It was the third day after a caesarean birth in Melbourne's tertiary hospital which is also accredited as 'Baby Friendly'.
[For the first part of this discussion, click here]
Mother had received excellent midwifery support and care during and after the birth, and the midwife on duty had arranged to stay with the little family in the Recovery room so that baby could initiate breastfeeding immediately.
Baby breastfed well in the hour or so after the birth.
The following day I was unable to visit, as I had come down with a nasty head cold which I did not want to share. I spoke to the mother on the phone. Baby was only about 30 hours old, and had had limited success at the breast. Mother was happy giving her expressed colostrum.
The next morning - the third day - the midwife announced that baby looked jaundiced, and was dehydrated. Baby was weighed, and of course had lost weight. Although the loss was not excessive, that did not seem to be taken into account in the new care plan. Without making any effort to support breastfeeding, the midwife announced that the baby needed a blood test for jaundice. This recorded jaundice at the lower limit of the range requiring phototherapy. The mother was informed that baby needed to go 'under the lights' and would be given formula milk to complement the expressed breast milk.
The parents reluctantly agreed to the formula - there was really no alternative. They asked that they be able to give it via a cup or syringe, to avoid using a teat. The nurse's response was that that takes too long, and there's no problem with a teat anyway!
That nurse undermined the good work by midwives and the medical team in the preceding days, who had worked to promote, support and PROTECT breastfeeding.
Not only did the mother receive conflicting advice; she had reached a point where she was no longer able to trust the guidance of the midwives and other hospital staff. Breastfeeding was compromised by the formula, which took away the baby's appetite and interest in the breast, the enforced separation that came about with phototherapy, and the use of a teat.
Someone may be asking, "What alternative plan was there?" "What would a truly 'baby friendly' maternity service have done in this instance?"
At the very least, giving the supplement by cup or syringe, as requested by the parents, would have minimised the risk of nipple confusion.
Secondly, there was scope for more effort to help the mother with breastfeeding, while continuing to observe the baby for any medical problems such as jaundice and dehydration. In this case there was no cause for concern: the baby was at term, and would not be harmed by a more conservative approach than was taken.
And finally, I need to challenge the acceptance of artificial formula as a suitable alternative to a mother's own milk. The first alternative is human milk from another mother - yet Australian health authorities have put their collective heads in the metaphorical sand. Human milk banking, providing donated and pasteurised human milk for human infants, is the best supplement when a mother's own milk is unavailable.
Yet babies are routinely exposed to the bovine milk, and all the other micronutrients derived from plant oils and any number of foreign and potentially allergy-forming sources, when donated human milk would be far more suitable.
"There's no milk like mum's milk!"