can we have a polite thread about breasteeding?

  1. I wanted to respond on the other thread but since that one started out as a vent, I thought it better to begin anew.

    Shoelaces asked about whether some mothers felt revulsion during breastfeeding. I'm paraprasing, so I hope I got the gist of her question. I work with breastfeeding mothers in the community (and teach knitting, but that's another story) so I don't generally get to the mothers until a few days post-partum unless I make the very rare hospital visit.

    I know a couple mothers who are survivors of sexual abuse. One was physically unable to get her baby to breast. She pumped and bottle-fed expressed breast milk. My hat is off to her, because as far as I am concerned, pumping and bottle-feeding gives you all the disadvantages of both. Another mother was able to breastfeed her infant but as grew from baby to toddler she began to experience flashbacks to her earlier abuse.

    I don't know how common this situation is, but after talking to a couple other abuse survivors I keep this in the back of my mind as a possibility.

    I don't believe that mothers should be compelled to breastfeed nor do I believe that motherhood is every woman's destiny. Both attitudes smack of biological determinism. I do think that any amount of breasteeding, even one time, is beneficial, and my hope is that all mothers will get the education and support they need to make an informed decision. When I talk to a pregnant mother who is uncertain, I usually tell her that since her milk is going to come in regardless, she at least try breastfeeding in the hospital. That gives the baby the colostrum and the mother a chance to re-evaluate the situation.

    Next to abortion, breastfeeding seems to be one of the most controversial issues on the net. Who knew that something so basic could become so politicized?
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  2. 11 Comments

  3. by   Mattigan
    Probably not but you are brave to try.
  4. by   SmilingBluEyes
    I think you need to take each case on a individual basis. All survivors of sexual assault/abuse don't all react the same way. Some are very "well adjusted" and do fine. Others need a lot of help. This is where we and Social Services personnel step in. If someone is THAT against breastfeeding, for whatever reason, I try to elicit why. If I can't, I do let it go. Yes, that is right. I drop it and get her formula.

    Now for those who have obvious psych-soc issues, We do have social services and follow-up is arranged in cases like this. But from a breastfeeding point of view, I admit, I never pressure BF in anyone who obviously does not want to try. It goes against my nature and what I believe is an advocate role we nurses take caring for a variety of patients. Sometimes, to me, advocacy may mean allowing people their choices, even if they are opposite what ours would be in the same situation. It need not be about politics, as you know.
    Last edit by SmilingBluEyes on Apr 7, '03
  5. by   ShandyLynnRN
    That was an excellent post, but in answer to your original question, "can we have a polite thread about breastfeeding", I don't see it happening. Not unless we get two separate threads going, one for the posters who think that anyone that gets a little frustrated or irritated with all the issues that accompany breastfeeding are bad bad bad, and one for the posters who think breastfeeding is great, but not the be all and end all of child rearing.
  6. by   KnitRN
    Originally posted by ShandyLynnRN
    That was an excellent post, but in answer to your original question, "can we have a polite thread about breastfeeding", I don't see it happening. Not unless we get two separate threads going, one for the posters who think that anyone that gets a little frustrated or irritated with all the issues that accompany breastfeeding are bad bad bad, and one for the posters who think breastfeeding is great, but not the be all and end all of child rearing.
    I'm not sure how to respond to this but here goes. Do you want to discuss breastfeeding or continue to vent? It seems to me that his forum has a dual purpose - supporting OB/L&D nurses and educating nurses. If you have issues with breastfeeding educators and advocates, then please start your own thread and feel free to bash away. I am still interested in getting some serious responses on this.
  7. by   SmilingBluEyes
    I have to wonder: how would you like people to respond exactly? that you are right? ok-- you are right. there. that is civil enough. however, disagreement is NOT tantamount to being impolite or uncivil. WE make breastfeeding and other issues the HOTBUTTON topics they become in our behaviors.
    Last edit by SmilingBluEyes on Apr 7, '03
  8. by   Hardknox
    Every time we have a "discussion" on breast feeding I notice we (the frontline L&D and Mo/baby nurses) are bashed by new posters who have 1 or 2 posts to their credit and very little info under their profile. We are treated to a lecture on all they suppose we don't know about breastfeeding (even though nearly all of us have kept up to date with seminars and certifications in lactation counseling). Then we are told how unsupportive nurses were with their own or their "friends" breastfeeding experience when they were hospitalized. It's as if all the malcontents on breastfeeding.com lurk here to respond to just such a thread.

    Shandylynn somes here with very legitimate venting, feelings I encountered in my long career in OB,a career in which I was the nurse to go to when there was a problem with feeding. Shandylynn is treated to SHOUTING IN CAPS by poster's that I always thought were very supportive in their previous posts and now again you start in on her. Shandylynn is my hero--she does a great job with all they throw at her and is allowed to feel frustrated!

    So my answer is NO! There will NEVER be a rational breastfeeding discussion on this board! It seems to me you answered your own question in your last post.
    Last edit by Hardknox on Apr 7, '03
  9. by   KnitRN
    For me, this isn't about being right or wrong its about learning from the nurses who are the front lines in breastfeeding education. By the time I work with a mother, she is anywhere from several days to several weeks postpartum and have enough different issues (nipple confusion, incorrect latch, flat nipples, nipple trauma, whatever) that breastfeeding doesn't work for her. I know that breastfeeding isn't the be all and end all of mothering but there are many mothers that grieve because they were unable to breastfeed.

    If I might make another analogy, consider a mother who comes to your unit hoping for a natural, drug-free birth and ends up with a cascade of medical interventions including AROM, pitocin, epidural, pushing for two hours, failed vacuum extraction and then a cesarean for failure to progress. She's happy because she has a healthy baby but she's also sad because the birth was a lot more difficult and traumatic then she ever imagined it could be. She's recovering from major abdominal surgery and getting to know her newborn all at the same time.

    Those first few hours in the hospital are a critical window for establishing breastfeeding. Unless I can get third party reimbursement for making home or hospital visits the floor nurse is the only person who has the opportunity to help these women get started. I accept that patient education has to come after a lot of other issues have been addressed but I think it worthwhile.

    I'm still puzzled as to why breastfeeding gets singled out as such a political issue on this board and others.

    I am interested in hearing about how you educate your postpartum patients about breastfeeding and whether there are particular factors, besides the obvious and chonic issue of understaffing, that help or hinder you. I'm working on an inservice for the nurses at the community hospital where I had my last two children and your perspectives would be extremely helpful.
  10. by   SmilingBluEyes
    Here is a long post of things from a nurse who you may wish to inservice one day: first,

    I think you can get a lot of your answers by re-visiting that very heated thread. Try to see past all the emotion expressed there really try to understand what we nurses have been saying. Staffing issues are a HUGE factor in how much attention breastfeeding problems receive in the hospital, especially on nights and weekends, where I work. It is not fair or just, but if we are "slammed" it is hard to place breastfeeding problems at the top of list of priorities. But when someone calls for help BF, I make is a priority to get to that room and help her any way I can. I put it up there on the list of my priorities with pain control for my patients and try to be there within 5 minutes of their call. Or I try to find a less busy coworker to help her. I do all I can but sadly, it is sometimes not enough. I am always happy for moms who deliver during the week --if they have severe problems, they can see our LC. She is an experienced L and D nurse who is also A certified LC. She can be invaluable during our busy times. Plus, she DOES initiate follow-up calls to each breastfeeding mom who delivered at our hospital after they are discharged home.

    That said,here is how I initiate breastfeeding for ALL moms in my care who are willing: Immediately after delivery, often while the placenta is waiting to be delivered, I put the baby to breast if he/she is doing well. I do all in my power to ensure the baby is at breast within the first 15-30 minutes following birth. I often get moms who say "no give him a bath first" . When they do, I tell them it is best to breastfeed first as the first 30-60 minutes are when baby is most receptive to nursing and bonding til he/she gets sleepy and lethargic for 4 hour or so. There is PLENTY of TIME for bathing and shots in 30-60 minutes. Many nurses ARE stuck on the "nursery" routine, however, insisting bathing and shots be done before everythign else. I try to encourage nurses in the delivery room with me to "let go" of that and let baby nurse first. To me it is critical.

    I already SAID the NUMBER-ONE ELEMENT OF SUCCESS (or sadly, failure) in breastfeeding is the MOTHER and her ATTITUDE. IF she is COMMITTED (as are her family members to support her), she is much more likely to succeed than the one who is NOT dedicated to breastfeeding. Attitude determines much.

    Yes, nursing staff attitudes are HUGELY contributory. I would be a fool not to acknowledge that. And there are "lemons" out there. (referring to nursing here). NO doubt. But you are not seeing them HERE from what I can tell. And the majority of nurses I work with are COMMITTED to ensuring breastfeeding success with each and every family who desires it that is in her care.

    If you want to have an inservice to improve breastfeeding success, great. One thing you can emphasize is CONSISTENCY. I hear a lot from my patients that they get VASTLY different information from each nurse who cares for them. This concerns me. I understand there are many techniques and ways to succeed out there, but I think lack of consistency frustrates patients. Short of making very firm and clearcut policies regarding breastfeeding and mandating regular attendance at breastfeeding seminars/classes, I don't see this changing much. Unfortunately, the information we get changes oftentimes, too. We are taught many philosophies and beliefs and the "latest" info always has something new to try. I guess it would be best if we all got this same info and used what helped consistently. It is complicated and complex.

    But I still stand by what I said; it begins with attitude. The MOTHER's, the family's and the that of maternal/newborn staff. IF they come to me FIRMLY COMMITTED TO BREASTFEEDING AND ALL THE WORK IT INVOLVES, trust me, I will do all in my power to ensure they succeed. I like to think that is the attitude of the vast majority of us nurses.
  11. by   fergus51
    I am very pro-bf, but I come to it with the realization that these women have pretty much made up their minds before they come to me. I do what I can to encourage and support breastfeeding, but I often run into the same things Deb describes: short staffing (as important as breastfeeding is, if there is an emergency and no one else to go, I go and bf becomes priority#2), mothers who want baby to have a bath first, mothers who want to sleep through the night, mothers who are really not dedicated to the reality of bf (they like the idea of it only) and those who don't want early bf or pumping because colostrum is gross. The women who are truly dedicated to bf often come to the unit having read up on it or gone to prenatal classes or spoken with other women about it and are quite knowledgeable. They are capable of advocating for themselves and understand why we encourage rooming in and early bf. Those who aren't that interested are not in the best state to hear my spiel about the benefits of it.

    The only women I have had who seemed repulsed by the idea of a baby on their breast were teenage moms. They often have body image issues and see the idea of a baby sucking on a "sexual" body part disgusting.
  12. by   Anagray
    I think that education about b-feeding should start from the first prenatal visit and that mothers should be encouraged to visit the child's future pediatritian way before the baby is born to discuss different subjects, b-feeding included.
    How can the nurses be expected to fully educate a healthy mother in these 2-3 days ( max) she spends in the hospital? Aren't there lactation consultants for that as well?
    i honestly can not imagine a nurse spending long periods of time with her/his patients, when she has more than 3 people to take care of at the same time.
    Another aspect of that I got to know as a patient myself - I was so freaked out by the whole birthing experience ( i had some problems) , that when it came to b-feeding I was lost. This is why it needs to be addressed more strongly antepartum. The hospital lactation nurse was not of help to me, she didn't return my calls for days while my son kept losing weight.
    I stuck it out and successfully b-fed for 16 months, but I truly believe if I knew more about it before giving birth, it would have been much better. B-feeding is not just about breasts and feeding, it is about knowing at least a little about newborn's anatomy, behavior and physiology. This can not be taught in one day.
    jmo.
    Last edit by Anagray on Apr 8, '03
  13. by   SmilingBluEyes
    Ana makes some EXCELLENT points. Part of the responsibility MUST lie with the expectant family. We get so many who have NOT a CLUE who will be their baby's doctor; they have not given it one thought. Part of it is the obstetric community's responsibility also. MUCH more time must be spent on prenatal education, beyond "warning signs" and the like. I am sorry; it takes more than 5 minutes per visit/appointment to give these moms the information they need to make decisions regarding their birthing and baby care afterward. Most OB offices are maginal to very poor at this, at best. The moms receive pamphlets and hand-outs but no one spends much time w/them. I guess the expectation is they will attend childbirth prep classes and get what they need there. But that is not always the case, either. Many folks do not go and cannot either afford the money or time it takes to get these classes. Sometimes, these classes can be inadequate, too.

    I have to say this: The moms/families who come in BEST prepared for childbirth and breastfeeding/self-care and the ones who have seen Health Care Nurse Practioners or MIDWIVES prenatally. Especially in the case of certified nurse midwives, and NP's, these professionals are CONSUMATE educators, but more importantly, GREAT LISTENERS!

    Oh yes, the education/information an expectant family gets PRIOR TO DELIVERY is VERY important to breastfeeding success. Often, Too much pressure is put on us nurses in the hospital to get them going in a VERY short time; most of my patients only stay 24 hours' max. Not a lot of time for me to get it all together for them, is it? Especially if I have a large patient load to cope with. I can't always convince the doctors or patient to increase their stay to 48 hours, which to me is optimal in first-time deliveries.
    Last edit by SmilingBluEyes on Apr 7, '03

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