Is it necessary to supplement with formula in the maternity hospital? What to feed your baby: formula or breast milk
To begin with, let us recall that supplementary feeding is called the introduction of milk nutrition (milk mixtures) in addition to mother's milk. (The introduction of new dishes into the baby's diet: vegetable puree, cereal, cottage cheese - is called complementary foods, and juices and fruit purees that do not replace feeding - vitamin supplement).
Thus, supplementary feeding is prescribed if the child for some reason does not receive enough mother's milk. This is likely if the mother or baby is in serious condition. For example, if during childbirth or a cesarean section there were any complications from the health of the mother (bleeding, an attack of eclampsia - convulsions that arose as a manifestation of a complication of the second half of pregnancy - preeclampsia) and the woman is forced to stay in the intensive care unit for a long time, where for its treatment, drugs are used that do not allow feeding the baby with expressed milk (however, at the same time, the mother expresses milk with her hands or with a breast pump so that the possibility of natural feeding is preserved in the future).
The reason for the complete transition to the milk formula may be infectious diseases, the causative agents of which with mother's milk can enter the baby's body, for example, HIV infection or the detection of staphylococcus in milk. Supplementary feeding is most often required in severe conditions of the child, in which he is immediately transferred to a specialized department of the children's clinic immediately after birth, and the mother is at the maternity hospital at that time and there is no technical possibility to deliver breast milk to the baby. Most often, the need for supplementary feeding is caused by reduced milk production (hypogalactia). If there is a need for supplementary feeding, and the crumbs have any health problems, then there is considerable scope for the selection of a therapeutic mixture in order to correct these disorders. First of all, in this way it is possible to help children with low birth weight (mixtures are prescribed for premature and low birth weight children), as well as for functional and some organic problems of the gastrointestinal tract.
Thus, the strengths of supplementary feeding are the receipt of sufficient nutrition by the crumbs and the possibility of correcting some pathological conditions due to the introduction of therapeutic mixtures. No one questions the need for additional nutrition, if, for example, the baby, for whatever reason, cannot be attached to the breast. This occurs due to birth trauma, prematurity, hemolytic disease of the newborn (a disease in which the Rh-positive red blood cells of the fetus are destroyed by antibodies produced in the body of an Rh-negative mother) or any other ailments when placed in a special incubator or connected to a system intravenous infusion. Indeed, in the first 2-3 days, mother's milk has not yet come, and it is impossible to express colostrum. Approximately the same thing happens if the baby cannot be attached to the breast due to the condition of the mother (for example, while she is in the intensive care unit after a caesarean section). But, unfortunately, in maternity hospitals, babies are supplemented much more often than required by medical indications. In addition to them, there is also a “specific” reason for supplementary feeding of children: not all institutions have conditions for the joint stay of mother and baby and, accordingly, the possibility of feeding on demand. Where children are forced to be separately, they are supplemented with mixtures in accordance with the regimen. But it is even more offensive when the reason lies not so much in objective conditions as in the mentality of medical personnel. How many times have the world been told about the need to support breastfeeding (which includes, first of all, the rejection of supplementation and supplementary feeding), but to this day, even in the most qualified and prestigious obstetric institutions, no, no, and you will hear the phrase: “How can do you want to keep the child? You haven't got any milk yet! Do you want him to lose weight?!" You might even think that weight loss for a baby is not an inevitable process when changing from intrauterine to extrauterine existence, but something unnatural and terrible. Meanwhile, weight loss is physiological, that is, it should be normal. Nevertheless, before the arrival of milk, the baby has enough colostrum - the need for supplementary feeding can be discussed only in cases where the amount of urine excreted by the baby decreases, the number of urination is sharply reduced. In the first three days, only 2 urinations are enough, from the third to the sixth - 4, starting from the sixth there should be at least 6 per day. These are the lower bounds. There may be more of them, but, according to WHO, until the 10th day of life, the baby can safely exist without supplementary feeding, subject to such norms and regardless of weight loss (we are talking about a full-term baby). When breastfeeding, there is no need for supplementation: the baby drinks the offered water when he is hot (hot nose, reddish color of the skin). At the same time, the child loses a lot of fluid, so he drinks with pleasure. In such a situation, it is preferable to remove one vest than to offer the child water from the nipple.
However, they still offer to “feed” the baby with a mixture after the breast so that he “eats up”. And they leave helpfully prepared bottles near the wards or children's departments. Meanwhile, supplementation is fraught with a lot of pitfalls.
And the first among them, as already mentioned, is insufficient stimulation of lactation. A baby who is full from the mixture will suck on his mother's breast much less often and less actively, therefore, he will cause less further milk production. Moreover, some "sissies" may immediately prefer a bottle to breasts because of the ease of sucking. This is of particular importance in the first days of a baby's life, because it is then that he most easily gets used to both good and bad things.
In addition, any mixture is a foreign product and contains components unusual for mother's milk, more "difficult" to digest. Therefore, the mixtures introduced cause greater stress in the work of the digestive glands. In later life, children who are exposed to formula early are more at risk for gastrointestinal problems. If the proportion of the resulting mixture is large compared to the intake of breast milk, this can cause improper colonization of the gastrointestinal tract by representatives of the microflora and leads to dysbacteriosis. It is especially dangerous in this sense if the mixture is the first to reach the stomach and intestines of the crumbs. It is extremely important to apply the baby to the breast in the delivery room whenever possible. The first drops of colostrum will ensure the proper colonization of the gastrointestinal tract with beneficial microbes.
Of course, the appointment of supplementary feeding may be necessary for the baby. It just has to be thoughtful. In all cases, the least of many evils must be chosen.
Many young mothers immediately after childbirth find themselves, for one reason or another, unable to feed their baby themselves.
It happens that after a cesarean section, the mother needs time to recover, it happens that milk does not appear immediately, but it happens that the child does not immediately have a sucking reflex.
For this reason, maternity hospitals always have a stock of special infant formula for newborns.
Of course, this does not mean that any baby will immediately receive additional nutrition, usually it is prescribed only for certain reasons. Milk mixtures are fed in the maternity hospital who are not gaining weight well.
Completely transferred to artificial nutrition for babies with pronounced lactose intolerance. But if the mother does not immediately get milk, many doctors advise to continue offering the baby breasts: firstly, colostrum, which is initially secreted instead of milk, is very nutritious and useful for newborns, and secondly, in children who are often applied to the chest, the sucking reflex is strengthened faster.
Usually, already on the first day after birth, the baby dissolves the breast and there is enough milk.
If this does not happen, then the pediatrician, of course, will recommend starting to introduce infant formula. In most maternity hospitals, mixtures of the Belarusian brand Bellakt are successfully used. Less commonly, babies are offered mixtures of Nan, Nestogen or Nutrilon (this is most likely due to their higher cost).
- Bellakt
In many maternity hospitals, this mixture is offered for supplementary feeding of babies. It is relatively inexpensive and yet of high quality. Many mothers, even after discharge from the hospital, continue to feed their children with this mixture if necessary.
Bellakt mixtures contain a fairly high percentage of protein and healthy fats, so newborns on such a diet quickly and well gain weight.
The line of mixtures is quite large and fully covers all the possible needs of infants: there are formulas for premature babies, and for children with digestive problems, and for children with lactose intolerance.
The disadvantage of Bellakt mixtures is high osmolarity (at the limit of permissible) and the presence of palm oil in the composition.
- Nan
In some maternity hospitals, newborns are given mixtures of this Dutch brand. Even though they are not cheap, pediatricians can generally safely recommend Nan blends. The line includes formulas for both healthy children and children with special needs.
Nan formulas for newborns do not contain palm oil - the fatty component is made up of a mixture of high quality vegetable oils. This mixture is easily absorbed by the gastrointestinal tract of the newborn, as it contains probiotics and bifidobacteria.
- Nestojen
Another high quality mixture, which is fed to newborns in some maternity hospitals. Palm oil is also not contained in this mixture (lighter vegetable oils are used instead).
The formula is enriched with prebiotics for the proper development of the immune system of newborns and probiotics to support the functioning of the gastrointestinal tract.
- Nutrilak
The mixture is quite popular due to its relatively low cost and the complete absence of palm oil in the formula. In addition to the usual set of vitamins and minerals necessary for newborns from the first days of life, the Nutrilak mixture contains lutein to develop vision and protect the child's eyes from UV radiation and prebiotics for immunity.
- Nenny
One of the highest quality mixtures produced by the New Zealand company Bibikol. It does not contain heavy palm oil at all (instead of it, high oleic sunflower, coconut and canola oils are included).
The basis of this mixture is not cow's milk, but goat's milk, which, according to many pediatricians, is more beneficial for newborns.
If by the time of discharge the child still needs supplementary feeding, the pediatrician writes out to the mother a prescription for dairy cuisine, where you can take not only dry, but also liquid mixtures for artificial feeding of the child.
Unfortunately, it is not a fact that the mixture offered to a newborn in a maternity hospital or in a dairy kitchen is ideal for him. Sometimes babies develop allergies, gastrointestinal disturbances (diarrhea or, conversely, constipation), and excessive belching.
In this case, the mother needs to consult a pediatrician about a possible change in the formula and empirically select the appropriate mixture for the child.
The rules for feeding artificials are somewhat different from breastfeeding.
- It is recommended to feed a newborn with a mixture from a bottle strictly according to the regimen, since the composition of the adapted mixture is still different from breast milk.
- The first days of the child are fed approximately every 2.5 hours at the rate of approximately 30 grams of the finished mixture per feeding. It should be noted that this is only an approximate calculation, the exact number and volume of feedings must be calculated for each child individually.
- For the mixture, a special baby bottle with an orthodontic nipple is used, which repeats the shape of the female nipple. The bottle and nipple must be thoroughly rinsed and disinfected beforehand.
- The powder of the mixture is measured with a special measuring spoon according to the scheme indicated on the packaging of the mixture, and diluted with warm boiled water until the lumps are completely dissolved.
- It is necessary to ensure that the temperature of the finished mixture is not too high and not too low (ideally, it should be equal to body temperature).
The mixture from the bottle comes more intensively than milk from the breast, so that the baby does not choke, his head should be higher than the body when feeding.
To understand whether the mixture is suitable for the child, you need to see if he is full, if there are allergic skin rashes, if the child has problems with the gastrointestinal tract (bloating, profuse belching, stool changes).
In the latter case, the pediatrician may additionally prescribe a fermented milk mixture for newborns. If the child is not gaining weight well or has redness on the skin (diathesis), the mixture will need to be changed to a more suitable one.
Consider the most common options when a maternity hospital may offer to supplement a healthy full-term baby with a mixture:
1. Your milk supply is low. As an option: you have no or little colostrum.
In fact, it is quite difficult to determine the amount of colostrum. If, when pressing on the nipple, only a few drops of colostrum are released, then this does not at all indicate that there is no colostrum or there is very little of it. It is possible that after giving birth, the mother has problems with the process of colostrum secretion. The process of colostrum/milk release depends on the hormone oxytocin. After childbirth, especially if the mother was injected with artificial oxytocin during childbirth, some mothers may have reduced sensitivity to oxytocin receptors or a reduced amount of oxytocin. Oxytocin “loves” warmth, relaxation, positive thoughts. On the other hand, stress, fear, thirst, unwillingness to feed - inhibit the oxytocin reflex, as a result of which colostrum / milk is almost impossible to squeeze out of the breast. Therefore, before feeding, mothers can be advised to take a warm shower, relax, and experience positive thoughts.
You should also know that after transplacental feeding (that is, the supply of nutrients from mother to child through the placenta), the newborn baby has sufficient glycogen stores that maintain physiological glucose levels. Thus, on the first day after birth, the body of a newborn child is sufficiently provided with energy.
Therefore, most often, before the arrival of milk (and milk usually comes 48-96 hours after birth), the child has enough colostrum. If a mother is worried that her child may not have enough colostrum, then it is necessary to calculate the number of urination per day. On average, a child of the first days of life pisses quite rarely. the minimum urination rate is calculated by the formula:
child's age, days - 1 = minimum daily urination rate
For example, for a 3-day-old baby, the minimum urination rate is two: 3-1=2
In addition, it is very important to see how many times a day the child poops. A newborn baby, normally, poops at least 2 times a day. That is, if a colostrum-fed child poops 2 times a day or more, then, most often, this indicates that the child has enough colostrum and it is not necessary to supplement it with a mixture.
2. The child is large.
Quite often, if the child's weight approaches 4 kg, doctors may insist on supplementary feeding with a mixture, citing the fact that the child is large and therefore does not have enough colostrum. In fact, a large child has more glycogen stores, so his mother's colostrum is enough for him. Most often, such children do not need additional supplementary feeding.
3. The baby is underweight
This is also one of the options when supplementary feeding can be offered. If the child is full-term, active, then even with a weight of less than 2500 g, he has enough colostrum. Such babies need to be breastfed quite often. If the child sleeps for more than 3 hours, then it is necessary to wake him up and attach him to the chest.
4. The child is crying - it means hungry.
Practice shows that this is one of the most common reasons for the appointment of supplementary feeding. About 10% of newborns often cry within a few days after birth. But, most often, this behavior is not associated with the fact that the child is hungry, but with the experience of birth stress. If a mother puts the baby to her breast on demand, carries it in her arms, cradles, then usually this baby goes away without the use of supplementary feeding. The trick is that if the child is given formula, then he usually falls asleep after the mixture. In fact, the baby falls asleep not because he was hungry and only after the mixture was able to get enough. Usually, after waking up, the child starts crying again. The fact is that the artificial mixture, unlike breast milk, does not contain any enzymes that help the baby absorb it. Digestion of the mixture is a rather energy-intensive process, therefore, very often the child is forced to fall asleep after the mixture, since only in this case the body can find some additional resources for digesting the mixture. At the same time, despite the fact that the volume of the stomach in a 1-2-day-old baby is very small: on average, 7-10 ml, supplementary feeding in the maternity hospital can be offered in a much larger volume (15-30 ml). All this leads to the fact that the child, feeling a feeling of heaviness in the stomach, falls asleep.
5. The child sleeps a lot, which means he is hungry, he does not have the strength to suckle.
Some postpartum babies (about 15%) sleep a lot after giving birth, sometimes it is not easy to wake them up. It is believed that this behavior may also be due to birth stress. In such cases, they are fed not “at the request of the child”, but “at the request of the mother”. It is desirable that the mother, watching such a baby, be able to catch such a moment when the child goes from deep sleep to superficial. It is at this moment that you need to offer the baby a breast. If this does not help, then you should wake the child every 3 hours during the day, and then apply to the chest. If such a child is given supplementary food, then he can go into even deeper sleep for the reasons mentioned above. When a mother and baby come home, then, most often, this behavior disappears - the child already overcomes, basically, the stress received during childbirth, and returns to his natural rhythms.
6. The child often asks for breasts, which means he is hungry.
This behavior is also one of the options for the norm after childbirth. Approximately 25% of newborns in the first day after birth can literally "hang" on the chest. Thus, they overcome the stress received in the process of childbirth. All this is absolutely normal, you should not worry that the child is hungry. Of course, it can be difficult for a mother with such a child, especially if the birth was difficult enough. Therefore, in this case, it is better to have an assistant who can help mom. With this behavior of the child, when he asks for the breast very often and sometimes can practically not release the breast for hours, it is very important to monitor the correct attachment. With proper application, the nipples should not be injured and cracks should not form.
7. The child is losing weight.
Mom should know that weight loss by a child during the first days after birth is absolutely normal. The child has certain reserves of glycogen, which he spends adapting to new conditions. In addition, the original feces - meconium - come out of the child, which can also lead to weight loss. It is believed that weight loss in the range of 5-8% of birth weight is a physiological norm. The borderline norm is considered to be a weight loss of 10% of birth weight, that is, supplementary feeding can only be prescribed if the weight loss is more than 10%.
8. The child has jaundice.
Physiological jaundice in a child is a fairly common occurrence. Bilirubin is a fat-soluble substance and is excreted in the feces. Therefore, colostrum feeding helps to reduce the level of bilirubin. Supplementation with a mixture in this case is not needed! At the same time, it makes absolutely no sense to give the baby an electrolyte, some water, seagulls, etc., since all this does not help the process of removing bilirubin, but at the same time, significant harm is caused to the child's body.
9. The child has hyperthermia (fever), which means that he does not have enough fluid in the body.
Currently, it is believed that an increase in body temperature in a child (hyperthermia) on the first day after birth is associated with immature thermoregulation of the child, and is not an indication for supplementary feeding. That is, if, in addition to an increase in temperature (up to 37.5-38.5 degrees), nothing bothers the child, then such an increase in temperature is one of the options for the norm, and at the same time, the temperature returns to normal quite quickly. It is possible that the child is in a hot room and cannot yet fully adapt. It is necessary to often put the baby to the breast and monitor his condition in dynamics. The temperature usually returns to normal 12-24 hours after the rise.
10. Cesarean section
In principle, such an operation is not a contraindication to breastfeeding. When using general anesthesia, the child can be attached to the breast after 4 hours, and until this time, do without supplementary feeding. If the operation was performed under epidural anesthesia, then the child can be attached to the breast within 1.5-2 hours after the operation. The most important thing in such cases is to have an assistant who will bring the baby and help him put it on. Unfortunately, at present, in Kharkiv maternity hospitals, such a practice has developed that after the operation, the mother usually spends a day in intensive care, and the child is in the children's department, where he is fed with formula. Let's hope that, perhaps, something will change, and mothers after cesarean will be able to fully breastfeed their baby in the first day.
11. Mom taking antibiotics
Currently, there is a sufficient number of antibiotics that are compatible with breastfeeding. These antibiotics pass into colostrum/milk in small amounts. If it is necessary to prescribe antibiotics, doctors in the maternity hospital most often prescribe a medicine that is compatible with breastfeeding.
12. The presence of the mother's negative Rh factor
If during pregnancy a mother with a negative Rh factor did not show the appearance of antibodies, then there are no contraindications to breastfeeding.
A mother who wants to feed her baby with her milk should know:
If the child is forced to receive supplementary feeding on the first day after birth, and the mother plans to continue breastfeeding later, then supplementary feeding should be given not from a bottle, but with a syringe (without a needle), a spoon or a cup!
Pre-breastfeeding from a bottle significantly increases the likelihood of improper attachment, as well as rejection of the breast.
All of the cases listed above are not indications for supplementary feeding, but practice shows that it is in such cases that supplementary feeding with a mixture can often be offered. I think that a mother should remember that only she is responsible for her child, which is why it is so important to make the right decision. Therefore, it is necessary to know in what cases feeding with artificial milk substitutes is really required.
So, contraindications to breastfeeding:
From the side of the child:
1. Congenital metabolic disorders (phenylketonuria, galactosemia, maple syrup disease). Such diseases are very rare: from 0.5 to 5 cases per 100,000 children.
2. Asphyxia of moderate and severe degree.
3. Gestational age less than 32-33 weeks or baby weight less than 1500 g
4. Respiratory failure of 2-3 degrees.
5. Hemolytic disease.
6. Congenital malformations.
7. Cleft lip or cleft palate.
8. Acute form of dehydration.
9. Hypoglycemia.
From the mother's side:
1. Eclampsia.
2. Severe bleeding during childbirth and in the postpartum period.
3. Open form of tuberculosis.
4. The state of severe decompensation in chronic diseases of the heart, lungs, kidneys, liver, as well as hyperthyroidism.
5. Acute mental illness.
6. Especially dangerous infections (typhus, cholera, etc.).
7. HIV infection
8. Taking highly toxic drugs.
Cases when temporary weaning is necessary :
1. Herpes simplex (if there are herpetic eruptions on the nipple).
2. Breast abscess.
3. The need to take medications that are incompatible with hepatitis B.
Not a contraindication (from the mother's side) :
1. General non-severe infectious diseases of the mother.
2. Chicken pox.
3. Cytomegalovirus.
4. Hepatitis A and B.
5. Staphylococcus and streptococcus.
6. Mastitis.
7. Endometritis and urinary tract infections.
As you can see, there are very few actual contraindications to breastfeeding, in fact, such cases are quite rare. But, for one reason or another, supplementary feeding is prescribed much more often. In my opinion, mother's awareness, the presence of sufficient motivation for feeding are the key to successful and simple breastfeeding.
Kastakovskaya Elena, physiologist, breastfeeding consultant, Center "The Art of Motherhood"
Hello dear readers! Conscious mothers try to sort out in advance all the controversial issues that accompany the birth of a baby. And one of the most painful questions is whether supplementary feeding with a mixture is needed in the maternity hospital?
As you know, breast milk appears 0. Before that, there are only drops of colostrum in the breast.
Many modern doctors consider this abnormal and actively supplement newborns with artificial mixtures. In many maternity hospitals in Russia, no one will even ask you if you want to supplement your baby? At every opportunity, they put the mixture on him and are indignant if you try to protect your child from this.
Fortunately, this is not always the case. I heard from some women that basically no one fed their baby anything. I heard that in some institutions there is a completely different policy ... And this is very pleasing!
What's wrong with mixes?
Formula is always artificial formula and cannot replicate breast milk. Mothers of artificial babies say how important it is to acquire high-quality supplementary food, if there is a need for it. Do you think the maternity hospital is ready to overpay two or three times for the nutrition of newborns? Personally, I highly doubt it.
But in this case, that's not even the point. The fact is that a newborn needs absolutely nothing but a drop of colostrum. Nature is wise, she has thought of everything. In the early days, the baby does not need food. Moreover, he is completely unprepared for it.
All 9 months your baby was fed through the umbilical cord. And this food was completely different, it was ready-made nutrients, they were very easy to digest ...
Now the newborn has to learn a new way of getting food. And this transition should be very smooth. In the early days, you need to cope only with drops of colostrum. A bottle with the mixture will definitely be superfluous!
Moreover, there are still unprocessed substances inside the baby. Therefore, even in the absence of nutrition, the newborn regularly poops - this is how meconium comes out. And if in the first days the baby also actively ate, this would create too much stress on the digestive system.
And supplementary feeding negatively affects. The baby gets used to the bottle, sucks less breast ... He no longer needs to try to get his own food. Sometimes it ends very sadly.
By the way, there is not as little colostrum in the female breast as it seems ... The peanut eats a tablespoon a day. A tablespoon of the most useful substance, which is prepared for him by wise nature.
As for weight loss ... Any doctor will confirm that this is the norm. And if we are talking about a healthy full-term baby, then you don’t have to worry about body weight.
My experience
As always, I'll share my experience. When I immediately put her in the next box, she was lying there and crying, waiting to be taken away for examinations.
Oh, now I would not want to put up with such a situation. But then I was a stupid inexperienced mother who completely trusted doctors. I asked the midwife, "Why is she crying?" To which a calm reply followed: “Hungry! But nothing, now they will come and feed her!”
Can you imagine?! According to this midwife, a baby is born hungry!
Now I understand that it was necessary to put the baby in the chest. And she needed not food, but contact with her mother. Now I know that it is unnatural for a newborn to lie somewhere alone ... But then I believed.
And for three whole days the child was fed with a mixture. Every three hours. Because - hungry! First, the health workers fed, and then I myself. Because I saw: the little one after the mixture becomes calmer and falls asleep. And at the same time, he does not want to suck on an empty breast ...
After the second birth, I was already desperately fighting for the fact that the baby was not given anything. But it was still very convenient for the nurses to pop the formula on every occasion. They took him for examination... The kid, of course, screamed... A bottle of the mixture - and the conflict is over.
Why are they supplemented in maternity hospitals?
It seems to me that the main reason is that it is convenient for employees. A portion of the mixture is a very heavy food for a newborn. After that, he quickly falls asleep.
In addition, nurses in maternity hospitals really like it when the weight loss is not so big. They usually do not think about how this loss is physiological. And they are even less concerned about the consequences of supplementary feeding.
It's up to you then to live with this child. And the nurses will discharge you with a good weight - and forget. They don't care that supplementation jeopardizes breastfeeding. That it increases the risk of infantile colic and allergies. Nurses have other concerns.
What to do?
If you decide that you will only breastfeed your baby, you need to take a number of actions in advance:
I hope my experience is helpful to you! Subscribe to new blog articles and support by reposting on social networks. See you soon!