baby friendly questions - page 5
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... Read More
Aug 31, '11 by suezan59Our hospital is currently in the process of going baby friendly (we have about 6 weeks before they close our newborn nursery) and most of the staff is pretty upset about it. Not that we aren't already supportive of breastfeeding and rooming-in, but we just feel like our concerns aren't being listened to (dropped, smothered babies; exhausted moms who desperately need a few hours of uninterrupted sleep; spitty, gaggy babies whose parents are too terrified to sleep, etc...).
One thing that no one will address for us is why we have to get rid of the nursery - from what criteria we found online, you only have to "allow" moms to keep the baby in the room 24/7, not that you can't have a nursery! I think that what management really wants is for the nurses to do more "procedures" (hearing screens, blood work, weights) in the room, since those are the main reasons our babies go to the nursery, but too many of our nurses are "old school" and resistant to it (some even take the babies to the nursery just to get vitals!!). If we could get these nurses to do all of it in the room (and all the peds to see the babies in the room), we would have a higher percentage of "rooming-in" babies, be able to keep our nursery AND be "baby friendly" (and yes, several months ago they collected data on how many babies went to the nursery for ANY reason and the percentage was too high to get "baby friendly" status).
I feel like all of us (and the new moms!!) are being "punished" because a handful of staff is resistant to change - it's like management is too afraid (or too lazy!) to hold these nurses accountable for adhering to new policies and they are taking the easy way out by just getting rid of the nursery and saying "there, problem solved, now they HAVE to do it".
The most upsetting thing is that we seem to be making these changes just to get a certification - not because moms want it, not because the community wants it, not even to necessarily increase our rate of breastfeeding moms (which, being a night-shifter, I think this will hurt our rates. That exhausted mom who simply can't cope with her cluster-feeding baby's demands at 3 in the morning any more and asks for a bottle, I can usually persuade to forgo the bottle in favor an hour break from the baby - mom needs a break and some support, not a bottle! Now that option is being taken away). We're doing it because we have a new clinical director and his old hospital was baby friendly and he wants the certification here, too. Period.
Did I mention that our first "change" was to put ALL babies to the breast immediately after birth? Not just skin-to-skin, but actually latched on - even with the moms who are bottle feeding and absolutely do NOT want to breastfeed. Oh, and this is without asking and getting mom's consent first...
Apr 14, '12 by jeriksmoenI am a nursing student six weeks from graduation, and the hospital I am doing my OB rotation at is baby-friendly overboard. They go so far as to discipline a nurse who provides formula, or even a breast pump, without a physician's order. If the baby can't latch-on, the mother is supposed to manually express her milk and "cup-feed" the baby -- no mention is made of what to do if the milk hasn't come down all the way to the nipple...
Apr 15, '12 by anurseatlastQuote from jeriksmoenActually, having a mom hand express colostrum and spoon- or cup-feeding it to the baby is an appropriate intervention if the baby is not yet able to latch. There are many advantages to the baby receiving colostrum as early as possible (and for the mom to express or nurse ASAP after birth) and amazingly, newborns often do well with spoon- or cup-feeding which can help to maintain their blood glucose. Your comment about "milk hasn't come down all the way to the nipple" shows lack of understanding about breastfeeding. I am not saying this to be critical - most nurses get very little education about the importance and process of breastfeeding in nursing school. (or many other important topics for that matter - they can only cram a certain amount of information in!) If you will be working with women or young families, please take time to learn more so that you can provide up-to-date information. There are a lot of great resources on the internet: Academy of Breastfeeding Medicine (primarily for docs but others can access it), CDC, American Academy Of Pediatrics, to name a few, have accurate information. There are many great topics with which to start (and right now your priority is to finish school and pass NCLEX but someday you will have free time again!) but perhaps researching why it is important not to give even one bottle without clear medical need would be an interesting place to start.I am a nursing student six weeks from graduation, and the hospital I am doing my OB rotation at is baby-friendly overboard. They go so far as to discipline a nurse who provides formula, or even a breast pump, without a physician's order. If the baby can't latch-on, the mother is supposed to manually express her milk and "cup-feed" the baby -- no mention is made of what to do if the milk hasn't come down all the way to the nipple...
Congrats on being almost DONE with nursing school. Soon you will have your license in your hand!
Apr 15, '12 by melmarie23We've been Baby Friendly for a few years now and our unit gets rave reviews. Its not militant like some of the pictures/scenarios that are being painted here.
We have great breastfeeding rates. Most parents love the fact that we encourage rooming in-as we find most do not want to be separated from their baby anyway. This also goes for our formula feeding couplets (because yes, contrary to popular belief, we do support that too!). Vitals, weights, immunizations and some lab work are done in room (mostly Istats for glucose readings and metabolic screens). If the baby requires more extensive lab work, such as samples needed by venous draw, they go to the nursery. Pediatricians round on the baby in the room...not the nursery. We also encourage dad or another family member to also room in to help mom with baby care, so mom can get those few precious hours of sleep.
With regard to our nursery is not a well baby nursery, its special care. So no, we do not routinely keep babies in here for mom to nap/get some sleep. Right now, our unit is inundated with LPIs, NAS and feeder-growers. If a mom really wants her baby to come to the nursery, we bring them to the nurses station where if there is a LNA/PCT, secretary or a RN with a free moment, they will will snuggle the babe for a little. But this is not standard protocol.
Our nursing staff is all trained in breastfeeding support. Most OBs and Pediatricians are too. We have Lactation consultants on the unit 7 days a week...mostly day shift. We have one LC who occasionally moonlights at night, and we're entertaining regularly scheduling a LC for night.
We encourage skin to skin immediately after birth, or soon there after, if the baby needs to be assessed and attended to right away. Usually, within a half hour to hour, the baby will show interest in the breast. So we try and get the breast feeding baby (one where mom has indicated that that is how she wants to feed her child) onto the breast within that first hour.
We do not give pacifiers to breastfeeding couplets, unless the baby is pre-term. However, we do not discourage parents from using their own that they've brought in on their own. We will give pacis to formula fed babies if parents ask for it.
We do not supplement breastfeed babies unless there is a medical need (or unless there is a maternal request-as we also do so in this case). However, we first entertain supplementing with mom's own milk that she has expressed, then we offer human donor milk, and then formula. In that order. The final decision is always left up to the parents and we do not coerce them into one method vs. another. That is not our ob. What our job is however, to support them in whichever decision that they make. And if they are undecided, that we provide them accurate information so that they can make an informed decision.
All of what I describe is in our written breastfeeding policy, which is another BFHI requirement.
I realize that I may be a bit biased, but I think that BFHI is great and the way our unit is run is great. And there is a right and wrong way to approach this. What I suggest for those units looking to go Baby Friendly is visit/be in contact with another unit who is and ask them about their process and unit culture and see if they can get help and advice on how to move forward.
Apr 16, '12 by beachmomI know of a 12 pound baby, exclusively breastfed, great latch, plenty of time on the breast. But he was large and needed more than mom was able to give. By the time her milk came in, baby was badly dehydrated, ended up in NICU with renal failure, almost died. That doesn't sound very baby friendly to me. Baby went home from the hospital the first time with a good mom and dad and a grandma who is a midwife. Even the midwife didn't catch the problem until baby was critical.
Traditionally a new mom had her mom and maybe some aunts or friends present at and after the birth. She got rest while other women took care of baby. Now we allow one person to spend the night (usually dad, who may never have even held a baby before). And we require an exhausted, painful woman to take total care of a fussy spitty baby. That's not very baby friendly or mommy friendly either.
I like where I work. Sending baby to nursery at night is given as an option. Breast feeding is strongly encouraged and supported, but moms are not made to feel any guilt if they want a bottle.
All our Mexican moms breastfeed and bottle feed. We joke sometimes that only white babies get nipple confusion.
Apr 16, '12 by Elvish, BSN, RN GuideQuote from beachmomThis is what makes me the angriest. It doesn't even have to be a 12-pound baby. If I have a baby who lives at the breast and has a great latch but is jaundiced and has inappropriate urine/stool output along with a >10% weight loss and dry mucus membranes, that is a pretty clear cut case for temporary supplementation. So I have a mom who has done everything right (Baby too, for that matter), but her baby clearly has a need for more than what she is producing at the time. Give her the option to supplement (heck, even have a damn pediatrician order for it!) and use the SNS, and still get read the riot act for supplementation. I can get over the insult to myself. What is unconscionable is that now this tired, sore, hormonal postpartum mother gets made to feel like she is a monster for trying to feed her hungry, dehydrated baby! Ugh.I know of a 12 pound baby, exclusively breastfed, great latch, plenty of time on the breast. But he was large and needed more than mom was able to give. By the time her milk came in, baby was badly dehydrated, ended up in NICU with renal failure, almost died. That doesn't sound very baby friendly to me. Baby went home from the hospital the first time with a good mom and dad and a grandma who is a midwife. Even the midwife didn't catch the problem until baby was critical.
Don't get me wrong, this is not an across-the-board slam at lactation consultants (I'm obtaining my CERPS to sit for the IBCLC exam) nor at the BFHI. I agree there is a right way and a wrong way, and the above anecdotes are clearly the wrong way to do this.
I am in complete support of breastfeeding and in favor of societal changes that make it easier for babies to get their moms' breastmilk when and where they need it. However, I also strongly believe that women should breastfeed because they want its many benefits for themselves and their babies, not because they are guilted into it by hospital personnel.
Apr 26, '12 by dreamworx07Many things you have said sound familiar to our facility also. We are being asked to have our mothers sign this huge waiver if they choose NOT to breastfeed. The wording is ugly and makes those that want to bottle feed-feel like they are harming their babies. I am an advocate for breast feeding but it's not for everyone!
I am all for skin to skin, bonding, breastfeeding...I really feel that "doing away with nurseries" is a financial measure, pure and simple. Sorry but leaving a newborn at the nurse's station...for whoever" to keep an eye on baby" BAD IDEA. If something like a choking incident were to occur-is the unit secretary expected to intervene? I worked nursery for years, and trust me, there was always plenty to do. What happens to babies who are up for adoption-or on DYFS holds. Where do they go? Is ins charged a larger amount, because there is no nursery..and they must go to special care or NICU. Are all rooms private, and are family members aware, in advance of delivery, that they are expected to stay with mom, and assist her with baby?
ONE final question...WHAT EVER HAPPENED TO THE PATIENT BILL OF RIGHTS??
Apr 29, '12 by JolieQuote from anurseatlastSo please offer suggestions as to how to assist a mother in this situation who is unable to express colostrum (either by hand or pump), keeping in mind that most hospitals do not offer DBM, and some parents prefer not to use it, even if available.Actually, having a mom hand express colostrum and spoon- or cup-feeding it to the baby is an appropriate intervention if the baby is not yet able to latch. There are many advantages to the baby receiving colostrum as early as possible (and for the mom to express or nurse ASAP after birth) and amazingly, newborns often do well with spoon- or cup-feeding which can help to maintain their blood glucose. Your comment about "milk hasn't come down all the way to the nipple" shows lack of understanding about breastfeeding.!
Apr 29, '12 by melmarie23Quote from dscrnBUFA's and DCYF holds become "nursery" babies and thus into our special care nursery (as its our only nursery). Yes, all our rooms are private and yes, parents are told this in advance and that we encourage 24/7 rooming in. This info is made available to them on our website, during tours and during our childbirth classes.\ What happens to babies who are up for adoption-or on DYFS holds. Where do they go? Is ins charged a larger amount, because there is no nursery..and they must go to special care or NICU. Are all rooms private, and are family members aware, in advance of delivery, that they are expected to stay with mom, and assist her with baby?
We rarely get complaints over our rooming in policy. And we only occasionally have babies that are sent out by request of the parents. Most want their babies to room in.
Change isnt easy, and I get that. Something that works differently than what one is used to...its hard to envision the logistics. I get why some might be resistant to it, but the only way to know if it wil work is to try it out and work out the kinks as they arise.
Change is not easy...I think that the success of this program depends in large part to the sector of people that the hospital serves. And yet, there are still a fair amount of patients who expect to get some rest in the hospital who expect and need to get rest in the hospital...those who do not have family near by to assist, or who have many children at home to care for-and I feel that their needs should not be overlooked...When all is said and done, this trend all comes down to saving money for the hospital..
Apr 29, '12 by melmarie23There are lots of ways to encourage rest that do not necessiarly result in removing baby from the room. Limit visitorsand instill a unit "quiet time." Encourage mom to sleep when baby sleeps (because lets be honest here...most healthy babes sleep quite often, espeically in that first day). Cluster your care. Keep mom comfortable and medicated for her pain. Ensure babies are feeding adequately (however it may be...via breast or bottle). So on so forth.
...some Moms WANT to send baby out of room for a spell-what about their request? I still feel that too much guilt is being laid on..