Dr. Jack Newmans Interview 12/13/2010
Dr Jack Newman Interview 12/13/2010
Dr Jack Newman interview with www.askthelactationconsultant.com:
Liz Pevytoe RN, IBCLC
One of my biggest frustrations as a lactation consultant is a breastfeeding mom being instructed to supplement with formula in the early days by their primary care doctor.
I wrote and asked Dr. Jack Newman if he would comment on the following scenario. He graciously commented. (I was overjoyed when he replied) Below are the contents of our email conversations.
My initial email:
"Would someone from your clinic be willing to answer a question from about supplementing with formula? We have a HUGE problem here in the south with pediatricians recommending supplementation for newborn wt loss. I am racking my brain trying to figure out how to stop this maddening process. It is sabotaging breastfeeding. "
Dr. Newman’s initial response:
"I will answer. And yes, the “need” to supplement is hardly ever necessary. And supplementing does indeed sabotage breastfeeding."
My Scenario question:
At your leisure, here is the question.
Scenario: For a near term or term infant with no medical problems. At discharge from hospital had 5% wt. loss. Has been nursing on demand every 2-3 hours. Today is day 5 and mom goes in for a weight check (common practice here in TX). Mom’s milk is in as of yesterday. Today's wt. check reveals an 8% wt. loss. Pediatrician recommends supplementing with 1.5-2 ounces of formula with a repeat wt check in 3 days. Mom calls me in tears because she is now scared.
I attempt to reassure mom. I see mom, do a pre-feed wt and post feed wt of baby on the breast, discover a one ounce gain. Inform pediatrician and he recommends continuing supplementation as prescribed. SNS is set up. During the night parents began bottle feeding because "it was too much work". Mom does not even attempt breastfeeding for most feeds because baby "doesn’t want it". Downhill from there. About half return to breastfeeding and the other half discontinue. But ALL planned on breastfeeding. Heartbreaking.
I am sure you have heard this story before. In my practice this is very common.How can I overcome this hurdle? Do I appeal to the doctors?
Dr. Newman’s comments:
Dear Liz,
The whole notion of % weight loss is meaningless. It assumes, first of all, that mistakes are never made during weighing of babies. It assumes also that you can compare two different scales, which is absolutely not true. I have documented differences in two different scales of up to 400 grams (12 oz). Of course, that’s not common, but 80 grams (almost 3 ounces) is not rare, and this is between two electronic scales made by the same company sitting side by side.
Furthermore, there is no question that babies whose mothers received large amount of fluids IV during labour and birth (and who doesn’t these days?), that a part of that fluid will go to the baby. And what does that mean? It means that the baby will be born “artificially heavy”.
Even if % weight loss meant something, what should be done is not automatically supplement, but rather fix the breastfeeding. And in many cases, the baby will start to feed better and gain better.
But you can’t “fix the breastfeeding” without observing a breastfeeding, and I will bet your physicians and pediatricians do not observe a breastfeeding, never mind help a mother to overcome any issue.
Dr Jack Newman, MD, FRCPC
My summary:
Reading Dr. Newman’s response was like someone breathing new life into me. He said everything my heart knew and said it beautifully. Supplementing just did not seem fair or right to me but he brought clinical “light” to the situation.
The breakdown is simple (in my opinion): breastfeeding issues are not being addressed by primary care physicians. Instead they are automatically referring to formula for whatever reason. Easier to measure? Feels safer? Who knows?
But the bottom line is breastfeeding is being sabotaged by this practice and I will not sit idly by and allow babies on my watch to be robbed of this valuable resource (breastmilk). So, in my private practice, I will continue to fight, kicking and screaming if necessary to stop this unnecessary supplementing madness. I will continue to search for a pediatrician in the Tarrant County area who is truly breastfeeding friendly. Unfortunately, I have not found one yet. I WILL NOT GIVE UP. The babies are worth the fight.
The Newman Breastfeeding Clinic and Institute have many helpful videos available for public viewing on their website. Also, please consider a monetary donation to the NBCI clinic. They lost their government funding and are in real danger of having to close. Dr. Newman is a valuable asset to the breastfeeding community at large and let’s rally behind him to keep his work going strong. Click here to donate to Dr. Newman's breastfeeding clinic : www.nbci.ca Want to read more of Dr. Newmans work? Here is his amazing breastfeeding book, one of my faves:
Thank you Dr Jack Newman, you are an amazing advocate and I appreciate all you do, from the bottom of my heart.
Dr Jack Newman interview with www.askthelactationconsultant.com:
Liz Pevytoe RN, IBCLC
One of my biggest frustrations as a lactation consultant is a breastfeeding mom being instructed to supplement with formula in the early days by their primary care doctor.
I wrote and asked Dr. Jack Newman if he would comment on the following scenario. He graciously commented. (I was overjoyed when he replied) Below are the contents of our email conversations.
My initial email:
"Would someone from your clinic be willing to answer a question from about supplementing with formula? We have a HUGE problem here in the south with pediatricians recommending supplementation for newborn wt loss. I am racking my brain trying to figure out how to stop this maddening process. It is sabotaging breastfeeding. "
Dr. Newman’s initial response:
"I will answer. And yes, the “need” to supplement is hardly ever necessary. And supplementing does indeed sabotage breastfeeding."
My Scenario question:
At your leisure, here is the question.
Scenario: For a near term or term infant with no medical problems. At discharge from hospital had 5% wt. loss. Has been nursing on demand every 2-3 hours. Today is day 5 and mom goes in for a weight check (common practice here in TX). Mom’s milk is in as of yesterday. Today's wt. check reveals an 8% wt. loss. Pediatrician recommends supplementing with 1.5-2 ounces of formula with a repeat wt check in 3 days. Mom calls me in tears because she is now scared.
I attempt to reassure mom. I see mom, do a pre-feed wt and post feed wt of baby on the breast, discover a one ounce gain. Inform pediatrician and he recommends continuing supplementation as prescribed. SNS is set up. During the night parents began bottle feeding because "it was too much work". Mom does not even attempt breastfeeding for most feeds because baby "doesn’t want it". Downhill from there. About half return to breastfeeding and the other half discontinue. But ALL planned on breastfeeding. Heartbreaking.
I am sure you have heard this story before. In my practice this is very common.How can I overcome this hurdle? Do I appeal to the doctors?
Dr. Newman’s comments:
Dear Liz,
The whole notion of % weight loss is meaningless. It assumes, first of all, that mistakes are never made during weighing of babies. It assumes also that you can compare two different scales, which is absolutely not true. I have documented differences in two different scales of up to 400 grams (12 oz). Of course, that’s not common, but 80 grams (almost 3 ounces) is not rare, and this is between two electronic scales made by the same company sitting side by side.
Furthermore, there is no question that babies whose mothers received large amount of fluids IV during labour and birth (and who doesn’t these days?), that a part of that fluid will go to the baby. And what does that mean? It means that the baby will be born “artificially heavy”.
Even if % weight loss meant something, what should be done is not automatically supplement, but rather fix the breastfeeding. And in many cases, the baby will start to feed better and gain better.
But you can’t “fix the breastfeeding” without observing a breastfeeding, and I will bet your physicians and pediatricians do not observe a breastfeeding, never mind help a mother to overcome any issue.
Dr Jack Newman, MD, FRCPC
My summary:
Reading Dr. Newman’s response was like someone breathing new life into me. He said everything my heart knew and said it beautifully. Supplementing just did not seem fair or right to me but he brought clinical “light” to the situation.
The breakdown is simple (in my opinion): breastfeeding issues are not being addressed by primary care physicians. Instead they are automatically referring to formula for whatever reason. Easier to measure? Feels safer? Who knows?
But the bottom line is breastfeeding is being sabotaged by this practice and I will not sit idly by and allow babies on my watch to be robbed of this valuable resource (breastmilk). So, in my private practice, I will continue to fight, kicking and screaming if necessary to stop this unnecessary supplementing madness. I will continue to search for a pediatrician in the Tarrant County area who is truly breastfeeding friendly. Unfortunately, I have not found one yet. I WILL NOT GIVE UP. The babies are worth the fight.
The Newman Breastfeeding Clinic and Institute have many helpful videos available for public viewing on their website. Also, please consider a monetary donation to the NBCI clinic. They lost their government funding and are in real danger of having to close. Dr. Newman is a valuable asset to the breastfeeding community at large and let’s rally behind him to keep his work going strong. Click here to donate to Dr. Newman's breastfeeding clinic : www.nbci.ca Want to read more of Dr. Newmans work? Here is his amazing breastfeeding book, one of my faves:
Thank you Dr Jack Newman, you are an amazing advocate and I appreciate all you do, from the bottom of my heart.