baby friendly questions - page 8

by Rhee 20,825 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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    I work at a baby-friendly facility, too. Just started here 2 months ago. I do believe breast is best, but gosh darnit I should not be forced to push breastfeeding on these moms if they absolutely want to bottle feed. When they go home, there is a 99.9% chance they are gonna give the baby formula anyway, no matter how much we sit with them, educate, assist with latching on, etc. I love the facility I work for but this breastfeeding thing, especially when moms aren't interested in breastfeeding at all and have their hearts set on bottle feeding no matter what you say or do is kind of irritating! We are required to educate them on why breast is best and the "risks of bottle feeding over breastfeeding", then make them sign this form before we can get formula out of the pyxis for them. And to top it off, we are starting to get emails calculating which nurses are giving the most bottles during their shifts!!!!! Come on!!! In my eyes, as long as the baby eats and both mom and baby are healthy, I'm OK!!!
    Question: What are the benifits for the staff and the facility for being a baby-friendly hospital, anyway?
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    Quote from carrie_c
    While breast milk may be best, there is nothing wrong with formula either. It is not the poison that most LCs think it is.
    You're right. Formula is not poison. I would hope that anyone who is working with mothers and babies doesn't describe it as such.

    Human milk isn't best, it's normal. It is species-specific food for human infants. It has everything a baby needs nutritionally, plus active immune factors, pre and probiotics, growth factors, and even stem cells! Human milk is a living substance that provides more than just nutrition, and breastfeeding is more than a food delivery system. In short, breastfeeding matters.

    Formula is like a medical replacement food, such as Ensure. Formula provides nutrition in the right proportions to fuel infant growth and development. That said, it's not equal to human milk, just like medical replacements such as Ensure are in not equal to a diet of fresh, whole, living foods. Does that make sense?

    Formula is available for babies who need it, and thankfully so. That said, human milk and formula are not equals; it's not like choosing between Coke and Pepsi. Parents deserve to know the differences between the two, so they can make an informed choice about infant feeding. Ideally, this would happen during pregnancy, not in the first hours after birth. Unfortunately, the subject is rarely addressed in any real detail until it's time to feed the baby. That's a real problem with the system.

    IMHO everyone who works with mother baby pairs should know the differences between human milk and formula, and why breastfeeding (and exclusive breastfeeding) matters. I can understand how it would be easy for anyone to be blase' about the early introduction of formula if they didn't know that the lack of human milk increases risk factors for illness and health disparities, and even one bottle of formula can have a negative affect on the developing gut flora of the newborn.

    Quote from carrie_c
    I often have very fussy babies, with high weight loss and obvious dehydration, dry lips, etc. We are not allowed to even suggest formula for these babies unless the weight loss is greater than 10%. If we do, or even if lactation suspects we did, we get in trouble. We also get in trouble sometimes if we take a mother a breast pump. Our policy is that babies eat within 7 hours, or they must be given formula. So if the baby won't latch for what ever reason, I offer them a pump. The LCs think it's ok for a baby to go over 7 hours before eating. I think this is just cruel. Who wants to let their child go that long without eating? We have no LCs at night, and that's when most of the breast feeding issues occur. I am really tired of having to justify my nursing care to lactation. Maybe instead of complaining about our care, we should just call them at 3 am to come in and get a baby to latch after we have tried for hours, when Mom, baby, and nurse are all exhausted. Maybe then they would change their way of thinking.
    You might find this information helpful:
    ABM Clinical Protocol #3: Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2009
    http://www.bfmed.org/Media/Files/Pro...ementation.pdf

    Are the mom and baby in your example above in skin to skin contact (kangaroo care)? If not, that would be the first "intervention" to try. It can help to minimize interruptions and afford mom as much privacy as possible. Ask visitors to wait (having an audience of visitors and staff can make initiating breastfeeding even more stressful).

    If baby is unable to latch after spending a considerable amount of time in kangaroo care, you could teach mom hand expression. This is usually a much more effective way to remove colostrum than pumping alone (plus much of the colostrum expressed by pump is lost in the breastshield). One method is to hand express onto a spoon (like a disposable teaspoon), then feed to baby. It is taught here, by Dr. Jane Morton of Stanford Medical School: http://newborns.stanford.edu/Breastfeeding/HandExpression.html
    I
    f baby is still unable to latch, mom should ideally hand express and pump in order to stimulate copious milk production. See here for a technique to help her remove more milk and maximize her milk production:
    Maximizing Production - Newborn Nursery at LPCH - Stanford University School of Medicine
    melmarie23, jeriksmoen, and LibraSunCNM like this.
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    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.
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    Elvish I agree with you. I've worked post partum in two different baby friendly facilities and the only one in which I felt I was able to truly provide good support and education with feeds was the rural hospital where we rarely had more than 3:1 on a shift. In the big hospital with 4-5:1 it was a nightmare, so sad for those poor Mums.
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    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.
    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!!!
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    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 think it has a major affect on the babies, and I believe it is part of breastfeeding problems. I work night shift, so the vistors being in the room is rarely the problem. And like the above posters pointed out, there is not enough time on night shift to spend trying to help breastfeed. Our ratio is 4:1. Plus we have no nursery nurse, so we all have to take turns staying in the nursery. (There has to be 2 nurses in there at all times.) Plus, we have to round on our section patients every hour. There is simply not enough time.

    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.
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    All I know is that they're taking away our FREE formula and pacifiers...and we're already a broke, public hospital. :/
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    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.
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    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.
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    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.


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