Pregnancy Diary: An Argument for Supplemental Feeding

By: Courtney McCrimmon

Breast is best. It’s a phrase expectant and new mothers hear constantly, from obstetric gynecologists, pediatricians, mommy blogs and news organizations covering the latest infant nutrition-related research.  
For newborns, breastfeeding helps decrease the risk of respiratory tract infections, gastroenteritis, asthma and inflammatory bowel disease; for mothers, it promotes bonding with the baby, helps with weight loss and reduces the mom’s risk for developing breast cancer, ovarian cancer and type 2 diabetes.  Recent research from the University of Pittsburgh School of Medicine even discussed the importance of breastfeeding and the cost of health care, stating that if the majority of women followed the recommended breastfeeding guidelines, billions in health care dollars could be saved by reducing the mother’s risk of developing cancer, diabetes and heart complications.
It’s certainly something I, and other mothers I know, took to heart.  As an expectant new mom, I read as much literature as I could on successful breastfeeding technique. I didn’t allow any formula into my home (to guard against moments of sleep-deprived weakness) and, after delivering my daughter, I fed her as quickly as the doctors and nurses allowed me to, believing successful breastfeeding was predicated upon establishing an early, successful latch. I was lucky – my daughter was born voraciously hungry and even the nurses admired her appetite, claiming most newborns liked to, well, sleep, after delivery.
It came as a surprise when, four days after her birth, the same day my milk finally came in and the day of her first doctor’s visit,  our pediatrician in no short order diagnosed our daughter with jaundice, shoved a small bottle of formula in her mouth, and declared my daughter “very hungry, indeed.” What followed was a schedule of hospital visits, blood tests, and formula supplementation that interrupted our healing and left me blaming the entire field of biology for our predicament.
It was something of a revelation, then, to have Dr. Michael Moritz’s, clinical director, Pediatric Nephrology, at Children’s Hospital of Pittsburgh of UPMC, editorial in the July 13 edition of Archives of Disease in Childhood come across my desk. His editorial, “Preventing breastfeeding-associated hypernatraemia: an argument for supplemental feeding” tackles the complications sometimes associated with breastfeeding, arguing “addressing and resolving these issues is a necessary part of making breastfeeding successful.”
According to Dr. Moritz’s editorial, one of the most serious complications of breastfeeding is neonatal hypernatraemic dehydration, a condition which results from insufficient lactation (when a new mom’s milk is delayed coming in or when she isn’t making enough milk).  If left untreated, this condition, which causes elevated sodium levels in an infants’ blood, can cause severe short-term problems, such as seizures, coma or, in extreme cases, even lead to infant death.
Less that forty-eight hours passed from our daughter’s clean bill of health at the hospital and our discharge to her first pediatrician’s appointment. In that short period of time, her skin started to turn slightly yellow and she didn’t have the “soaking wet” diapers all of my breast feeding books and websites recommended. Oddly for me, though, I didn’t worry, because those same books and websites claimed my body was making exactly the right amount of food my baby needed, that her tiny body wasn’t equipped to handle more than the teaspoon here or there of colostrum it was receiving before my milk came in.
According to Dr. Moritz, first-time mothers sometimes produce less milk during their newborn’s first week than they will in subsequent pregnancies, and their milk can often be delayed coming in. In my case, it took three and a half days after my daughter’s delivery for my milk to arrive. While lactation support and education can assist with breastfeeding issues like latch difficulties and inadequate feeding frequency, they can’t always help overcome milk production issues, and while bottle supplementation raises concerns about whether or not a baby will learn to properly breastfeed, if infants become too dehydrated they may not be able to do so at all once the milk supply does come in.
It turns out my daughter’s rapid weight loss in the hospital could have been a warning symptom of hypernatraemic dehydration. Other symptoms of this condition include decreased stool frequency and low urine output, but these symptoms can be common in healthy babies as well. Dr. Moritz admits the warning signs are vague.
“We need further studies to determine when and how supplemental feeding should be offered, and to what extent they could prevent issues requiring re-hospitalization,” Dr. Moritz said. “While it can be argued that bottle feeding interferes with breastfeeding, if we apply supplemental feeding carefully, and only when medically indicated, it actually could promote successful breastfeeding, since women might be less likely to abandon it if difficulties occur.”
Despite my best intentions, my daughter required two weeks of formula supplementation on top of breastfeeding, as well as daily visits to the hospital for blood tests to make sure her health improved. I worried about “nipple confusion,” or the possibility that she would come to prefer the faster delivery of formula from a bottle over nursing, but neither of those scenarios happened and she and I were able to nurse successfully for many months.  In the end, formula supplementation got us both to a healthy place, and I was grateful for it.

This is the first in an occasional series examining pregnancy from the viewpoint of an expectant mom. Courtney McCrimmon is a Manager in the Media Relations department at UPMC.