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What Should We Do?

Heelsticks during breastfeeding

by Dennis Ernst • November 01, 2019


Dear Center for Phlebotomy Education:

At our facility, the OB staff wants to keep mothers and babies together as much as possible, especially in the first five days. So our phlebotomists are being asked to perform heel sticks while the baby is nursing, not take them away from the mother and into the nursery for the draw. They say is also helps with pain management. I'm not opposed to this, but some of our male phlebotomists are uncomfortable with it. I'm also concerned about the choking risk. What should we do?

My response:

Many studies have found that a nursing baby feels significantly less pain during a heelstick than non-nursing infants. The standards don't advise against it, so you should consider working with the nursing staff in this regard and facilitating the bonding experience that is so important between the mother and her newborn.

Studies show the pain-reduction benefits of oral sweeteners like sucrose and dextrose to be equivalent to breastfeeding as a pain reduction strategy. You might want to consider this approach if a compromise is necessary. You may also consider using a combination of cold and vibration as a pain reduction strategy. The scientific literature contains many studies confirming the effectiveness of devices that employ this technique like the Buzzy.

Aside from that, there are positioning issues that have to be addressed when drawing from an infant that is nursing. Remember, it's always important to maintain the infant’s heel in a downward position if you want the draw to go smoothly and quickly. If the baby is being cradled in a horizontal position, the flow of blood is less than if the foot is below the plane of the heart and will make the collection difficult. But if the baby is positioned in such a way that the legs are lower than the heart, the flow of blood through the feet will be greater.

As for the male phlebotomists being uncomfortable with the scenario, perhaps it might be prudent to send only female phlebotomists to draw nursing babies. A light blanket draped over the feeding child and breast is likely to make your male phlebotomists and the nursing mother form comfortable. Keep in mind there may also be a cultural taboo for the mother to have a male phlebotomist while she is nursing.

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