baby friendly questions - page 8

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
    2
    Quote from carrie_c
    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.
    I totally understand the issue you face, which is why I said that in order to truly go baby-friendly, properly staffing the unit also needs to be addressed. My response was not to minimize yours (or other's) struggle with breastfeeding support, but rather give insight on how my unit, a BFHI one, staffs. Because when you properly do so, there will, under most circumstances, be enough time for the RN to spend the at bedside to help mom and baby with whatever nursing issues that may arise. Handing them a pump, or giving formula, is essentially just a band aid. And just by the tone of your posts, you too understand that.
    Marymoomoo and Elvish like this.
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  3. Visit  carrie_c profile page
    0
    We do not have access to a milk bank. I don't even know where one is located in the US, and I never even heard of them till a few months ago. It would help so much if we had LCs all night. That is when the majority of breastfeeding issues happen. That is the main thing I don't like about my job.
  4. Visit  melmarie23 profile page
    1
    We dont staff LCs at nights either. Its the nursing staff that supports breastfeeding couplets then. But per BFHI, we all have had to be formally educated on breastfeeding and are certified counselors (not to be confused with consultants). We took an 18 CEU to be so.

    I do think that all RNs who work with mom and babies should have some sort of formal education, preferably paid or subsized to them, by their facility. We are doing mom and babies a disservice when the staff caring for them are not adequately educated/able to support them themselves.
    Fyreflie likes this.
  5. Visit  melmarie23 profile page
    0
    info on milk banks across the U.S.

    https://www.hmbana.org/
  6. Visit  carrie_c profile page
    0
    Quote from melmarie23
    We dont staff LCs at nights either. Its the nursing staff that supports breastfeeding couplets then. But per BFHI, we all have had to be formally educated on breastfeeding and are certified counselors (not to be confused with consultants). We took an 18 CEU to be so.

    I do think that all RNs who work with mom and babies should have some sort of formal education, preferably paid or subsized to them, by their facility. We are doing mom and babies a disservice when the staff caring for them are not adequately educated/able to support them themselves.
    I totally agree with you. I think if our hospital isn't going to staff us with LCs at night, then they should pay for us to take some classes. Some of the night nurses found a class in another city that they were going to go to. But the price was way more than they could afford, and the hospital refused to help pay for any of it. I don't have children, so of course I have never breastfed. I have also never even been around anyone who breastfed. So it is a challenge for me helping Moms. I feel very inadequate. The only training I got at all was I got to walk around with one of the LCs for half a day when I was on orientation. Thankfully she is one of the best ones, and I did learn from her, but it was not enough time for me to really be able to help Moms.
  7. Visit  carrie_c profile page
    0
    Quote from melmarie23
    info on milk banks across the U.S.

    https://www.hmbana.org/
    Thanks!
  8. Visit  Fyreflie profile page
    4
    Quote from Rhee
    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 breastfeeding is a wonderful, healthy, mutually beneficial thing, but I wonder if the experience where I work is typical. If a patient says she intends to bottle feed, or a breastfeeding mother requests a bottle, we are supposed to try to persuade her to breastfeed. We've been given a script to follow that basically seems guilt inducing to me. We are supposed to use this script on everyone from a exclusively breastfeeding first time mother to a patient who has had her sixth baby and has supplemented every single child. I've had patient's tell me that they have asked for bottles and the previous nurse acted as though she didn't hear the question and some mothers actually crying and begging for bottles. I feel that my job is to help my patients do whatever it is that they want, not to guilt people into breastfeeding. I will go over the benefits of breastfeeding, how babies need to nurse frequently, how frequent nursing will encourage milk supply, I will tell my patients who want to supplement during the first 24 hours that it is not necessary, I will talk about baby's nutritional needs and stomach capacity . . . I will give my patients all the information I can, but I try to do it in an informative way. And this isn't good enough. If a patient is still requesting bottles, I don't feel that I should tell them no, but the next day our lactation consults are telling me (and other staff, too) that we should try harder and that we must be pushing formula. I will help my patients do whatever they want to do, but I refuse to tell them that formula is basically poison, which seems to be what the hospital wants.

    I work at night and the other issue is the night time nursery. We are being asked to make our patients sign a waiver before their babies will be allowed in the nursery. The waiver lists an entire page of reasons why baby should room in and at the bottom it says something like "I would like my baby to be separated from me despite all of the benefits of rooming in. I give permission for my baby to go the nursery despite the fact that we will not receive the mutal benefits of rooming in." This form should only be given to parents once they've asked for their child to go to the nursery. I feel awful taking this waiver in to a sleep deprived woman with hormones surging through her body who has finally decided that it's okay to let us watch her baby between breastfeedings. There has to be a better way.

    We have also been told that we will not be able to give out pacifiers even if parents ask for them in the near future. Pacifiers are only to be used for comfort during circumcisions and then thrown away.

    For many people, they already feel guilty asking for a bottle or for the baby to go to the nursery. I don't really know what to say to parents who are literally so exhausted that they can't keep their eyes open or patients who have had the baby to breast so much that their nipples are so tender that they are crying. Since we've started going through the baby friendly process, we've had more babies dropped during the night, babies in bed with mothers--I found one baby half hanging off the bed next to it's mother's knees, and one completely covered with the blankets over its face next to its snoring mother. These situations are not typical, but we have been noticing that they are happening more and more frequently.

    I don't think that formula and mandatory night nursery are the answer either, I feel that my patients are adults who should have the ability to make informed decisions. I would like to know what other nurses experiences with baby friendly are. I feel like the my hospital is taking it a bit far and that breastfeeding has become more important than anything else, it's almost become as if lactation services have more power (for lack of a better word) than anyone else, and the relationship between the LC's and the nurses has become so adversarial, to the point where they are telling our management that we are collecting the babies every night and taking them to the nursery to feed them bottles. Actually, it's easier for me if the baby is in the mother's room and she and dad are caring for the baby and feeding him or her and changing the diapers . . . the nursery isn't for my convenience, and most of my coworkers have this same opinion.

    Anyway, I'm sorry this is so long, and I thank anyone who reads all my rambling and gives me some opinions and advice.

    ~Rhee
    Rhee I've been waiting until I'm not on my phone to write a "real" reply to this because I think there are a lot of different ways to look at BFI and I'm really passionate about this!

    I've worked at a Baby Friendly Hospital (one of the few in Canada when I started there in 2008) and at a hospital working on BFI but not quite "there" yet. I'm now working at a large hospital in Western Canada that doesn't even have "baby friendly" on its' radar. Both of my first two hospitals I worked combined L & D/post partum and here I work L & D only (which I think is part of the problem, but that's a whole 'nother post!).

    At my first hospital, they had made it well past the stage you're describing. I don't think they ever had a nursery to begin with, honestly. On the occasions that a Mom needed a few hrs of uninterrupted sleep we would bring baby in bassinet out to our "baby park" which was just our locked room in our nursing station with a big glass window. Most of the time those babies ended up being held by whomever was free at the time and then taken back to Mom to feed. We weren't quite at the point where Mom had to sign a waiver, that seems a little silly to me. We DID get to the point where formula was decanted into a non-brand name cup in small quantities and I thought that was fair (probably saved the hospital money as well) and went well with our teaching policy when parents asked which formula was "better" (answer: they're all made in the same lab!).

    I can't imagine how stressful having conflict with the LCs must be, I haven't had that experience at either of my jobs that were baby friendly, the first LC was actually a mentor of mine to some degree and we had a great relationship.

    What frustrated me most about being in post partum was that the ratio was really so high. Having 5 dyads to look after pretty much guarantees you don't get to see more than one feed/couplet/night or day. Sending Moms home at 24 hours checking off the "breastfeeding well" box felt like a big fat lie to me--that cluster feeding that inevitably happened the second night usually happened after they'd been sent home, but because we only kept them 24 hours our exclusive BF rates were really good on paper. The LC saw a lot of those Moms back in the first week with issues though and here's my thought on breastfeeding education:

    IT NEEDS TO HAPPEN BEFORE MOMS GIVE BIRTH!!!! For mothers to have a successful breastfeeding relationship in the face of many obstacles, they need to have an understanding of skin to skin, early BF (in the labour room, before two hours if possible--such a huge factor in successful BF), the difference between colostrum and breastmilk, the reasons behind clusterfeeding and the biological ways in which babies are programmed to protect their food supply. That is WAYYYYYYY too much information to try and teach during labour (which I do when at all possible, especially with a patient with an epidural) and early post partum. Moms who come in unprepared for that amount of work, because it IS hard work, are more likely to interrupt that crucial first 48 hours of nursing because they feel like they're not doing it right, the baby is starving, etc. etc. etc.

    That doesn't mean we can't try to support them the best way we know how. Sometimes that is holding the baby for even 45 minutes so they can sleep or shower, then bringing them back to Mom for the next feed. But we have to be very aware of a simple fact, and it blows me away that we haven't gotten to this stage yet:

    Breastfeeding exclusively is a recommendation that is highly endorsed around the world when at all possible because of well researched, well documented benefits to mother and baby. It is Best Practice. It is Evidence Based. These are things that we as nurses are obligated to endorse because they work and promote the health and well being of our patients. Saying, as an L & D or PP nurse, that it's just "not that important" is like saying that it's not important to mobilize a hip surgery patient or engage a Cardiac patient in ongoing rehab. We would get hung out to dry in another area for refusing to (or being, at best, ambivalent about) endorse the practices that result in the best outcomes for our patients. This is not about how we as nurses feel about whether or not it is "right" for breastfeeding to be "pushed" on new moms and babies. I think it's awful that we are the ones on whom the onus for success is largely placed--because we shouldn't be the point of first contact for that kind of information, and it makes our work SO MUCH HARDER--but adhering to the most recent, most up to date researched practice standards is what we signed up to do.

    I think the way in which breastfeeding differs from other best practices is the emotional component that is less controversial with other endorsed best practices. We're not going to hurt the feelings of a surgical patient if we push them to get up out of bed--at least, not in the way in which we might hurt the feelings of a new Mom if we challenge her decision the wrong way.

    I used to work with a pediatrician who said she had stopped talking to her patients about the benefits of breastfeeding, and instead, taught them the risks of formula feeding. Risk of increased allergies, obesity, diabetes, etc. etc. etc. She thought it was ridiculous that we couched the teaching in such politically correct terms--that if it was anything else, smoking for example (poor example because sometimes formula is necessary, and smoking is definitely not) we would have no qualms about sharing the risks.

    Anyway. I digress. This is so multifaceted and the practice implications are really frustrating for us on the front line. But the bottom line for me was that when I saw dyads who had been supported in their BF goals from minute one (skin to skin at delivery) and addressed the teaching from as early in the labour process as I possibly could, INCLUDING FAMILY MEMBERS, who more often than not have some pretty outdated ideas about what breastfeeding means--those Moms and babes did well in post partum and even though it was sometimes a struggle in those first 48 hours, with the right support they pulled it off.

    When I worked out east I had a labour patient whose support was a girl I had looked after post partum six months before. She pulled me aside when we had a minute and thanked me for being so supportive of her breastfeeding while she was in hospital, and told me she was still exclusively breastfeeding and loved every minute of that relationship with her son. THAT is why it's important. Even if it's hard work. Especially WHEN it is hard work.

    Haha whew can you tell I feel strongly about this?

    PS I am not anti-formula. I think it's sometimes medically necessary, and sometimes lifestyle-necessary, and the number one rule is "always feed the baby" no matter what--but I like my patients to be properly educated about the differences, benefit vs risk and to feel truly informed about the choice that they're making. In the end, that's all you can do anyway.
    kmarie724, Marymoomoo, Elvish, and 1 other like this.
  9. Visit  Fyreflie profile page
    2
    Quote from carrie_c
    I totally agree with you. I think if our hospital isn't going to staff us with LCs at night, then they should pay for us to take some classes. Some of the night nurses found a class in another city that they were going to go to. But the price was way more than they could afford, and the hospital refused to help pay for any of it. I don't have children, so of course I have never breastfed. I have also never even been around anyone who breastfed. So it is a challenge for me helping Moms. I feel very inadequate. The only training I got at all was I got to walk around with one of the LCs for half a day when I was on orientation. Thankfully she is one of the best ones, and I did learn from her, but it was not enough time for me to really be able to help Moms.
    carrie are you able to shadow one of your LCs further? It's frustrating to try to help Moms when you feel you don't have adequate training.
    when my old hospital went to "team" nursing they created an 8 hour position for an extra LPN to be on nights 2300-0700 just to help with breastfeeding support so that the nurses with 5 dyads could do their "tasky" stuff but the more complicated breastfeeding support could also be attended to. It was very creative
    Elvish and melmarie23 like this.
  10. Visit  Fyreflie profile page
    3
    However, our policy is baby must eat within 7 hours.
    Just to comment on this, too, is that policy a recent one? The Baby Friendly policies I've seen have always stated that the infant and mother being skin to skin with frequent attempts/drops hand expressed or cup fed to baby's mouth were considered "successful feeding" in the first 24 hours (in healthy, term, low risk babies). Maybe your policy needs to be updated to support this, and that would help take some of the pressure off of the nurses to get that "feed" in the first 7 hours?
    Marymoomoo, Elvish, and melmarie23 like this.
  11. Visit  Marymoomoo profile page
    2
    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.
  12. Visit  calaab profile page
    2
    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.
  13. Visit  Fyreflie profile page
    1
    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.
  14. Visit  rn/writer profile page
    3
    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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