baby friendly questions - page 6

by Rhee 20,809 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 rn/writer
    While that is the ideal, it may not be feasible for families with other children who don't have close friends or relatives able to help them out. If there is no one to take those kids, dad goes home with them and mom is on her own with the new baby. And, too, there are far too many women (some just girls really) who either do not have a committed partner or whose partner won't be staying overnight with them.

    As for the baby-dropping and baby-squishing, a mom doesn't need narcs to arrive at a state where she no longer remembers her own name. Some of these moms labored for two+ days before delivering. And there are plenty of them who haven't slept comfortably for several weeks before the birth. Add to that the rush of visitors that insist they must see the baby right away before it goes home, and you can end up with a woman who feels drugged even if she isn't.

    I just can't see telling any mom she has to keep the baby in her room. That smacks of the same harshness and disrespect that occurred years ago when moms were told they had to leave the babies in the nursery. Neither extreme is right for everyone. And neither edict should be coming from the nurses on the unit.

    It makes me really sad to hear about hospitals deliberately eliminating nurseries so that moms will have to have their babies room in. That just doesn't take care of everyone effectively. And it's a dirty trick to play on women who didn't think to ask ahead of time if they'll be able to catch a couple of hours of uninterrupted sleep before they go home.

    It's a terrible thing to do to nurses, too. I've heard many of them say they'd be more than willing to give the mom a break except that they have no place to put the baby and no one to watch it.

    Do we really have to handle things this way? Or can we be halfway reasonable, provide the proper resources, and trust moms to do what is right for themselves and their babies?
    Well said......
    sharpeimom likes this.
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    I am a Doula with a nursing background; and not a radical Doula. I respect medical and nursing staffs when I am in the hospitals and I do not confront them regarding medical decisions; although I know there are some bad ones out there that do. I find this discussion about Baby-Friendly Hospitals interesting. Some of the posters seem to feel that mothers should be educated and have "choices". That's fine, but it seems a little funny to me. The hospitals that I work at, do not provide FULL informed consent when it comes to Pitocin, epidurals, etc. They provide only partial information, and dismiss the seriousness of any possible side effects to mother or baby. They most certainly do not disclose how often those interventions result in C-Sections. They routinely start IV's, run Pitocin and offer epidurals; unless the mother specifically says that she does not want them. They also do not promote breastfeeding, automatically give the babies pacifiers and do not call in an LC, unless requested by the mother. Are these mothers being given "choices"? NO!
    The Center for Disease Control and Prevention and the World Health Organization are beyond the BFHI; because its practices are BEST for babies. According the the CDC the majority of hospitals around the county, not just here, do not encourage breastfeeding, use drugs during labor and delivery that affect breastfeeding and routinely give pacifiers, which also affects breastfeeding. I have given birth myself; one labor was 29 hours with an OP baby, I know how exhausing it is. I am all for babies going to the nursery if mom needs to sleep after delivery; with the baby being brought to her for breastfeeding - but not being given a bottle because the nurse didn't want to wake her. Many routine medical practices are not evidenced-based and are not what is best for babies and mothers. We need to re-evaluate our birth practices.
    melmarie23 likes this.
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    Our 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...
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    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...
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    Quote from jeriksmoen
    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...
    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. 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.

    Congrats on being almost DONE with nursing school. Soon you will have your license in your hand!
    melmarie23 likes this.
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    We'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.
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    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.

    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.
  8. 0
    Quote from beachmom
    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.
    This 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.

    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.
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    Many 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!
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    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??


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