Preventing Breastfeeding Roadblocks: Finding a Pro Breastfeeding Pediatrician

 There are some roadblocks to breastfeeding than come up often when moms are in the hospital or at their first pediatrician visits.  Depending on a mom's personality some are good advocates for themselves, but a lot of moms just go along with what they are told without questioning.  Often even if the pediatrician is pro-breastfeeding, a staff member will give you a biased opinion of what needs to be done in a certain situation.  While there are times supplementing with formula is helpful, often it is not necessary and depending on how the supplementation is done can hinder breastfeeding success.  Common scenarios that present barriers to breastfeeding are listed here including science-based evidence for this information in case you need to pass it along to any health professionals who may disagree so that you be your baby’s advocate.  1. The baby has low blood sugar. The high protein content of colostrum helps with glucose stabilization and promotion of ketogenesis which is as effective as formula supplementation. https://www.jognn.org/article/S0884-2175(15)31316-2/fulltext 2. The baby has jaundice. There is a difference between breastfeeding jaundice and physiological jaundice.  Physiological jaundice appears within the first few days and can be a normal result of an immature liver which is not removing bilirubin quickly enough.  Colostrum is an effective treatment because it helps the baby pass meconium, the first stool, which removes excess bilirubin from their body. The cause of breastfeeding jaundice is unknown, but it is most likely related to infrequent feedings. It does not usually present itself until after the first week of life. https://www.ncbi.nlm.nih.gov/books/NBK537334/  Phototherapy is common protocol to treat jaundice.3. The baby is big and “needs” supplemental formula. Birth weight can increase the stomach capacity,  but supplementation, especially without expression hinders the mature milk from coming in on time. The defense is a good offense.  Initiate the first feeding within 30 minutes of birth because after the first 1-2 hours baby goes into rest mode and is difficult to feed well for the next 8-12 hours, but any attempts at suckling will help stimulate milk production.  Approximately 5ml to 10ml is the typical colostrum feeding in the first 24 hours of life so if the baby is larger, it is important to feed more frequently than 2-3 hours as normally recommended.  Studies show that babies can metabolize up to 20ml per hour and since colostrum comes in approximately 5ml teaspoons, feeding every hour is beneficial. Mature milk normally comes in between the 3-5 day postpartum so frequent feedings can help the mature milk to come in on the earlier end of this range and help offset the big baby syndrome. https://pubmed.ncbi.nlm.nih.gov/23662739/ 4. The baby has lost too much weight and “needs” supplementation. Typically, the baby’s first pediatrician’s appointment is on day 5-6.  It is normal for breastfed babies to lose 7-10% of their birthweight as the mature milk does not come in until day 3-5 and moms and babies are learning how to breastfeed.  Formula babies only typically lose 3-5% of weight since larger amounts than are necessary are often fed and bottle nipples drip formula into the baby’s mouth without effort. Not putting formula standards on breastfed babies can prevent unnecessary supplementation which can interfere with breastfeeding success. https://www.ncbi.nlm.nih.gov/books/NBK536449/    It is beneficial when interviewing a pediatrician to tactfully get a feel for how quickly they recommend supplementation.  Here are some sample questions:   I understand some jaundice is common, do you recommend pumping and feeding the baby colostrum or formula?   Is low blood sugar a reason I would have to supplement formula instead of colostrum?   When is the follow up visit scheduled after birth?   How much weight is ok for my baby to lose the first week while I am breastfeeding?   How the pediatrician answers these questions may help you determine how pro-breastfeeding they are.  It is more difficult to determine how pro-breastfeeding their staff is without being a patience, but if at any time you get advice from a doctor’s staff that seems contradictory to the doctor’s values, don’t hesitate to ask for a phone call from the pediatrician in person.   That being said, sometimes supplementation is necessary but sometimes moms are bullied into supplementing even when not necessary.  If either is the case, it is important to stand firm on not using a bottle nipple to supplement.  A 10cc slip tip syringe can be used to finger feed the baby easily and this method keeps the baby’s tongue in a good position for breastfeeding.  In addition, it is easier to slow the pace of the feeding with a syringe which keeps baby on track with moms increasing milk production instead of exceeding her production where she is always playing catch-up.Here's to all the pro-