John and Kristen are both surgical residents who recently had their first child. This is their story.
By John and Kristen Waters
Let me start by saying we are one of the lucky ones. Our first-born was born at term on July 25th, 2019 at 9:43 p.m., a healthy 7 lb, and 10oz. My wife – a general surgery resident – was planning on beginning to breastfeed right after birth. My wife had undergone a bilateral breast reduction about 15 years ago, so issues with breastfeeding were on our radar. Immediately after birth, we were taken from the delivery room to the postpartum unit, where at 2 a.m. my wife and I were given a pile of paperwork and instructions on breastfeeding practices. All the while both of us were seeing double from the long day and night of laboring and delivery.
Over the course of the next 12-24 hours, our baby attempted to latch and breastfeed, continuing to have issues with falling asleep while on the breast. We spoke with a lactation consultant and multiple nurses who stated that things were going fine and that everything was normal. Over this time the rate of wet diapers continued to decrease and our baby did not have a bowel movement.
As we got into our second night of life, our child began to cry hysterically.
We were again told that this was all normal and to continue to breastfeed. Early the following morning our baby was weighed and had lost 9 oz (8.2%) of her body weight from birth. Again, the lactation team reaffirmed that everything was normal and the staff neonatologist thought that it was okay for us to be discharged. She still had not had a bowel movement and her wet diapers were scarce at this point. We were told to “think about” supplementing with formula by the following morning if she did not have a bowel movement. No clear instructions were provided about how much, when and how frequently to do this.
As two tired new parents, we assumed everything was okay. No one talked to us about signs of dehydration or the importance of supplementation in any real actionable way. We were provided with no resources related to “Fed Is Best.”
After being home and continuing to breastfeed for 24 hours, my wife and I began to realize that something was wrong. Her latch continued to weaken. Our baby would sleep for long periods and would not wake for feeds.
We decided to supplement with 10-20 cc of formula as was briefly mentioned by the neonatologist. Even then, we were nervous to do this and did not want to alter the breast milk supply, so we only supplemented three of her feeds over the almost two-day period we were home from the hospital before our first pediatrician appointment.
At our first pediatrician appointment the following day, we found out that our baby had lost 13 % of her birth weight.
We, as parents and physicians, and our pediatrician were very concerned. We were worried that she would need to be readmitted to the hospital for dehydration and that this could have some serious long-term consequences. It was at this point, with the help of an outpatient lactation consultant and the pediatrician that we developed a plan to supplement with 50-70cc of formula every 3 hours and monitor her weight and diapers closely. This was in addition to continuing to attempt breastfeeding and pumping every 3 hours.
Fortunately over the next 24 hours, with the addition of formula supplementation, we saw great improvements. She gained 4 oz by the visit the following day and has grown stronger over the last week as we have continued to supplement with formula for every feed. Our baby’s energy level, diaper frequency, and weight have started to return to normal. I think we have avoided what could have been a very dire situation by intervening when we did. Despite my wife’s best efforts at pumping, she is only making 10 – 20cc of milk every 3 hours at this point, so we’ve now realized that formula supplementation is absolutely imperative.
My wife and I were happy to come across the “Fed is Best” organization when researching what happened to us on the internet. We are both physicians, and we were disappointed in ourselves for not realizing what was happening sooner. But in the whirlwind and fatigue of new parenthood, I can clearly see how things could be missed. We also were disappointed by our “Baby-Friendly” hospital for not seeing what was happening and at least giving us clear guidance on how to intervene if needed. At no point during our hospitalization was there truly any concern, despite the knowledge that my wife’s breast surgery may impact her ability to breastfeed and the scant amount of colostrum she was producing upon discharge. It is almost as if the breastfeeding pendulum has swung too far to one side.
Our daughter is doing great now. At 2 weeks, she was back to birth weight with a combination of mostly formula-feeding and some breastfeeding.
I think the lesson I would pass on to parents is to focus on the well-being of the newborn and not the ability to solely breastfeed. It seemed like before delivery and in the time immediately after there is a lot of focus on breastfeeding and not a lot of focus on strictly feeding the newborn. New families should have a plan in place in the event they are not able to solely breastfeed. This was never discussed with us beforehand. Ideally, FedisBest.org would be a reference that should be shared with new parents in the peripartum period to provide a balanced perspective on feeding and to make new mothers who are struggling with supply or other breastfeeding issues not feel like they are alone.
I would not have left the hospital without a firm plan of how we were going to feed our child before our first pediatrician appointment. Have confidence as new parents to speak up if something doesn’t feel 100% right. Trust your instincts.
In closing, thank you for providing information and advocating on the topic and making us feel like we are not alone in our story. We hope our story can provide information to future parents that may be experiencing similar circumstances.
— John and Kristen Waters
The authors have requested pseudonyms to protect their privacy.
Preventing breastfeeding complications from inadequate colostrum intake is the ethical and safe thing to do as no baby should be underfed and forced to cry out in hunger in order to increase exclusive breastfeeding rates before hospital discharge.
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