Our baby friendly hospital had an NICU and the biggest thing was getting peds on board. Once that happened they rewrote the policies to encourage BM first, then supplementation as indicated by the baby's status.
In LD we supported this by 1) bringing hand expressed colostrum (even if only a few drops, which is enough to stabilize sugars in most babies) to the nursery as soon as possible after birth 2) getting mom to the nursery within the first 2 hours (even our c/s moms, in stretchers) and 3) keeping our late preterm infants with Mom as long as possible after delivery--depending on the pediatrician, even some of our late 34 seekers were allowed to stay for skin to skin and a first feeding attempt. Babes over 35 weeks often stayed with Mom in post partum in the absence of complicating risk factors and were given extra feeding support and encouraged to keep babies in Kangaroo care.
For babies at risk of low sugars we helped Mom hand express after each feeding attempt (nursery or not) and cup fed as well as at breast feeding. We rarely had to supplement in these cases and our NICU nurses were very supportive! But it did take a lot of re education and our peds being on board was a huge factor because it was reflected in our policies.
We also kept babes on PP who needed IV antibiotics and an NICU nurse would come give the antibiotics in the room as scheduled. Basically we tried to minimize our NICU admits by being really creative and decreased their workload a bit to make it easier for them to spend more time with moms whose babies really needed to be in the nursery helping them to pump or hand express and learn to latch their babies when ready. It worked really well all around.
Not like my current job--I brought FIVE CCs of hand expressed colostrum to the nursery from a PRIMIP recently (for her term baby admitted for observation for possible mec aspiration) and they refused to cup feed it even when the mom told them she wanted to BF exclusively. The nurse said 'oh we don't like cup feeding here, it's too much work' and dumped it in a bottle--then, when I brought mom and dad over and baby was rooting, told the mom she was looking too tired to safely hold her baby and that she should just go sleep all night and not worry about the next couple of feeds *aaaaaaahhhhhh* /endrant
In my second job out east we kept even babies on IV Dextrose rooming in with Mom and just checked their pumps and sites every hour on our rounds.
Last edit by Fyreflie on Jun 15, '12