Can I/should I ask NICU not to give my baby formula if we have enough EBM?

[imchad]

NICU started my LO on formula today even though I’m supplying enough breastmilk and okayed using donor breastmilk.

Is this normal? Do I have a say in this?

They told me they’d start tomorrow and would gradually introduce it, not give it all in one bolus. But they started it today at 3p in one whole feed without any of my BM, contrary to what they told me this morning.

Also, after all the crazy pressure from nurses, MDs, and lactation consultants to provide 8 pumpings a day, with 4 hr max of uninterrupted sleep, it feels like such a betrayal to switch him to formula so nonchalantly. I asked why switch him now and the nurse said “if he needs it when he’s home because I’m not producing enough, that his stomach will be sensitized to tolerating it.”

Sadly, it made him vomit and swallow more air than ever … 20ml. Later he was so desperate for my breastmilk that he tried to latch onto my husband’s nipple while biting shakily and drooling at his own wrist. We saw an aggrieved shaky side we’d never seen before after his 3p first ever formula feeding.

Is this ok?

UPDATE: Thanks Everyone for your input!! I asked for the nurse to be removed from my son’s care after discovering there was no doctor’s orders to give him formula.

While it is standard practice to “transition” premies at 33-34 weeks off donor breastmilk and to Similar Special Care 24 ml as a backup because DBM is so expensive, she blatantly LIED about this, TWICE … either to cover up her own error, or because she straight up decided he should be on formula despite our earlier agreement to add this in GRADUALLY, and only if there were none of my breastmilk.

 

[dichthuatsaigon]

@imchad It’s my understanding that most preemies need fortification. However, I believe that if you’re breastfeeding/pumping, that’s usually breast milk with formula mixed into it. That’s what they did for my girl at least, and she went home still getting 3 fortified feeds a day (again, my breast milk with formula mixed in). I’d definitely ask about that option.

 

[isaacmiks]

@dichthuatsaigon Our NICU introduced formula to our baby because their preference was that she went home on 5 bottle of BM per day with 3 bottles of 24-calories fortified Neosure (preemie formula) to provide both the extra calories from fortification but also the vitamins it has especially for preemies.

Their logic isn’t entirely flawed - though personal. I keep my baby on one bottle per day of Bobbie formula now that she no longer needs the fortification or Neosure just to keep her tiny balanced for both.

 

[imchad]

@isaacmiks Thanks for explaining. Yes, this tracks with what an MD told me later. Did they have reason to believe your breastmilk didn’t provide all the necessary vitamins for premies?

 

[isaacmiks]

@imchad Not at all - it’s just that oftentimes the preemie formulas have above and beyond what breastmilk would have.

 

[imchad]

@isaacmiks Got it. So it’s a nice-to-have, not a must-have.

 

[woodrowcall]

@imchad I wouldn’t say it a nice-to-have, it can be a must-have for some babies. Breastmilk averages 20-22 calories per oz. Some babies (like preemies or low weight) need the extra calories hence why some are given fortified breastmilk or straight formula with a higher calorie content. Trust your neonatologist, but also ask questions.

 

[imchad]

@dichthuatsaigon Thanks! Yes, he’s getting human milk fortifier added to my breastmilk. But they dumped 35ml of an entire bolus of what they call “isolated feed” of formula in one go, despite my wishes to mix things and incorporate slowly, if even needed at all.

 

[nathaneharvey]

@imchad I literally don’t understand this

 

[ej_staytrue]

@imchad We added a fortifier to my ebm so this is definitely not right

 

[everpraying3168]

@imchad That isn’t okay; they made him ill! I know they don’t want him to starve if you can’t keep up production, but that is not okay.

 

[reallyconfused0512]

@dichthuatsaigon This is what we did too and he’s still on that plan (11 weeks adjusted). We have never given him straight formula, I am surprised they’re saving this to you, OP

 

[straykat]

@imchad How old is your little guy (gestational age wise)? Have they been using donor milk to fill gaps in your supply? Donor milk is only medically appropriate(necessary) to a certain point, most NICUs transition away from it between 32-34 weeks and switch to using formula to fill in any gaps in mom’s supply, because at that point the risk of NEC decreases significantly compared to younger preemies. That said, if your supply is enough for what baby is getting right now then there’s no reason to use formula and it’s worth saying something! If your supply isn’t quite enough to cover baby’s current needs, then you can also request that your milk be divided up evenly across all baby’s care times, so for example if baby is eating 40mL per care time, you can ask if the NICU is able to use 30mL breastmilk and 10mL formula (or whatever, based on your supply) at each care time instead of using up all breastmilk and then having to give a full feeding of formula.

 

[imchad]

@straykat Thank you. He just turned 33 weeks.

Yes, I’d requested this, that they slowly add it to my milk, and only if my milk wasn’t there … and the nurse agreed. Then an hour later after I left, she did the exact opposite and dumped a whole 35mm bolus in his gut, which he threw up and gave him 20ml of gas.

She claimed she didn’t check the fridge thoroughly and didn’t see that my breastmilk was there. But she could’ve used the donor milk which is still in doctors orders.

She also claimed she was just following doctor’s orders to start him. Except after another nurse checked the records, we discovered there were no doctors orders.

 

[straykat]

@imchad She can/should get in big trouble for giving a baby food that they aren’t ordered to receive. Even if it had been discussed, that’s not the same thing as having the order to do something. You wouldn’t be wrong to ask for the charge nurse and tell her about what happened (with focus on the fact that the baby was fed without an order… the other stuff stinks for sure but isn’t itself a discipline-worthy issue; the safety issue is that the baby was fed food he wasn’t ordered to receive, regardless of symptoms or your request/preference)

 

[imchad]

@straykat Great points. And thanks for prioritizing them!

 

[belinda02]

@imchad You have a say in everything. My son's doctor only ordered extra fortified calories when he wasn't putting on weight, but it was still okay'd through me first. Once he gained a good amount of weight, which took all of 3 days, they took him off the extra fortified calories without me having to mention anything at all. That wasn't formula though. It was calories mixed with either donor milk or my milk.

If I were you, I'd demand no formula during rounds, unless someone can explain why its being used if you approved donor milk to supplement until you can get your supply up. There could be a shortage or loss due to power outage. If they have sound reasoning such as in aiding with weight gain, go ahead and ask what is end game and the goal to getting him off formula and on your milk only.

 

[imchad]

@belinda02 Thanks for this consideration. Yeah, his weight gain is just fine.

This is great. Thank you. I requested no formula until we can assess his weight gain and my milk supply in a week. They said it wasn’t a shortage issue of donor milk, just to get him accustomed in case I run out of my own supply. The nurse didn’t check thoroughly to see if my own supply was enough and misread the MDs orders to start formula a day ahead.

 

[nathaneharvey]

@imchad That literally makes no sense dude, just deny the formula straight up. If he’s getting his calories then they need to use the breast milk if your supply is keeping up

 

[belinda02]

@imchad Of course!

It will all work out and mistakes happen but maybe mention it to the charge nurse when you can. The NICU is a place where little to no mistakes should happen, so for that preventable mistake to happen is kind of not acceptable IMO. You can make it very known you don't want him started on formula, as that's why you approved donor milk. Then you could let the charge nurse know he can get accustomed to it when he needs to and until then you'd appreciate an honest chance at supplying him enough. If you over-pump, you will over supply. What worked for me was pumping every 2 hours while awake. I had an over supply in no time. If he's tolerating feeds well, they need to feed him what you prefer. Good luck OP.