Anyone going baby friendly?

[babyktchr]

We are in the beginning stages of initiation of the WHO baby friendly initiative. Just wondering if anyone else has received the accreditation or is in the process. I am having difficulty with it really. Not that I am against breastfeeding. I really just don't want to discriminate against a bottlefeeding woman. Would love to hear your thought!!

[geekgolightly, BSN, RN]

This is the biggest conundrum I find with the whole baby-friendly thing. If you want to breastfeed your baby, breastfeed him. If you are too tired to do it, and your baby is hungry, it is wrong for me to let him starve.

Wouldn't you inform the mom of this rather than going behind her back? If so, and if she chooses to let her baby starve rather than FF or get up to breastfeed, she might need to be reported.

[sharpeimom]

What does this breastfeeding/formula debate do about a woman in my position? I took tegretol for over 30 years and was cautioned not to nurse any babies I might give birth to in the future. the longest I carried a baby was into the 26th week, so it was a moot point anyway. as our son was in nicu fighting to live, I was being brow beaten by a pp nurse who could not get it through her thick skull that: A. I did, in fact, have our son's welfare at heart and B. I could not just "go off" the tegretol so I could nurse (because it was the only drug that kept me seizure free.) Since our baby died, it ceased to be an issue, but it could certainly have been handled differently. Fwiw, our pedi did not want me to breastfeed while taking tegretol.

Back to the diaper bag issue, I feel they should be given to all moms or none. To me, it would not have been the actual diaper bag itself, it would have been the principle of the thing. If I had been a bottle feeding, formula using, low income, (although by no means all formula using moms are poor) woman or teen, I'd have felt left out once again, had I not received a diaper bag. in many ways, it's just one more class distinction.

[Rhee]

Wouldn't you inform the mom of this rather than going behind her back? If so, and if she chooses to let her baby starve rather than FF or get up to breastfeed, she might need to be reported.

When I take a bf baby to the nursery, I tell the parents something like, "Your baby breastfed at ten pm, so he will probably be back to nurse sometime around one. I will bring him back earlier if he is hungry, if he's still sleeping, he may be back a little later." That we are all on the same page. If someone tells me that she doesn't want the baby to come back until four or five, I tell them that the baby needs to eat at least every 3-4 hours at night. If they don't want the baby to come back they can either send pumped milk to the nursery or we can give the baby formula. Sometimes people will agree to supplement, sometimes they won't.

The problem lies with the people who refuse to feed the baby when he/she goes out to the room, or only make a token attempt and send the baby right back. I can tell them that their child is hungry, but if they won't feed him, even if I do report them, no one will come until the morning. What to do with the baby in the meantime? I would never supplement a baby whose mother is willing to breastfeed, but to perfectly honest, I have supplemented ones whose parents won't feed them. To do otherwise just seems cruel. I do tell the parents, though, and I only do this after talking with them first. If they still won't feed their hungry child, I can't just let that baby cry until morning. If that makes me a bad nurse, so be it.

[babyktchr, BSN, RN]

Has anyone looked at the other models out there? Texas and Colorado have both developed their own program b/c the baby friendly steps were too restrictive.

I would LOVE to hear more about this. I really think this BFI is much to restrictive and EXPENSIVE.

[Marymoomoo]

Just as providing only formula bags in hospital, as I experienced, is a way of marginalizing breastfeeders, so is only handing out pro breastfeeding bags. Either there should be both or none.

I totally agree with that. Why couldn't hospitals provide bags that say nothing about how babies are fed?

Formula isn't a medication, so I think it's an entirely different category. Do you (does anyone) know if we give out Boost products or similar things upon discharge? Or if Boost is allowed to market in hospital? Maybe they don't need to... the patient will see it on the tray at each meal.

I've never heard of patients leaving the hospital with swag bags from Boost or Ensure. That is one example I thought of, but it doesn't seem to apply since so few people are forced to live off liquid replacement nutrition (and it is unlikely that anyone would do that by choice unless a psychological issue was also present).

The decision has been made. If a women has made an informed choice, and wants to FF, she should be supported and helped to understand what to look for to buy the best formula for her baby. That is supporting optimal health for her baby.

Of course, she should be educated about the options for formula feeding and what kinds of formula are best for her baby's situation. This is one thing that formula marketing actually hinders, because the choice is taken away from the family. The choice is made for the family by the hospital and the formula manufacturer they choose to contract with.

To make a truly informed choice, mothers need to know all the facts. If a family is formula feeding due to choice or necessity, safe formula feeding practices and methods to reduce the risk for formula fed babies (such as hygienic practices and paced feeding methods) should be taught. This is even more important if the hospital takes part in formula promotions.

What about the time a woman was breastfeeding and her child starved to death because she refused to FF and her milk wasn't enough? I'll try and find the article for you.

Yes, that was increcredibly sad and absolutely unnecessary. It's not the same as unknowingly feeding a baby food that is contaminated. The issue I brought up has happened in hospitals, too--healthy, full-term babies becoming ill from contaminated formula. If a hospital gives a family that sample, do they then become liable? On a related topic, nurses at one hospital are under fire because they fed breastfed babies formula without their parent's permission, and that formula turned out to be contaminated with E. sakazakii. As I recall, one baby died and another is on a ventilator.

The AAP recommends that mothers come in for a check up several days after discharge to assure that breastfeeding is on track. All breastfeeding mothers should be educated about feeding frequency, what to look for in a "good" feeding (signs of swallowing, etc), output, and alertness. They should also be referred to lactation services and community support groups in addition to their pediatric appointments.

What about introducing bacteria to a baby when a woman gets mastitis.

Breastfeeding can continue in all cases of mastitis except MRSA (and then it can continue on the unaffected breast).

What about thrush?

Thrush is uncomfortable, but it's certainly not deadly to a healthy mother or baby. Usually, it is passed from baby to mother (not vice versa).

What about mercury levels and other toxins in breastmilk?

The very same toxins are in formula. We live in a polluted world.

Bringing up these issues does no good for either party.

The issue I spoke of is that of contamination. It happens far more than we want to think about. My specific question was about liability for the hospital if they were to offer freebies that happened to be one of the few batches to become contaminated (this is rarely apparent until after babies become ill).

[dscrn]

I am so very sorry for your loss.osses, rying to become a mom. The pp nurse who badgered you perhaps needs a bit of an inservice as far as sensitivity (arrrgh, hate that word!{ is concerned. Your health has to be figured into the mix.

Again, my sympathies to you...

[Elvish, BSN, DNP, RN, NP]

Wouldn't you inform the mom of this rather than going behind her back? If so, and if she chooses to let her baby starve rather than FF or get up to breastfeed, she might need to be reported.

Of course I would have a heart-to-heart with Mom, since technically it constitutes battery for me to formula feed a breastfed baby without parental consent. And most moms, given the chance will feed their babies something, which is all I ask. I just have a real issue with the ones that feel the need to stick to a q3h schedule when they have a hungry, jaundiced baby. Some folks just don't 'get' that it IS a commitment and yes, you might have to sacrifice some sleep or some personal time if you want to exclusively breastfeed. But that's not the topic of this discussion.

I am a huge breastfeeding supporter but I tell all my moms who ask that how they feed their baby is less important to me than that they feed their baby. I'm not about to tell a mom that she has to breastfeed a baby or she's a bad mom. I will certainly go through the benefits of BFing with her, but about 98% of people have made up their mind about how they're going to feed their kids before they ever get to me on mother/baby. If I have a mom whose heart is totally set on BFing, I do everything in my power to make it work for them.

At my place we have different bags that we give the moms that are BFing that don't have any formula-promoting stuff in them. I'm cool with that. The bottlefeeding moms get a bag w/ a can of formula, a burp cloth, and some other stuff. I can't remember them all - I work nights and we don't go through their bags on nightshift. Probably not on days either. :)

[Marymoomoo]

what do you do in the nursery with a breastfed baby whose mother refuses to breastfeed him or her because she wants to sleep, and doesn't want the baby to get any bottles. As an advocate for the baby, who doesn't have a voice, should I just let that baby cry? That definitely is not baby friendly. This happens rather frequently. Or a baby will go out to nurse, and come back in ten or fifteen minutes screaming. Then parents get upset if the baby is brought back out. I suppose the alternative would be to say that breastfed babies must room in, but that would upset many parents too.

In this case, the family may need some education. They need to understand why babies should breastfeed as often as they cue, even if the baby "just ate" 15 minutes ago. They need to understand that it's normal for babies to breastfeed frequently in the early days, and they need to be given some suggestions for ways to cope with that demand. If the mother is tired one solution might be that someone could assist her in nursing side lying so she could doze and nurse at the same time. This would be one situation were the family would truly benefit from the help of a lactation consultant. :)

[BabyLady, BSN, RN]

What? I'd have smacked a nurse if they tried to "supplement" formula to my breastfed newborn because she was "hungry." Seriously, I would have smacked her.

OP - all of those changes being made sound like good ones to me except for the bags issue. Are there no longer bags, or are just the breastfeeding moms receiving them?

In our unit...Mom had better have a good supply of breast milk or there is always a standing order to bottle feed.

A baby's health, nutrition, blood sugar, etc...always takes priority over Mom's desire to breastfeed.

We call her ONCE when the supply gets low and tell her upon admission that even though her baby is NPO, she needs to start pumping now and bring in milk because if the Neo starts feedings, it's an immediate order.

No way do we compromise an infant's health for a personal desire...no way.

Nutrition is the most basic of all needs...and a hospital can override Mom on that in a New York minute.

[Marymoomoo]

just have a real issue with the ones that feel the need to stick to a q3h schedule when they have a hungry, jaundiced baby. Some folks just don't 'get' that it IS a commitment and yes, you might have to sacrifice some sleep or some personal time if you want to exclusively breastfeed.

I've seen this in the community setting. Oftentimes, these mothers read parenting books that tell them that babies should feed no more than q3-4h or their babies will be spoiled, control their parents, not sleep enough for development, etc. For some babies, this may work fine. For others, it could lead to undernourishment and even failure to thrive. Since these books often have religious basis, it's hard for the parents to understand why it might not work for them. They want to trust the "expert" rather than their babies and their own mothering instincts.

In these cases, you can make a concerted effort to point out the baby's feeding cues to the parents. :) You can also educate about the necessity to feed on cue (including baby's small stomach capacity, the digestibility of breastmilk, and the individuality of breast storage capacity). In cases were the parents want to stick to a strict schedule, I would encourage you to inform the lactation consultants and/or the baby's pediatrician as this can be a red flag for difficulties.

[Marymoomoo]

In our unit...Mom had better have a good supply of breast milk or there is always a standing order to bottle feed.

In a situation like this, I would wonder how are the mothers who wish to breastfeed are being supported. Are they provided with a pump, education about using it, the support of an LC, etc? Are they taught how to hand express colostrum and how to combine hand expression with pumping in order to maximize production?

If the mother is unable to pump enough to meet her baby's needs, is the option of using donor milk available while she's building her milk production?

I don't think breastfeeding is simply about "personal desire". It's an issue of long term health for both the baby and the mother. In no way should a mother ever be made to feel that she is compromising her baby's health if she is unable to pump a certain quantity on demand. If it were a choice between brand A or brand B of formula, that would be one thing but we're talking about the biologically normal food for human infants vs a manmade substitute. There two aren't equal choices and no mother should be forced to feed her newborn formula unless it is an absolute medical necessity.

[brillohead, ADN, RN]

Wouldn't you inform the mom of this rather than going behind her back? If so, and if she chooses to let her baby starve rather than FF or get up to breastfeed, she might need to be reported.

Oh snap.... you've just released the hounds!!! :lghmky: