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 to 2 hours of life achieve self-latch, self-regulate blood glucose levels, and have longer breastfeeding relationships. Recent literature and Joint Commission recommendations indicate that one formula feed affects the infant. However, current hospital guidelines continue to support the use of formula and intravenous (IV) glucose to correct infant hypoglycemia.
As an experienced L&D and trained breastfeeding support nurse, I assisted a new mother facing such a challenge. A 28-year-old primigravida delivered vaginally at 39 3/7 weeks. Labor was complicated by prolonged rupture of membranes and chorioamnionitis. The infant weighed 4,110 grams (9 no. 1oz) and was classified large for gestational age (LGA). The mother intended to exclusively breastfeed; a successful latch was noted. Current hospital guideline requires blood glucose to be performed between 1 and 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 less than 36 require physician 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 breast milk to correct the hypoglycemia. I taught the mother how to hand-express colostrum and spoon feed the infant, and 35 ml of colostrum was successfully expressed and spoon fed to the infant. The repeat blood glucose was 52. The pediatrician was notified of the results using the mother's expressed breast milk. The infant remained on the hypoglycemia management guideline, but did not require formula supplementation or IV glucose. Mother and infant were able to exclusively breastfeed for the duration of their hospital stay. This successful scenario of treating infant hypoglycemia with the mother's expressed milk was well received by my hospital's neonatology and lactation departments, as well as hospital management, thus generating new teaching projects surrounding hand expression and spoon feeding.
As nurses, we must strive for excellence in the care of the exclusively breastfeeding mother–infant dyad realizing that current practices and hospital guidelines must be updated to align with recent research and Joint Commission recommendations. By utilizing current evidence surrounding a mother's expressed breast milk, we can ensure successful breastfeeding for the long term as well as increase the mother's confidence that she can provide for her infant's needs.