By Pam Floyd, Mother and Fed is Best Advocate
Twenty-five years ago, Chaz, the son of Pam Floyd, was born and developed hypernatremic dehydration from insufficient breast milk intake while exclusively breastfeeding. Chaz developed brain injury from dehydration and now lives disabled with cerebral palsy. Their story was published on the front page of the Wall Street Journal. She was subsequently interviewed on 20/20, which prompted a similar feature on ABC’s Prime Time Live. Pam contacted the Fed is Best Foundation to share her story again to warn mothers of the dangers of insufficient feeding.
“25 Year Anniversaries Should Be Celebrated Not Served As A Warning”
Twenty-five years ago my son almost died. He was only six days old. I had chosen to breastfeed, as everyone around me kept reminding me that ‘breast is best.’ So I followed their advice, and I exclusively breastfed. Even though I felt like something wasn’t quite right those first few days, everyone assured me everything was fine. The nurses in the maternity ward suggested that since I was a new mother, I wasn’t able to appreciate how much he was getting. The home health nurse that visited me, courtesy of my health insurance, the day after I left the hospital, reassured me that as long as he was getting six to seven wet diapers a day, then he was getting enough. And the nurses in my pediatrician’s office told me not to worry, that he was a big baby that he would eat when he got hungry. And my personal favorite, “the great thing about breast milk is that you never have to worry about how much or how little he’s getting. Because he’ll always get what he needs.” Well, that works great, if your milk comes in. My colostrum wasn’t enough for my son, Chaz. And my body never produced enough milk to keep a 10 lb. 4 oz. baby boy healthy.
Then when my son’s eyes started rapidly zig-zagging back and forth on that sixth day of life and I called the pediatrician’s office to tell them he was having a seizure, they told me that I didn’t know what I was talking about and that sometimes newborn’s eyes do that as they often wander. Well, the pediatrician finally agreed to see us. We were immediately sent to the emergency room. Then we were transferred to the children’s hospital. There, my son was put into a drug-induced coma until his seizures were under control. His diagnosis was a stroke due to hypernatremic dehydration. Children’s Hospital had me use their hospital grade breast pumps those first few days. The most I ever pumped was 3 cc’s. About a teaspoon. Usually, I just came back with mist. Or what looked like spit. There was never milk. I never got engorged. I never leaked. There was never any milk.
I got mad about this. Especially when I found out that it can and does happen regularly. It didn’t show up in any of my baby books or videos. So I called our local newspaper, The Virginian Pilot, and asked them to write an article about it, they did, it was called, “Mother Knows Best.” That was later revived by a journalist from The Wall Street Journal in an article entitled, “Dying for Milk: Some Mothers, Trying In Vain to Breast-Feed, Starve Their Infants — `Yuppie Syndrome’ Among Well-Meaning Parents Stems From Bad Advice — A Generation of Perfectionists.” We made the front page with that one. Of course, that set off a media frenzy. Continue reading
It was December 13th at 2:30 in the morning. My water broke as I was sleeping. I woke my husband up and the panic set in. My son was a scheduled C-Section due to the fact he was breech and he was going to be a big baby according to all the scans. I was scheduled for the 18th, which was my birthday, but he decided to come early. My husband and I rushed to St. Joseph’s Hospital in Tacoma, WA. This hospital was a “Baby-Friendly” hospital, which meant they push things like exclusive breastfeeding, no pacifiers and no nurseries. I didn’t think much of these things at the time, as I was a first-time mom and hadn’t pondered on them much. On paper, this all sounded great, and I was excited to go there. I had a simple birth plan: no circumcision and I wanted my husband in the operating room. That was it really. I trusted the doctors and nurses there to help me out.
The doctors were amazing. I got into the triage area at about 3:00 am and the doctors were awesome about monitoring me and keeping me up-to-date. The anesthesiologist and my OB helped me feel so comfortable. The cesarean went so well, I was in complete shock. After we had our initial bonding as a first-time family, things began to head downhill. By this time, I had been asked about 3 times if I was going to breastfeed, and I was planning to, but I would be doing a lot of pumping since I run around for my job. I was hoping to learn how to use a pump. However, the hour of recovery before being moved to my room was the start of the insanity. I was pushed to try and get my son to breastfeed, even when I was still throwing up from the medicine. I wanted to so badly, but I was vomiting every 15 minutes. I eventually could last for about a half hour before throwing up on myself again.
When I tried to breastfeed for the first time, my breasts were manhandled more than I had ever experienced in my life. I never consented to having so many nurses touch my breasts. I should have been sterner about not having so many people manipulating my breasts in order to breastfeed, but I was still out of it from the surgery.
To give some background at this point: My son was conceived using fertility treatments after many unsuccessful tries and he was born two weeks early. I was only an hour in recovery after a major surgery and I had a swarm of nurses touching my breasts to top it all off. After trying for several more hours, my nipples became so cracked, they started to bleed. I had about 10 different nurses trying to get him to feed and they all commented on his good latch. Okay! Great! Good latch means he’s getting food, right? No. Unfortunately, I was so dry nothing was there for him and I had to wipe blood off of his lips.
Fast forward to about 36 hours post-birth and my husband and I had no sleep at this time because our son was crying so much from being hungry. This hospital had no nursery and I was supposed to take care of him while recovering from major surgery. My husband helped as much as possible, but he obviously couldn’t help much with breastfeeding. I was at a critical point where the lack of sleep, pain from surgery and pain from cracked nipples was so bad, I broke down.
I begged for something for him, I begged for food because I knew he was so hungry and not getting anything from me. I begged for nipple relief. I am not sure why, but I still hadn’t had a proper lactation consultant stop by.
My nurse finally put in a request for a lactation consultant to see me. It was rather late at this time, and I begged the nurse to please help my baby and get him some formula. She looked at me as if I had committed the biggest sin. She kept making me try before finally (after two hours of begging) she had donor milk on hand. GREAT! Finally, he can get some food. This was now into the late night and my husband and I were so tired from him crying all night that we were done. He passed out. The nurse finally took pity on us and took him to the nurse’s station for about 2 hours. She was the silver lining, even after giving me such a hard time before.
My son was born on February 18, 2019. He was 6 lbs 10 oz and had a little trouble regulating his temperature at birth. But after 24 hours, he was okay. I was always told breast was the best way to go. I never breastfed my 9 year old so this was my first experience with it.
My son had latching issues at first and it caused major pain and bleeding. But after latch correction and using nipple shields, the pain dissipated. When we left the hospital, my son weighed 6 lbs (9.3 percent weight loss) and at his checkup the next day, he had gained half an ounce.
At home I was feeding straight from my breasts, every time. My son was content and seemed happy. He smiled and was great the entire time, so I thought. I didn’t pump to see how much milk I had because the hospital where I delivered told me pumping in the first 6 weeks could cause confusion for the baby with latching.
Now fast forward to when he was 21 days old. He had his three week checkup and he was extra sleepy that morning. When we got to the doctor, and not only did he lose weight, (down to 5.5 lbs), but he also had a temperature of 92 degrees. He was hypothermic! So they sent us urgently to the children’s hospital in Nashville. Continue reading
By Christie del Castillo-Hegyi, M.D., Co-Founder of the Fed is Best Foundation
The primary reason why newborns experience starvation-related complications every single day as a result of the Baby-Friendly protocol is because the complications associated with the protocol are hidden from mothers who seek to breastfeed. The primary objective of the Baby-Friendly Hospital Initiative is high exclusive breastfeeding at discharge. Unfortunately, because the rates of insufficient breast milk and delayed lactogenesis II are high among mothers, the necessary consequences of hospital policies that seek high EBF at discharge rates are higher starvation-related complications like hyperbilirubinemia, hypernatremia, dehydration and hypoglycemia, all of which can cause newborn brain injury and permanent disability. Below is an example of the way mothers are made to fear formula supplementation while the risks of NOT supplementing are hidden. This is a waiver form published on the California Department of Public Health Website to provide an example of a model formula waiver form for hospitals.
Here are examples of FEAR not FACTS contained in formula feeding waiver forms that Baby-Friendly hospitals require moms to sign before they allow a newborn to be formula-fed.
1. FEAR: Supplementation CAUSES delayed milk production.
FACT: The known risk factors for delayed milk production include being a first-time mom, cesarean delivery, flat or inverted nipples, higher BMI > 27, prolonged stage II of delivery (when a mom pushes to deliver), having a large baby, excessive blood loss, being an older mom > 30, PCOS, diabetes, hypothyroidism, insufficient glandular tissue, retained placenta to name a few. While supplementation may be ASSOCIATED with delayed milk production, supplementation is in fact a REFLECTION of the need to supplement a baby who is being underfed due to delayed copious milk production. (Pediatrics 2003, 112 (3 Pt 1): 607-19)
2. FEAR: Not exclusively breastfeeding puts my child at risk of jaundice.
FACT: Exclusive breastfeeding is among the highest risk factors for excessive jaundice requiring phototherapy admissions according to the American Academy of Pediatrics and 10-18% of exclusively breastfed newborns experience starvation jaundice from insufficient milk intake according to the Academy of Breastfeeding Medicine. Exclusively breastfed newborns are at higher risk of jaundice than supplemented and formula-fed newborns due to the smaller volumes of milk they receive as milk helps the baby pass bilirubin into the stool. In fact one of the ways jaundice is treated and prevented is through supplemental milk feeding.
Pediatrics, July 2004, VOLUME 114 / ISSUE 1, BREASTFEEDING MEDICINE, Volume 5, Number 2, 2010
3. FEAR: Not exclusively breastfeeding will cause my baby to be underfed
FACTS: In the largest studies of supplemented/formula-fed vs. exclusively breastfed healthy, term newborns from a large Baby-Friendly Hospital system, the exclusively breastfed babies lost almost twice as much as the supplemented/formula-fed babies. 10% of vaginally-delivered and 25% of cesarean-delivered EBF newborns lost excessive weight of >10% while NONE of the formula-fed newborns experienced this complication. In fact, exclusive breastfeeding at discharge is associated with an 11-fold higher risk of rehospitalization for dehydration and underfeeding.
Early Weight Loss Nomogram of Formula-Fed Newborns. Hospital Pediatrics May 2015, VOLUME 5 / ISSUE 5
Rehospitalization for Newborn Dehydration. Arch Pediatr Adolesc Med. 2002;156:155-161
4: FEAR: Supplementing will CAUSE low blood sugar and colostrum protects my baby from it.
FACT: In a study of newborns fed antenatally expressed colostrum along with direct latch feeding of colostrum when compared to those who did not receive expressed colostrum, the babies fed expressed colostrum in fact had higher rates of hypoglycemia requiring admission. Lancet 2017, 389: 2204-2213
So NO, colostrum does not protect against hypoglycemia. In fact in the most recent study of EBF newborns, 10% had blood glucose levels low enough to increase risk of lower long-term academic achievement. An even older study on low blood sugar in EBF newborns, 53 out of 200 or 26.5% developed low blood sugar within the first 6 hours of life. What protects against hypoglycemia is providing a child their full caloric requirement, which is 100-120 Cal/kg/day to prevent them from running out of caloric reserve.
Study of Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life Journal of Clinical and Diagnostic Research. 2015 Sep, Vol-9(9): SC07-SC10
Association Between Transient Newborn Hypoglycemia and Fourth-Grade Achievement Test Proficiency: A Population-Based Study JAMA Pediatr. 2015;169(10):913-921.
Nutritional management of newborn infants: Practical Guidelines. World J Gastroenterol 2008 October 28; 14(40): 6133-6139
5. FEAR: Introduction of cow’s milk will lead to cow milk protein allergy.
FACT: In a study of over 13,000 children, earlier introduction within the first 2 weeks of life of cow’s milk REDUCED their risk of cow milk protein allergy by 19-fold.
Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy. J Allergy Clin Immunol. 2010 Jul;126(1):77-82.e1.
6. FEAR: Exclusive breastfeeding is the ideal way of feeding every baby and there are no risks associated it, only risks of NOT doing it.
FACT: The most significant risks to a newborn’s life and brain come from the fasting conditions imposed by exclusive breastfeeding before full milk production and these risks are hidden from mothers to gain compliance with exclusive breastfeeding.
A review of 116 cases of breastfeeding-associated hypernatremia in rural area of central Turkey. J Trop Pediatr. 2007 Oct;53(5):347-50. Epub 2007 May 12.
Hypernatremic Dehydration in Breastfed Term Infants: Retrospective Evaluation of 159 Cases. Breastfeed Med. 2017 Jan/Feb;12:5-11.
Long-Term Neurodevelopmental Outcome of Neonates with Hypernatremic Dehydration. Breastfeed Med. 2017 Apr;12:163-168
Of Goldilocks and Neonatal Hypernatremia. Academy of Breastfeeding Medicine Blog.
7. FEAR: Just one bottle will ruin my child’s future health.
FACT: Just one bottle can save a child’s life and save them from a lifetime of disability.