Posted by My OB said WHAT?!?.
Nov
29
Posted by My OB said WHAT?!?.
“Jaundiced Due To Lack Of Feedings, Mother’s Very Large Breasts & Flat Nipples.”
“Jaundiced due to lack of feedings, mother’s very large breasts and flat nipples.” – Hospital staff pediatrician’s report.
There are 44 comments to this post.
Because of course it couldn’t be anything the hospital staff did or just happened on it’s own, gotta blame the mom!
P.S. Same problem here, large breasts, flat nipples. LC in the hospital gave me a nipple shield, which made nursing much much easier the first 2 months! Successfully breastfed my older daughter 19 months, 9 months and counting with my youngest 
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Cassaundra had this to say,
Nov 29, 2011 @ 3:18 pm (Quote)
and is my saggy belly causing malnutrition? is my bad hair causing the baby to have colic? my baggy shapeless clothes causing acid reflux? my lack of make-up is causing a skin rash, my failure to get a perm and dye-job is stopping babe from sleeping through the night, my refusal to wear stilettos has led to birth defects and of course baby was a useless girl because I didn’t fellate my husband twice daily like every obedient wife should. right doc? did i miss anything?
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He might was well write “due to neglegent mother who thinks she can do this ‘breastfeeding’ thing that I’ve been hearing about but obviously don’t know jack squat about”…
Of course we blame the mother! The mother is responsible for EVERYTHING that might happen to the baby right? It can’t POSSIBLY be due to dr error, or just something that happens that isn’t anyone’s fault? ugh
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Mama Wrench had this to say,
Nov 29, 2011 @ 5:04 pm (Quote)
As far as I can tell, MOST hospital-born babies end up labeled as “jaundiced” whether their bilirubin levels are actually in the danger zone or not. Couldn’t just be that the threshold for the blood test is unreasonably low.
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Details Reply:
November 30th, 2011 at 5:35 am (Quote)
You know this test is just a screening test. They just want to catch the ones that might slip into a serious problem before sending them home. That is why the threshold is so low. They really shouldn’t be diagnosing based on the first blood test. If the first one comes back elevated then a second should be ordered after a certain amount of time and corrective action. If the second one is bad, as in higher and in or approaching the danger zone, then they can make a diaganosis of true jaundice. They really don’t need to panic just because the first test comes back in the “watch this one – Do not release to go home until you are sure this baby is not in danger” zone. That is all that first test means.
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I know this statment really sounds crappy but for insurance purposes diagnoses have to be written up. For nursing diagnoses we have to write the problem (jaundice) related to (lack of feedings) as evidenced by (mothers large breasts and flat nipples). Looking at this statment from the side of the medical team, the statement is reasonable and for insurance to justify payment, a diagnosis is needed. It sounds crappy to the mother, but in all honestly unless the doc said this with a snotty tone of voice, I see it as reasonable, in the world of documenting.
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Mama Wrench Reply:
November 29th, 2011 at 5:40 pm (Quote)
But when records are wrong, or don’t logically follow, it can end up actually really hurting your patients.
For instance, my records state that I had an elective c-section due to arrest of dilation. In reality I was 10cm and pushing for 2 hours before having an emergency c-section. Now I’m having to fight to get my records amended 2 years after the fact in order to be approved for VBAC.
If this mom was nursing adequately, then the “jaundice” (which very well could have merely been a normal bili spike that MOST newborns experience) could be caused by something else that the doctor just never bothered to look into because it was easier to blame the boobies. On the other hand, if she really DID have breastfeeding issues, then the differential should be followed with “requested lactation consultant for further assistance.”
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Details Reply:
November 30th, 2011 at 3:30 am (Quote)
What exactly would they be trying to get the insurance to pay for? Billi lights? A second round of blood tests? An LC? The this is the way we have always done it doesn’t float with me. Making up stories so you can get paid isn’t justifiable. I agree that if the doctor didn’t say it to the mother and just wrote it down, then the mother shouldn’t get too insulted. OTOH why are we training our doctors to think like this? It is a bad system. “Requested lactation consultant” would be a much better thing to write. Or boarderline jaundice follow up with second blood test after 6 more feedings or 24 hours. ie Jaundice related to – not sure since it is only boarderline as evidenced by blood test results. It is a screener. Additional screening may be necessary before an actual diagnosis can be made. Duh!
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Kim Reply:
December 1st, 2011 at 11:27 am (Quote)
Mamma Wrench,
“For instance, my records state that I had an elective c-section due to arrest of dilation. In reality I was 10cm and pushing for 2 hours before having an emergency c-section. Now I’m having to fight to get my records amended 2 years after the fact in order to be approved for VBAC.”
I don’t know why your chart would say that you were a failure to dilate when you were at 10cm. That does sound fishy. I hope you are able to get your VBAC. As for adding the request LC… that is not how medical records are written. When you are in the computer you get either options to choose from and you check the boxes or you write the diagnosis, what it is related to and what it is evidenced by. In a “document interventions” is where it would say if a LC was requested/offered and what mom’s response was.
Details,
All of your reasons could be logical reasons for insurance payment justification. And additional screening is not always done before a diagnosis is made. Such as the women (such as myself) that leave the hospitals less than 24h after birth. You cannot re-test and be accurate in such a short amount of time. Now the women that stay for days, those women and babies can get additional tests/help.
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Details Reply:
December 1st, 2011 at 12:40 pm (Quote)
Thus why they used to ask you to take baby to the ped at 3 weeks (because they were seen in the hospital for 2-3 day vaginal 4-7 days c-section. And now with drive thru deliveries, they ask you to see the ped at 1 week. But it doesn’t change the fact that the inital screen for Jaundice isn’t enough to diagnose and if they do diagnose after only one blood test less than 24 hours after birth THEY ARE DOING IT WRONG! I don’t give a damn what the paperwork says. The science says they are wrong and the paperwork should be corrected. That is my point. We need to stop following the paperwork and the policy and start paying attention to the evidence. And you aren’t helping.
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Cassaundra Reply:
November 30th, 2011 at 7:53 am (Quote)
plus, to suggest the CAUSE of a feeding problem whn you have ZERO training in lactation (because “large breasts” is NOT a reason nor is flat nipples both of which are completely normal and do not cause problems) is simply being misogynist.
how about a diagnosis of:
“feeding problems caused by doctor’s unresolved issues with his mother and inability to look at breasts without giggling, pointing and calling people names” ?
i mean, THAT fulfills the insurance requirements too right?
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Sheva Reply:
November 30th, 2011 at 8:50 am (Quote)
…caused by doctor never having matured emotionally past the fifth grade.
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Kim Reply:
December 1st, 2011 at 11:34 am (Quote)
Cassaundra,
It is not that OB’s have NO breastfeeding training, because they do, it is more that many are not pro breastfeeding or do not encourage it even if they are indifferent on the subject. The words used “large breasts” ARE very acceptable terms that are used. What if the mother really does have very large breasts and it they are getting in the way of breastfeeding. Breastfeeding is a learned talent and not every woman is comfortable with holding their breast, latching baby and dealing with a wiggly baby all at the same time. So for the wording to say that there is a lack of feedings because of large breasts is reasonable.
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Cassaundra Reply:
December 1st, 2011 at 12:28 pm (Quote)
really? what are the clinical guidelines for this diagnosis of “very large breasts”? these are NOT, NOT,NOT acceptable terms! and actually, i have been told by several OBs that they have NO training on breastfeeding. in fact, i have yet to hear of a medical school that requires any training on lactation. this is why the WHO created their new text on lactation, because there was NO text prior to this!
but again, let’s clarify this. what terms are you using to decide what “very large” is? and what further terms are you using to decide if there is a problem being caused by this? because to me, it sounds like you are just trying to come up with excuses for your barely veiled deep hatred for women. i mean, you are saying some breasts (and quite possibly ALL breasts, since a newly birthed momma normally and physiologically can have greatly expanded breasts)cause breastfeeding problem just by virtue of their existance!! so what criteria are you using to judge who has “good” boobs and who doesn’t? and what criteria are you using to decide the punishment women should receive for the sin of having “bad” boobs? or is having the doctor insult and abuse them enough of a beating for you?
oh, and by the way, i am a not-flat-chested mom who has successfully breastfed 5 children including a preemie and i know literally DOZENS of women with “very large” breasts that have fed just fine! WE aren’t a problem, or broken or desrving of your or this doctor’s scorn
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Kim Reply:
December 1st, 2011 at 7:08 pm (Quote)
You need to quit being so defensive. I am a large chested woman myself who has breastfed all 4 of my children.
For the sake of any further argument, I like reading these qototes but the way you and others just jump all over the medical community is just wrong. Yes, there are some very horrid people out there, but I am not one them. I tried to explain the rational for the comment from the side of the medical team. But it seems that you just don’t want to hear it. I suggest you take a look at where your frustrations are really coming from and stop taking them out here. I am a very good ob nurse and every time I see people like you bashing us it makes me sick. Not every OB or L&D nurse is some 3 eyed witch just pushing epidurals and episiotomys on women while making women lay in bed hooked up to machines!
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milkchocolatemidwife Reply:
December 2nd, 2011 at 1:02 am (Quote)
Whoa. Why must these dialogues often get so defensive and unproductive? And Cassaundra, this comment isn’t solely directed toward you but to others as well. Kim did not make a distinction between “good” breasts and “bad” breasts. Neither did the peds report from the original quote. Who said very large breasts are bad??? Fact is SOME large breasted women (myself being one of them) can have difficulty with breastfeeding because of the breast size. It can be downright tricky to get a baby latched properly when dealing with extra tissue and a wiggly little person. That’s not blaming the mother. That’s calling it what it is. And the original quote NEVER said that the mother neglected to feed the baby. It simply said the baby was jaundiced (which could be a simple observation as opposed to an actual diagnosis as jaundice=yellowing of the skin/eyes) due to lack of feedings, etc. The actual diagnosis would be hyperbilirubinemia if the testing indicated that the baby’s bili levels were getting high. And the mother did indicate some difficulty with breastfeeding because of the health issues she was experiencing postpartum.
As for what clinical guidelines for what large breasts are, I think we’re talking common sense here. We know what large breasts look like as opposed to small breasts, don’t we? To claim otherwise would just be playing devil’s advocate and that’s fine, but say that.
While I don’t necessarily agree with the conclusion of the ped’s report and I’m sorry that this mama had a bad experience postpartum, I don’t think it’s fair for us to bash someone who’s trying to explain why certain wording might’ve been chosen. Wouldn’t it do us more good to understand where the offending party might’ve been coming from? Not to excuse it, but to facilitate better dialogue between ourselves and our healthcare providers and hopefully change some of the dynamics at play. If we want to be understood, we must also seek to understand. Just my 2 and a half cents.
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Details Reply:
December 2nd, 2011 at 6:49 am (Quote)
“Jaundiced due to lack of feedings, mother’s very large breasts and flat nipples.”
Translation – Problem is caused by mother’s large breasts. I don’t see why you don’t see that the implication is that the mother’s breast are not going to be capable of breastfeeding ever. If they meant “getting off to a slow start because large breasts are harder to manage” then they would have been getting her a nipple shield, getting her an LC and bringing her her baby. Yes, the doctor did say that very large breasts are bad. If he thought they were merely harder to learn with then he would have orderd help. Instead he wrote the mother off as a failure to breastfeed. It is pretty clear to me. It also happens to be a lie, since lack of feedings was the fault of the nursing staff. He could have just as easily blamed the “slow start” to recovery from c-section, but that would have made it the OB’s fault. He choose to blame it on the mother.
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Sheva Reply:
December 2nd, 2011 at 10:53 am (Quote)
I’m pretty sure proper wording would have been “Jaundiced *related to* *difficulty feeding*, not ‘due to’. And the “lack of feeding” was the hospital’s fault, not the mom’s.
Large breasts may cause difficulty, but not lack of feeding. This was a mistake in charting d/t doc’s lack of patience and knowledge. And r/t nurses’ incompetence.
And if the next few lines enumerated the steps being taken to correct the problems – such as photo therapy, further screening, etc, then it should have also included frequent feedings and a competent LC for the mom, since that was the other problem mentioned. If the records didn’t continue on to say all that, then the doc and nurses were way out of line.
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Holly Reply:
December 9th, 2011 at 6:49 pm (Quote)
Actually we can’t all agree on what “large” breasts are. It isn’t “just” common sense. It is widely effected by history, where/how we grew up, size of our mother’s breasts etc. My step mother had FFF sized breasts. She special orders her bras. *I* saw these as “big” not overly large not humongous but big. Now my 38DD’s to me are small. Not as small as my A and B cup friends’ but certainly not “big” or even large. “Mom” had big breasts. Those were the breasts *I* thought *I* was going to have and wanted as a child. Nice, big, in your face breasts. To “only” get DD’s seemed not fair when I was younger. Now I know that mine are fairly big (not huge) but that hers were HUGE. So “large” is certainly subjective.
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milkchocolatemidwife Reply:
December 9th, 2011 at 7:55 pm (Quote)
We may not all be able to agree on what specific breast size would be considered the threshold for large vs small. However, even in the course of your argument, you acknowledge the fact that your 38DD’s (also my size) would be considered “large”, a synonym for “big”, by many people. So, with this in mind, does it make sense to bash a doctor (or anyone else) who might look at breasts even larger than ours and conclude that these breasts are large? And I realize that there’s a different connotation with the word “huge” than there is with “large”. The doctor wrote large as per his or her own observation. As I said before, the doctor did not make a judgement about whether or not large breasts were a good or bad thing. That’s our own interpretation and perhaps our own feelings about breast size coming into play here. Or perhaps it’s a reaction to what we’ve been told or experienced in the past. While I agree that “large” may sometimes be subjective, there comes a point where we’re playing devil’s advocate or being snarky just because. Otherwise, why teach our children the difference between big and small if it’s all subjective, anyway?
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Jane Reply:
November 30th, 2011 at 8:50 am (Quote)
For nursing diagnoses we have to write the problem (jaundice) related to (lack of feedings) as evidenced by (mothers large breasts and flat nipples).
And why can’t the diagnosis be written up as the problem {jaundice} as evidenced by {elevated bilirubin levels} and {sallow skin tones}? Why does the write-up of a diagnosis need to have a cause involved?
When a mom comes in with placenta previa, do you write the problem {placenta previa} related to {some crap you just made up because it’s one of those bad luck things} as evidenced by {placenta is covering the cervix}?
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Details Reply:
December 1st, 2011 at 5:23 am (Quote)
And you know they would never write up placenta previa caused by previous c-section as evidenced by adherance to the previous c-section scar. Unless they could also write told this mother to never get pregnant again and she didn’t listen.
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Kim Reply:
December 1st, 2011 at 11:41 am (Quote)
Jane,
To write up a diagnosis you have to have a problem, what it is related to and what it is evidenced by.. unless it is a risk.. if you are at risk for something you do not have an as evidenced by, because you can not have evidence of something without actually having it. Such as Risk for infection, related to open sore on right great toe ( now you cannot have evidence of infection such as elevated fever, red borders, puss.. without having infection.) Because you wouldn’t have all those things without not having an infection. Once you have those symptoms your diagnosis changes to infection related to open sore on great toe as evidenced by purrulent drainage, fever… Hope that makes sense. Now your diagnosis could work jaundice R/T elevated bili levels AEB skin tones.. but in this case we do not know if baby had blood drawn. The diagnosis given was “Jaundiced due to lack of feedings, mother’s very large breasts and flat nipples.” So maybe this doc was just going by the fact that baby was very orange. You never know all the details with these comments.
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Details Reply:
December 1st, 2011 at 12:51 pm (Quote)
Apparently you didn’t bother to check for a pink link before you shot off your mouth.
“She(the baby)ended up getting phototherapy and the entire 12 hours she was in there they would forget to feed her!!!”
So explain to me how it was the fault of the mother’s breasts if the NICU forgot to either feed the baby or bring her to the mother to feed? Alrighty then, You can shut up now Miss Medical billing expert. The eyewitness says the Ped was a nightmare. Therefor the ped was a nightmare!
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Kim Reply:
December 1st, 2011 at 7:01 pm (Quote)
Details,
You must really have such a cold and hard life that you feel you need to be such a snot. I NEVER said it was the mothers fault, sometimes things happen that are out of your control. I was just explaining the rational for the statement from the medical point of view. I will now take my smart a$$ billing expert a$$ to another discussion, since you cannot have an open and non confrontational one. Discussion with you over.
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Details Reply:
December 2nd, 2011 at 5:07 am (Quote)
Fine with me, but you still never explained how it was the mother’s fault that the child was under phototherapy and not being fed.
The point of this site is to lambast the BAD medical staff. If you come back on Thursday you will see that we love our good medical staff. And we freely admit that there are more good ones than bad one. And you know something the good ones can come here and not feel threatened because they recognize the difference between themselves and some of their really horrible co-works. so they don’t take it personally. I get that you wanted to explain how the wording came about. And if you read another of my posts on this thread (befoe the pink link got posted) I agreed with you that if it wasn’t said to the mother, but just written down (and I meant in a place the mother wasn’t likly to see it) that the mother should get too bent out of shape. But once that pink link came and we learned that 1) this wasn’t the only horrid thing this ped did and 2) that the nurses were not making sure the baby got fed, then it became a whole other story. And that is when you should have stopped justifying questionable paperwork and told the OP how sorry you were that she went through all that. That is the purpose of this site: it isn’t to be fair to the good doctors. It is to lambast the bad ones and tell the various OP’s that they are totally justified in feeling like they have been run over by a train.
For the record I don’t have a cold heart. I’m actually extremely empathetic, and I feel these mothers’ pain when they are treated like shit. And I don’t like you telling us that it is okay for the doctor to do so because it makes the paperwork happy.
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Sheva Reply:
November 30th, 2011 at 9:01 am (Quote)
A baby’s ‘lack of feedings’ cannot be ‘evidenced by’ the shape and size of the mother’s breasts or nipples. The evidence of ‘lack of feedings’ would have to be poor weight gain, lethargy, or some other symptom in the child.
You would never write in an older child’s notes that the child’s fever is evidenced by mother not hydrating sufficiently, or patient is experiencing back pains as evidenced by husband’s refusal to massage her. That’s not evidence.
And it can’t hurt to mention that, quite possibly, the fact that the nurses don’t allow the mother to room in, or are refusing to bring the baby to the mother more often than ever 3 hours, can be affecting the baby’s jaundice, because we all know that babies don’t get hungry more often than the magical three hours, and if they cry, it means they’re spoiled.
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maybe they could describe “lack of feedings” a little better…. like “mother refused to nurse on demand” or “nursed every 3 hours as the OB/pedi told her was appropriate”
my daughter was jaundiced, dangerously so, and it wasnt “lack of feedings” on my part, i tried to nurse her every 10 minutes around the clock… but she was so bad off that she would fall asleep after a single swallow then wake up 10 minutes later, (lather rinse repeat)
i do understand how flat nipples could cause a problem, but small/large shouldnt be much of an issue! the only thing i’ve heard that makes sense is that women with larger breasts often find more use out of the football hold than mothers with smaller breasts.
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Rebecca Reply:
November 30th, 2011 at 6:12 am (Quote)
That might be the exact issue. The nursing staff (save one nurse) where I delivered my daughter only wanted me to nurse cradle or cross cradle. No side-lying (which was easeiest for me and my son) or football (which ended up being my daughter’s preference)
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Ashley Bean had this to say,
Nov 29, 2011 @ 7:41 pm (Quote)
My son was very jaundiced. To the point that they wanted to readmit him to the hospital if his levels went up at all. I have large flat nipples, and was neither of us were getting the hang of breastfeeding right away. thankfully, my son’s pediatrician was the opposit and was VERY supportive. She kept pushing me to feed more and he’d get the hang of it, flat nipples or not. Amazing how a lil encouragement goes a long way there doc!!
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Then how about we amend it the ” lack of feedings, mother’s very large breasts and flat nipples” part to read “lack of adequate breastfeeding advice and support” since all of these issues could have been addressed by a qualified lactation consultant?
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This was mine!!! And no, this ped definately did NOT observe me while breastfeeding!! My ugly nurse told her!!Basically my BP was through the roof the night my water broke because my job was stressing me waaaayy tooo much,and the placenta broke away just enough that after 19 hours of labor they decided to section me.The team in the ER was excellent,the man that held my hands while they did the spinal was awesome,everything after that SUCKED!!!!! I nursed her right away in recovery while I was still numb,she latched on right away.She nursed fine throughout the night.However when I woke up the next day I was so swollen and full of fluids I had a hard time getting her to latch and couldnt find a good position to nurse(im a H cup so I had to hold my boob in order to not suffocate her)I BEGGED for a nipple sheild,but they told me they were supposedly all out. She ended up getting phototherapy and the entire 12 hours she was in there they would forget to feed her!!! I was livid!! And then after all that the day she was released this nightmare ped hands me this piece of paper and says here give this to your ped.I read it and hid it from my BF,cuz I knew he would blow his stack.At her 1st appointment our ped said ha and basically said this ped was a dummy =)
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Or maybe from the pitocin,or the vacuum/forceps, or maybe it was the cesarean? Whatever the case, I’m sure it’s HER fault!
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