baby friendly questions - page 11

by Rhee

20,435 Views | 109 Comments

The hospital that I work at is in the process of becoming baby friendly, and I have some questions about how the baby friendly initiative is implemented in other hospitals. I want to start by saying that I think that... Read More


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    Quote from carrie_c
    I always suggest to moms to pump when baby won't latch. The problem is a lot of times, moms can't even pump anything, or hand express. LCs are also another problem. They don't even want Moms to pump. They are against pumping. However, our policy is baby must eat within 7 hours. So I really don't know what the LCs expect us to do when baby won't latch. But I always take Mom a pump, even though I risk getting in trouble. But I would rather do that that offer formula.
    You clearly want to support your moms, but it sounds like your tools for doing so are limited, as well as the time frame you're given to work within.

    Pumping in the first 24-48 hours isn't bad per se. It may even be necessary if the baby isn't latching at all (combined with hand expression, of course). If possible, assure there are colostrum cups available (sits between the bottle and the breastshield fitting) since small quantities of colostrum can be lost in the bottle and pump assembly. I'm not sure why you're actively being discouraged from providing mothers with pumps when necessary. That's very confusing to me.

    As far as when to offer supplements goes, it appears that your facility is behind the times when it comes to evidence-based practice. From the Academy of Breastfeeding Medicine protocol on supplementation, when supplementation is "NOT indicated":
    "Careful attention to an infant’s early feeding cues, andgently rousing the infant to attempt breastfeeding every
    2–3 hours is more appropriate than automatic supplement after 6, 8, 12, or even 24 hours."
    Under recommendations: "Healthy newborns do not need supplemental feedings
    for poor feeding for the first 24–48 hours, but babies who
    are too sick to breastfeed or whose mothers are too sick
    to allow breastfeeding are likely to require supplemental feedings"
    Please see table 2 in the link for indications for supplementation.
    melmarie23 and Elvish like this.
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    I realize this is an old topic, but I was interested in seeing what had became of the situation.

    In the hospital where I had my daughters (4 years ago and 14 months ago) , I was simply asked if I was BF or formula feeding. I chose to formula feed for personal reasons that I wont go into detail about here. I was NEVER questioned, NEVER bullied, and NEVER made to feel bad for my choice.

    As far as sending the baby out at night, it was recommended. At ANY time that the newborn was in the room, one adult over the age of 18 MUST be awake and a light must be on. My husband and I were exhausted, I was post c-section both times (actually doing quite well ,but still sore, tired, and hormonal!) and needed our rest. The wonderful, kind nurses took my baby (babies lol) to the nursery and I was able to get rest and my baby was brought back to us in the morning as soon as we awoke.
    DizzyLizzyNurse and Twinmom06 like this.
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    Quote from calaab
    I realize this is an old topic, but I was interested in seeing what had became of the situation.

    In the hospital where I had my daughters (4 years ago and 14 months ago) , I was simply asked if I was BF or formula feeding. I chose to formula feed for personal reasons that I wont go into detail about here. I was NEVER questioned, NEVER bullied, and NEVER made to feel bad for my choice.

    As far as sending the baby out at night, it was recommended. At ANY time that the newborn was in the room, one adult over the age of 18 MUST be awake and a light must be on. My husband and I were exhausted, I was post c-section both times (actually doing quite well ,but still sore, tired, and hormonal!) and needed our rest. The wonderful, kind nurses took my baby (babies lol) to the nursery and I was able to get rest and my baby was brought back to us in the morning as soon as we awoke.
    Hah awake with the lights on? What do they think is going to happen when you go home? What a silly rule!
    klone likes this.
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    Sending babies to the nursery is not an all-or-nothing proposition. Many of our breastfeeding babies are what's called "out on demand," meaning that we keep them in the nursery until they start to rouse. Then they go out to mom for a feeding. And many times they come back to us afterward. This works the best with babies who have cluster fed prior to leaving Mom's room, but even if that isn't the case, sometimes just a couple of hours of sleep really help both Mom and baby do better.

    The question that should help keep everyone honest is, "Whose needs are the biggest priority?" If it's the administrators who are trying to squeeze every last buck out of the situation, that tells you where the babies and mamas rank.

    The other important consideration is that you really need to take a hard look at any LDRP or PP unit that ends up pitting moms, babies, and staff against each other when collaboration should be the rule of the day.

    Guilt is a poor choice for a motivational tool, especially when information and inspiration can accomplish so much more. The bottom line is that moms should do what works for them and their babies.
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    We are a "baby friendly" hospital...and I had a nurse tell me "it hasn't been an hour yet, take the baby back!" Well mom was tired, her delivery was HARD and this wasn't the first baby. I was yelled at because the nurse was angry mom wouldn't breast feed yet and didn't want skin to skin and at one point said "I don't care what mom wants, unless she wants to be a bad mom, but I guess that's what she wants" really?!?!?! I was ashamed for the nurse!
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    I agree that a woman using the nursery or choosing not to breast feed is entirely their choice.

    But I have come across many women who chose to bottle feed and most of them say "there is no difference between breast milk or formula, it doesn't matter".

    Yes... it does matter. It is our job as healthcare professionals to do the best that we possibly can to educate patients and sometimes you have to repeat things and use more direct wording for someone to get the point. Having someone read something about the benefits of breast feeding is a lot different than having them sign something saying "I understand that by not breast feeding, I am allowing my child to be more at risk for upper respratory infections, asthma, cancer, heart disease...".

    It may seem like you are "inducing guilt", you are not. The facts are the facts. If a mother chooses not to breast feed they must be completely aware of the effect of the decision that they are making. If she still says "No." then great, move on and help her find the best formula.

    I just think that people are not educated enough and sometimes are babied, not allowing them to understand the seriousness of their decisions.
    Marymoomoo, duckydot28, and LibraSunCNM like this.
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    We are going through getting baby friendly certification. The skin to skin initiative in my opinion is such a good thing---mom gets baby right away and she gets to see him/her the first hour before anyone else. Sometimes moms do great with sections and sometimes not...sometimes they do great delivering vaginally...sometimes not. Sometimes there is a significant other, and sometimes not. I feel like it's my job as a nurse to protect the mom and the baby. If mom is viciously puking and having nausea with terrible pain and no support person---yup, I'll help her with the baby. I'll hold the baby and feed him/her if requested AND take it to the nursery. I've had moms drop off their babies at the nursery to walk the unit....and we take them. I have seen a baby get a bottle feeding and go on to breastfeed without trouble---supporting a mom in the way that she needs us to doesn't mean she won't know what to do when she gets home and won't "get a break". It's our job to provide support the first few days, to help them on their feet. There was a baby dropped on the unit late last year...and I just recently was doing hourly rounds and found a mom sleeping with the baby---I had to gently wake up mom, take baby and offer to take baby to nursery bc she obviously needed rest (csection). If I get fired for that, fine. If I ever have to explain why I was fired, fine. I will say that once a mom says she wants to bottle feed, we let her bottle feed. An initial exchange is usually had about benefits of bfing, but then it is left alone as her choice and we SUPPORT her. We do not give out pacis, but if they bring them we do not harp on that decision as they ARE the parents.
    duckydot28 likes this.
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    The baby isn't the only one who needs care. Momma does too.

    And all that stuff about how babies shouldn't be separated from their mothers during the first few days is overblown. We went over this in psych...mothers used to be told that if they didn't immediately hold their babies within minutes after birth, they could not properly bond throughout their lifetime. When babies had to go the NICU, often their mothers assumed that their relationships would be tainted forever...and proceed to act that way toward their children. Later research revealed that parent-child bonding has almost nothing to do with being able to hold your baby immediately, but rather more on being a dedicated parent throughout the lifetime of the baby. And you can be a dedicated parent, and still take breaks to take care of yourself. Tsk tsk tsk.
    Elvish and Twinmom06 like this.
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    Quote from duckydot28
    The baby isn't the only one who needs care. Momma does too.

    And all that stuff about how babies shouldn't be separated from their mothers during the first few days is overblown. We went over this in psych...mothers used to be told that if they didn't immediately hold their babies within minutes after birth, they could not properly bond throughout their lifetime. When babies had to go the NICU, often their mothers assumed that their relationships would be tainted forever...and proceed to act that way toward their children. Later research revealed that parent-child bonding has almost nothing to do with being able to hold your baby immediately, but rather more on being a dedicated parent throughout the lifetime of the baby. And you can be a dedicated parent, and still take breaks to take care of yourself. Tsk tsk tsk.
    Are you aware that skin to skin isn't just for the mother, it's for the baby first and foremost? Skin to skin contact is an important part of an infants' early development. It makes a difference not just in the first few days, but in years to come! The positive outcomes are most pronounced in premature infants, but all babies need contact with their mothers (or a loving caregiver if mom is not able or available). Here's a report on a recent study you might be interested in.
    Loving touch critical for premature infants
  10. 0
    Breastfeeding success is greatly enhanced by immediate skin to skin and not separating the mom and baby postpartum. NOBODY is saying that if mom and baby are separated, it will create a lifelong inability to bond properly.

    My own personal experience - my first two children, I had immediate skin to skin and rooming in 24/7. I had an abundant milk supply (was able to donate milk) and breastfed them until they were 4. With my third child, he had to go to the NICU. I didn't get to hold him until he was 6 days old. We struggled through primary lactation failure, I had to supplement 1/2 his milk until he was taking in enough solids, and he weaned at 19 months. Coincidence? Who knows.


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