baby friendly questions - page 7

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

  1. Visit  melmarie23 profile page
    0
    Quote from Queen2u
    YES!!!! I agree Elvish! It seems to me like night nurses are lactation consultants, nurses, techs/CNAs, sometimes secretaries, and at times we are short and don't even have a charge nurse! At that point, baby friendly and all the time consuming things it requires goes out the window!!!
    then I think that should your hospital wish to go Baby Friendly, they first need to address the staffing issues.

    We are 3 (couplets):1 on nights at my facility. We have a unit secretary on, 2 LNAs and on average 8-9 RNs (one charge) with at least one RN on call ready to come in.

    (if it helps, we are a 20 bed LDRP, with a special care nursery and a 3 bed triage. We average 100-110births a month).

    Its a lot of work, but on nights I certainly have the time to help patients with hand expression and/or other interventions to help facilitate breastfeeding.
  2. Visit  melmarie23 profile page
    0
    Quote from carrie_c

    And while I agree that breastfeeding is best, I also believe there are times when a baby should also be supplemented. High weight loss, dehydration, low blood sugars, etc. These babies need a supplement. Also, I had a baby last night who wanted to nurse constantly. She would latch well, and eat for hours. Yet she was still very fussy and acting very hungry, despite all the feeding. She obviously wasn't getting enough to eat. What do you suggest in these situations? Mom cannot breastfeed her 24 hours a day. The Mom was exhausted, and ask for a supplement. After the baby took it, she went to sleep, and didn't fuss for the rest of the night. She was obviously starving.
    are you sure the baby was actually hungry, or perhaps they just wanted to pacify?

    also why does supplementation necessarily mean formula? Why can't it first be mom's own (expressed milk), or donor milk? THere are other means of supplementation before formula needs to be used.
  3. Visit  melmarie23 profile page
    0
    Also, I disagee that the babe in your example was "clearly starving." Its more work on the stomach and gut to digest formula (as opposed to breastmilk) and the reason they slept for hrs after the formula supplement could very well have been due to the fact that the babe was so exausted from the energy expended during digestion.
  4. Visit  Elvish profile page
    0
    Quote from melmarie23
    then I think that should your hospital wish to go Baby Friendly, they first need to address the staffing issues.
    Yes, I agree completely. My coworkers and I have begged them for more staff. However, with admin pushing our management to cut costs, it doesn't look likely.

    I am curious. How do you supplement with donor milk when there is no milk bank in your facility or anywhere close by? I suppose private donors are an option, but it opens a hospital up to an enormous amount of liability. (That's not to say I agree that it should, just looking at it from risk management's eyes.)
  5. Visit  mshessle profile page
    1
    Breastfeeding has been taken to the extreme. People need to think about what is really important for baby and mom. Is it really better to allow a baby to starve and scream all day when mom is not getting anything when pumping and baby won't latch? I feel like that would have worse effects on baby and mom than temporary supplementation.
    Twinmom06 likes this.
  6. Visit  Marymoomoo profile page
    2
    Quote from Elvish
    Oh, to have the time to be able to do all the above.

    It was mandatory for us a few years ago to watch the hand expression and spoon feeding videos and it's all great information. This is where 'bad implementation' comes in. Teaching and reinforcing that kind of thing is impossible timewise with the staffing ratios we have (4:1, sometimes 5:1). On nights we have no techs and no lactation help, so whatever interventions there are - it's on the nurses. And that's a load to carry.

    That's not saying I don't appreciate the information. That's saying, I wish I had time to actually put what I know into practice.
    All you, Fyrelie, and Queen2u have said sounds familiar. Unfortunately, low staffing makes it difficult to really meet moms where they are at. Even worse, many moms leave the hospital with little or no information, conflicting information, or difficult-to-maintain solutions to temporary problems that makes them want to give up.

    Baby Friendly is a wonderful program for mothers, babies, and hospitals. Though, I believe the implementation by the majority of bean counters (who make staffing ratios) don't seem to take into consideration that what makes BF successful is patient education. If you don't have time to sit down and work with your patient, or if the IBCLCs on staff or so overwhelmed that they only have a few minutes with each mother/baby pair, that simply isn't effective. It's quite the opposite, really. Patient ratios matter.

    I wish you all had the time to assist your patients as you desire and as they deserve.
    melmarie23 and Elvish like this.
  7. Visit  melmarie23 profile page
    0
    Quote from Elvish
    Yes, I agree completely. My coworkers and I have begged them for more staff. However, with admin pushing our management to cut costs, it doesn't look likely. I am curious. How do you supplement with donor milk when there is no milk bank in your facility or anywhere close by? I suppose private donors are an option, but it opens a hospital up to an enormous amount of liability. (That's not to say I agree that it should, just looking at it from risk management's eyes.)
    We do have a milk bank. Its regional of course (greater new england milk bank) and our docs write scripts for the pts so they can access it.Of course, cost is an issue for some, so they have to determine whether thats is one they are willing to burden upon discharge.But while admitted, the cost is included in their stay, should they wish to supplement in that manner.And not for nothing, supplementation in the breastfed infant, no matter the mode, should be temporary until her supply is established, the babe gaining the appropriate weight, jaundice rectified etc.(and also equally important is keeping her breasts stimulated each time a supplemental feed is given).
  8. Visit  Marymoomoo profile page
    1
    Quote from carrie_c
    Marymoomoo, I appreciate all of your information. I do know the differences between formula and breast milk. I know that breastfeeding is best, and I support all Moms who want to do it. Yes, I do keep the babies skin to skin with Mom. The main problem I have is babies who won't wake up. They will scream in their cribs, but as soon as they are put to breast, they fall asleep and refuse to wake up. I do believe a main problem is all the elective inductions and c sections.
    I appreciate that you responded, and shared some of the problems you're seeing with your patients. I'm happy we're able to share information this way.

    I find it helpful to think about breastfeeding as normal. After all, breastfeeding really is not best, it's just the natural food for human infants. Lactation is the culmination of the reproductive cycle; it happens whether or not we intend to breastfeed. Breastfeeding moms and babies are just mammals, doing what mammals do.

    You are right about birth interventions sometimes causing breastfeeding issues. Keeping mom and baby together after birth (in kangaroo care) as much as possible after birth can really help mitigate a lot of the disparities they may face. If mom is unable to kangaroo baby, dad or grandma, or someone else may be able to take her place temporarily until mom is feeling up to it.

    Newborns want to be with their mothers, and the response you're describing is quite normal. When newborns are put in a crib alone, they exhibit what is known as the protest-despair response which involves crying, distress calls, release of stress hormones, and hypothermia. When placed back with mom, it's normal for a stressed newborn to go right to sleep. They know mom is their natural habitat. LMK if you'd like to see some research on this topic.

    If baby isn't roused after having time to rest and bring stress hormones back down, then she can try hand expressing colostrum and spoon feeding. Sometimes babies just need a little jolt of energy, or even the reminder that there is food available to eat.

    Quote from carrie_c
    And while I agree that breastfeeding is best, I also believe there are times when a baby should also be supplemented. High weight loss, dehydration, low blood sugars, etc. These babies need a supplement. Also, I had a baby last night who wanted to nurse constantly. She would latch well, and eat for hours. Yet she was still very fussy and acting very hungry, despite all the feeding. She obviously wasn't getting enough to eat. What do you suggest in these situations? Mom cannot breastfeed her 24 hours a day. The Mom was exhausted, and ask for a supplement. After the baby took it, she went to sleep, and didn't fuss for the rest of the night. She was obviously starving.
    Frequent breastfeeding alone isn't an indicator for supplementation (please see the Academy of Breastfeeding Medicine protocol I posted earlier for the details and when to/not supplement). If the baby you're describing was transferring colostrum, she wasn't starving. Was she wetting diapers? Did she have a bm? The 2nd day after birth (usually the 2nd night after birth!), newborns will often "wake up" and want to breastfeed very frequently. It's normal, so long as the baby is transferring colostrum. If the baby is nursing "all the time" and is agitated, not voiding/bming, obviously struggling...then something else is going on. In that case, the mom would ideally be shown how to hand express and supplement feeds with colostrum and both mom and baby should be evaluated by the IBCLC as soon as possible.
    melmarie23 likes this.
  9. Visit  Marymoomoo profile page
    1
    Quote from ToughingItOut
    All I know is that they're taking away our FREE formula and pacifiers...and we're already a broke, public hospital. :/
    I'm sure that is difficult for your hospital.

    Unfortunately, "free" formula isn't really free. Everyone who has to buy it (including taxpayers) pays for all the freebies, coupons, swag and marketing. The difference between the cost of producing formula and the wholesale cost is incredible (that says nothing of the cost to parents who are paying for it outright).
    melmarie23 likes this.
  10. Visit  Marymoomoo profile page
    1
    Quote from RedhairedNurse2Be
    I don't not agree with getting rid of the formula samples or coupons to new moms. The way I look at it is if a mom is determined to breastfeed she will regardless, and a coupon is not going to change that. All this does it takes away samples from those who need it.
    Why does any mom need samples, especially from the hospital, their OB, their pediatrician, etc? Shouldn't physicians and hospitals market health? Why should they be the marketing vehicle for multi billion dollar companies that can more than afford to do their own marketing?

    If a mother cannot afford formula, I would strongly encourage a referral to WIC (in the USA). Additionally, many food banks offer assistance in funding infant foods for families who do not qualify for WIC or SNAP (in other words, families that make too much money for government food assistance, but not enough to meet their needs). Mothers should know that they can sign up for sample programs themselves by going to the website of the formula of their choice. All of the three main manufacturers in the USA offer "clubs" for parents that include swag, samples, and regular mailings of coupons and formula checks. Preventing marketing in the hospital doesn't prevent parents from getting samples on their own. All they have to do is ask.
    melmarie23 likes this.
  11. Visit  melmarie23 profile page
    0
    I just realized that I had a reading comprehension fail. Sorry Elvish. (I'll blame my current state and say it was placenta brain, hehe). You were saying that you did not have a milk bank close by. Ours isnt local really either...its about an hour away, so we have it shipped up. I wish that donor milk was easier accessable to all.

    Its a large case to tackle, but there are many benefits, with regard to long term health of our population, to provide our patients these options & services. But all too often it comes down to the almighty dollar, which is unfortunate.
  12. Visit  carrie_c profile page
    0
    Quote from melmarie23
    then I think that should your hospital wish to go Baby Friendly, they first need to address the staffing issues.

    We are 3 (couplets):1 on nights at my facility. We have a unit secretary on, 2 LNAs and on average 8-9 RNs (one charge) with at least one RN on call ready to come in.

    (if it helps, we are a 20 bed LDRP, with a special care nursery and a 3 bed triage. We average 100-110births a month).

    Its a lot of work, but on nights I certainly have the time to help patients with hand expression and/or other interventions to help facilitate breastfeeding.
    I am glad that you have time to help so much with breastfeeding, but it is not possible for me to spend that much time. We are 4:1 on my floor. We have techs, but they are usually helping with deliveries. They do very little for postpartum. Our patients stay in one room for labor/delivery/postpartum, everything. (Except sections of course). We are the only hospital around where they stay in one room for everything, so naturally everyone wants to have their babies at my hospital. We average about 300 births a month. We do not have lactation all night. If we are lucky, we have them till 11 pm. We are not classified as 'baby friendly' but the LCs want us to be. But I doubt it will happen because they would really have to do something about staffing. I support breastfeeding 100%, and I feel really bad when I can't help. 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.
  13. Visit  Elvish profile page
    0
    Quote from melmarie23
    I just realized that I had a reading comprehension fail. Sorry Elvish. (I'll blame my current state and say it was placenta brain, hehe). You were saying that you did not have a milk bank close by. Ours isnt local really either...its about an hour away, so we have it shipped up. I wish that donor milk was easier accessable to all.

    Its a large case to tackle, but there are many benefits, with regard to long term health of our population, to provide our patients these options & services. But all too often it comes down to the almighty dollar, which is unfortunate.
    Ah, no worries, mel. We actually do have close access to a milk bank so donor milk is not a problem for my facility, so you read well. I was actually asking more on behalf of others who might have the same question and have no access to a milk bank.

    You are right, though. Too much is about the cash, and it is the babies who end up on the short end of the deal.

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