Personal Views

Breast feeding does not always work

BMJ 1997; 315 doi: (Published 20 September 1997) Cite this as: BMJ 1997;315:754
  1. Jenny Bennison, general practitioner
  1. Edinburgh

I was 38 weeks pregnant and had finished my last surgery earlier the previous day. At 4 am I was admitted to hospital and less than an hour later Sapphire had arrived. Her Apgar scores were 9 and we had a memorable hour on our own with this alert and happy little person. Her birth weight was 2450 g but her blood sugars were fine, and I made sure that she received only my colostrum.

Sapphire came home after 48 hours. By now she was beautiful, although beginning to turn yellow, and at home she seemed particularly small and vulnerable. I continued to feed her whenever she woke up, and awaited the agonies of engorgement and cracked nipples. The community midwife came every morning, full of reassurance and cheerful optimism. Yes, Sapphire looked peaceful, and she was getting wet nappies—but how wet were they supposed to be? I was weepy and worried, but this was surely just “the blues.” By the fifth day she was yellow, small, and wizened, and had still not had a dirty nappy since passing meconium in the hospital.

Next morning, after a bad night punctuated by frequent brief feeds, Sapphire was restless and unhappy, and when we found that her weight had dropped from 2450 g to 2100 g the reason was obvious: she was starving. Even now the cheerful optimism prevailed and I was assured that she would be fine after a few “top-ups.” A friend arrived soon afterwards with all the paraphernalia of bottle feeding. I had been sure that no formula milk would be needed, and was therefore completely unprepared.

By now Sapphire had fallen asleep, but when we woke her she would take only about 10 ml. After another sleep and a bath we could only just rouse her and she was not interested in feeding at all. I called our general practitioner who agreed that Sapphire was looking a bit dry and should not be sleeping through her feeds. On admission to hospital she needed a full infection screen, which revealed that she was indeed dry and hypernatraemic, but her cerebrospinal fluid was clear. By now she had remained frighteningly lethargic, taking neither breast nor formula milk, for at least eight hours. Finally she was given intravenous fluids. I shall never forget the moment a few hours later when she opened her eyes again and her intelligent look told me that all would be well.

I have written this down because the advice given about breast feeding is in danger of being misleading. Of course, breast milk is the ideal nourishment for a baby, and of course mothers should aim to breast feed, but the case is weakened by the stubborn refusal of some enthusiasts to admit that it does not always work. Parenthood brings anxiety which does not need to be supplemented with guilt for those who, for whatever reasons, do not exclusively breast feed their babies.

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