crazy. Good for you for being the squeaky wheel to your GI.
Itās hard enough having to let go the care of our precious LOs, much less feeling like theyāre withholding key info that would make our babiesā well-being and the quality of our lives better! Whether intentionally or not. Still sucks. I so feel you.
@imchad Baby is good. He's 11 months adjusted and has taken to solids really well. All the sudden his 13th percentile for his real age (we'd been struggling for so long to get him above 10th percentile for adjusted age, and hes 3 months behind!).
I'm probably far more emotionally scarred by the experience than he is developmentally. He seems completely fine and on track now.
@imchad This is so bizarre. Unless you've expressed interest in switching to formula when you go home, there is zero reason for them to do this. I'd definitely speak up about it.
@imchad I would be absolutely furious. Consent is required before giving a breastmilk substitute. If your baby has ample breastmilk available thatās ridiculous. How would they know that you wonāt have enough supply when you go home? You said you have breastmilk available now. Babies can get more from the breast than a pump can get. My supply went up and down when my 29 weeker was in NICU, Iām still BF now at 15 months and have never given formula (not that thereās anything wrong with formula- BF was just really important to me). Can they give evidence that early introduction of formula to a premature infants gut is beneficial??? Formula increases the risk of NEC. Breastmilk is really beneficial for premmies, thatās why my hospital offered donor breastmilk until 34 weeks. I would be making a formal complaint.
Edit to add: my baby was given fortifier with my milk, to help weight gain and nutrient stores.
@imchad Infants born under 34 weeks need additional calcium and phosphorus that they miss out on in the third trimester to grow strong bones. Breast milk provides 20kcal/oz while formula or fortifier provides 22-30/oz. Providers and dietitians closely monitor growth (weight/length/head circumference). Some premature infants are also born tinier and require additional support. Yes, mothers milk is gold but premature babies require additional calories and nutrients depending on their circumstances and comorbidities. NNP here who is a huge supporter of breastmilk and mommas, but please know we only want to use formula for fortification to provide the best nutritional support. Keep working hard mommas!
@imchad It depends on why they need it, my child would have Swiss cheese bones if not for doing formula and breastmilk. If itās just for weight gains you can try to fight it but imo itās not always worth it because they do gain better with fortification,thatās why they do it. Push for why vs pushing for not doing it.
Anecdotally my goddaughter went to breastmilk only home from the NICU and still struggles to gain, needs 18 months waist on pants at 4. She was 30 weeks, my 24 weeker is six months younger and average height and weight for actual age now, he had half and half because of osteopenia of prematurity.
Depending on gestation at birth preemies need more of certain nutrients that they donāt get from breastmilk, to help makeup for nutrition they missed in the womb, thatās why we used a preemie specific formula
@trancamhongkgv I think it depends more on the kid than on the gestational age. My 24-weeker was on breastmilk (not fortified, live feeding) from due date and did great on just that.
@imchad You can absolutely say no. My son was born at 39 weeks gestation, but has a severe cardiac abnormality so we spent a LOT of time in the NICU/PICU. I felt so bullied into formula. They kept blaming my breastmilk for his bloody poops. It was the formula. Weāre home now and I stopped fortifying and itās completely gone. Babies shouldnāt have to build up a tolerance to their foods, when something tolerable is right there and available AND the parents preference.
@debshirl So well said!! Thank you thank you. I will use your wording in my report to the charge nurse.
And Iām so sorry your LO had to go through that. Big Pharma (Abbot Industries in our case) really has their hands in the NICU/pediatric pots, and itās sad that staff are brainwashed to push their corporate profit-making agenda on our innocents.
I will not be bullied into any āformula as medicineā bullshit. I read the top 3 ingredients of the Similac Special Care 24 cal and itās GMO corn syrup solids, water, and low-fat cows milk with hormones and antibiotics.
