There's Nothing Sweeter Than Mom's Own Milk

Background: The Labor and Delivery (L&D) nurse's role is vital in achieving excellence and safe passage for the exclusively breastfeeding mother-infant dyad.  Infants remaining skin-to-skin during the first 1-2 hours of life achieve self-latch, self-regulate blood glucose levels, and have longer breastfeeding relationships.  Recent literature and Joint Commission recommendations cite that one formula feed impacts the infant.  However, current hospital guidelines continue to support the use of formula and IV glucose to correct infant hypoglycemia. 

Case: As an experienced L&D and trained Breastfeeding Support nurse, I assisted a new mother facing such a challenge.  A 28 year old primigravida at 39 3/7 weeks delivered vaginally.  Labor was complicated by prolonged rupture of membranes and chorioamnionitis.  The infant weighed 4110 grams (9# 1oz) and was classified "large for gestational age" (LGA).  The mother intended to exclusively breastfeed; a successful latch was noted.  Current hospital guideline requires a blood glucose to be performed between 1-2 hours of life on LGA and "sick" infants.  Initial blood glucose results were 34, with immediate repeat of 28.  Per hospital guideline, blood glucose levels below 36 require MD notification, infant feeding of 10 mL/kg of formula, and administration of IV glucose.  Upon notification, the pediatrician ordered formula supplementation; however, the mother stated her desire to continue giving breastmilk to correct the hypoglycemia.  I taught the mother how to hand-express colostrum and spoonfeed the infant.  35 mL of colostrum was successfully expressed and spoonfed to the infant.  The repeat blood glucose was 52. The pediatrician was notified of the results using mom's own expressed breastmilk.  The infant remained on the hypoglycemia management guideline, but did not require formula supplementation or IV glucose.  Mother and baby were able to exclusively breastfeed for the duration of their hospital stay.  This successful scenario of treating infant hypoglycemia with mom's own expressed milk was well-received by my hospital's Neonatalogy and Lactation departments, as well as hospital management, thus generating new teaching projects surrounding hand-expression and spoonfeeding.

Conclusion: As nurses, we must strive for excellence in the care of the exclusively breastfeeding mother-infant dyad, realizing that current practices and hospital guidelines need changing to align with recent research and Joint Commission's recommendations.  By utilizing current evidence surrounding mom's own expressed breastmilk, we can ensure successful breastfeeding for the long term as well as increase mom's confidence that she can provide for her infant's needs.

Keywords: breastfeeding, hand-expression, spoonfeeding, hypoglycemia, safe passage