Baby Friendly- getting a tad over the top

DalekRN · Jan 30, 2014

When a mom wants the baby in the nursery, I look at their situation. Are they crying from stress? Or, are they a second, third, etc time mom and totally solid on baby care and know what to do when they go home? Bam, let's make a plan for when baby will come back, enjoy your rest.

My first time moms I really encourage to keep baby with them overnight so they learn how to care for their kiddos when they go home. I tell them It's like practice for being home and that I am there to support them. If they then insist then I absolutely take baby and make a plan for her return.

Baby friendly is not about removing options for parents rest in the hospital. It is about enabling and empowering them to keep their babies with them so they can learn their babies and bond with them. It's about not routinely taking them away from their moms, instead, its about judicious use of the nursery.

As far as pacifiers/bottles, if a parent asks for it, I try to resolve what concerns they have which is NOT a lecture at all, and then if the pacifier/bottle is the best solution for them we go forward. Many times it truly is a great solution and then they are using those products with truly informed consent.

No baby friendly hospital says that parents canNOT send their baby to the nursery or canNOT formula feed or use a pacifier. That is the RN's mistaken interpretation. Lecturing is not a part of baby friendly.

chrisrn24 · Jan 30, 2014

I'm not a labor/delivery nurse but stuff like this truly "grinds my gears." I don't have kids but I already know that when I do I will not be breastfeeding. Nothing anyone lectures me on will change my mind.

Formula is not evil. Is breast milk better? Sure. But that doesn't make formula bad. If anyone tries to lecture me they will get an earful from me. I don't get why people can't just make their own decisions and they can be respected.

I don't blame a lady who just pushed a baby out of her lady parts for wanting to rest for a few hours and put baby in the nursery. It's not like anyone is beating the baby or neglecting them.

Policies as OP described are wrong.

DebblesRN, ASN, BSN, RN · Jan 30, 2014

It is not the necessarily the RN's misinterpretation, in most cases, it's management's. They make the rules in each facility based on their interpretation of the baby friendly initiative.

You should feel blessed to work in a facility where you are given the power to use common sense and good nursing judgment. Not all of us are so lucky.

I refuse to berate or lecture anyone on their infant feeding choices. Formula is not poison, and I will not make a mother feel guilty for using it. They have their reasons. Educating is one thing, forcing them to sign a form saying they are a bad mother for giving it opens a whole new can of worms. OP, I feel your pain. It is frustrating.

No baby friendly hospital says that parents canNOT send their baby to the nursery or canNOT formula feed or use a pacifier. That is the RN's mistaken interpretation. Lecturing is not a part of baby friendly.

Nineteen84 · Jan 30, 2014

I agree with both of you actually. The RN’s in my hospital (myself included) all jumped exactly to your concerns when they initially went nuts over this Baby Friendly Initiative and we've all learned to adjust to meet everyone's needs. First, with the pacifiers. They get a little wild. Pacifiers can be a good thing - especially with our preemies. On the other hand, I've seen parents who use a pacifier in place of on-demand feedings, and we all know that's not appropriate.

As far as formula goes; it has its place and time as well. I've actually had a pediatrician cause a mother tears and given her the impression that the reason her baby was in Special Care (what we call level II NICU) was because the baby was not getting breast milk. The mother asked multiple nurses if she was a bad mother for not breastfeeding. Totally uncalled for and the pediatrician was later "educated" (gag me). On the other hand...formula is not the poison they make it out to be.

Overall, I find myself asking a lot more questions and probing for their thoughts on feeding and so on more than before. I frame it as wanting to know their thoughts rather than pushing the hospital agenda on them. Are you bottle feeding or breastfeeding? If it's bottle, did you consider breastfeeding? If yes, why did you change your mind? If no, is there a reason? At this point if they either have a solid reason they are or are not going to breastfeed I say great and move on. If they're hesitant I continue the conversation about why they may want to consider breastfeeding and promoting the help we can offer them to do so if they should decide to go that route with THEIR baby. I always, in everything (pacifier, bottles, nursery, etc.), reinforce that this is their child, they make the decisions, not us, so they should never feel they are pressured to do something they do not want for their child. I remind them that we are simply there to help by giving them the most information possible and supporting them in their choices. And honestly, are we that self-absorbed to think that 2 days of our pushing breastfeeding is going to change what happens later at 3am when that now colicky 2 month old is screaming bloody murder? BUT 2 days of our helping Mom learn to problem solve feeding issues and 2 days of our teaching her that baby will be just fine even if everything’s not perfect 100% of the time can make a difference.

Having said that, there are times when it is simply not appropriate to go into a long presentation about what we know and making decisions this second. A baby can wait a half an hour while you sit with, comfort, and talk with Mom (and if they can’t wait due to blood sugars or other distress that becomes a different scenario entirely). A baby can go to the nursery for a couple of hours if she's having a mini breakdown that only sleep will cure. If a mom wants to hold off on making a decision for a couple hours it’s not the end of the world. That young of a baby is (most of the time) going to be just as happy skin to skin or swaddled well as it is actually nursing.

It’s a balancing act that involves good old human compassion and nursing judgment. It’s not doing what we do because that’s how we do it. It’s not making anyone feel bad for choosing a different method. Baby Friendly or not, my job is about doing what needs to be done to make sure that these parents go home with the knowledge they need to care for their infant to the best of their ability today and that they have the places and contacts and support to reach out when they find they don’t have all the answers later on.

klone, MSN, RN · Jan 30, 2014

I agree with others who have said that this is not the spirit of the BFHI. This is management's misinterpretation and bastardization of BFHI which has turned it into a draconian policy that nurses cringe at. I strongly believe that the best time and place for the majority of education on why breastfeeding is so important is in the antenatal period. However, I don't think it's across-the-board bad to have parents sign accurate and well-written waivers on the risks involved with not breastfeeding, just as I think it's appropriate that they sign waivers on the risks involved with not vaccinating, or circumcising. I think we do parents a disservice when we gloss over the very real risks to not breastfeeding, and minimize the choice as merely as insignificant as Coke vs. Pepsi. Here's a wonderful article on the topic.

Watch Your Language

ceebeejay · Jan 30, 2014

As a mother who has done both, it should always be the mother's choice and no mother should be made to feel inadequate or even abusive. That's unacceptable and it's poor implementation on the part of your hospital. I was also badgered in the hospital about circumcision. These are all very culturally and extremely personal decisions. It is our responsibility to provide education, not make the choice for them. I know in my state they push the breastfeeding, but it's more so they don't have to provide low income families with formula. It's a cost cutting ploy for states. Not saying it's all that everywhere, but look at where the push was started from.

silverbat · Jan 30, 2014

Wow, just wow.... My daughter breast fed her newborn, but within a few weeks, her severe psoriasis grew over her nipples making nursing extrememly painful for her and making it hard for baby to nurse thru the plaques. She tearfully changed to the bottle. Was she a bad Mom? NO! The hosp where she had her child was into nursing and rooming in. Daughter had a bad reaction to the C-section process and vomited 24 hours straight. The second night they wanted her to keep baby in room, and I put my foot down and said NO. I explained that she had vomited for 24 hrs and needed her sleep. She already was keeping baby in room unless the nurses needed her for something. You'd a thought I had grown two heads when I took baby to the nursey thatnight! Good Golly!

IrishIzCPNP, MSN, RN, APRN, NP · Jan 30, 2014

Formula comes with risks...risks many people aren't aware of. So by educating and making them sign a form you are providing informed consent. What's the problem with informed consent? It's about time we start ensuring mothers are aware of the risks associated with formula because they can be significant. We have become accustomed to feeling formula is fine...not as good as breastmilk...but fine. The truth is that it carries significant risks and it is our job to ensure informed consent.

DoeRN · Jan 30, 2014

I wonder if the powers that be that came up with this policy were breast or formula fed?

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IrishIzCPNP, MSN, RN, APRN, NP · Jan 30, 2014

I wonder if the powers that be that came up with this policy were breast or formula fed?
Sent from my iPhone using allnurses.com

What difference does it make? I was formula fed. I am now an IBCLC and a strong proponent of educating mothers about the risks of formula. It isn't fair to hand them formula and not explain the risks. We explain the risks of everything else...what makes us think it isn't okay to share the risks with formula? Yes, the mother has a choice in how she feeds her baby. She should be fully aware of the ramifications of that choice. It isn't always enough to sing the praises of breastmilk. Explaining the risks of formula is the only way for a mother to make an informed decision.

If we want to raise the rates of breastfeeding in this country we can't be afraid to speak the truth about formula. We know that if we increase the breastfeeding rates that healthcare costs go down. This is an important move. We need to stop being afraid of making mom feel bad. If we just gives facts we can't control if she feels bad. We give facts to the mom who is sending her child in for surgery and many times they feel bad but we still give the facts.

Here's an example....my daughter had an ng tube. She eventually moved to a gtube. I had the facts and I am actually the one who pushed to move to the gtube because she was having another surgery Her GI agreed to go with my request (which he later admitted was the right move). My husband didn't have all the facts. My daughter came home from the hospital with her gtube and my husband had a tremendous issue with guilt. He felt like a horrible parent allowing this to happen. He didn't have the information. Had he been fully informed...he would have had a better understanding.

We need informed consent.

morte, LPN, LVN · Jan 30, 2014

sooo, what do you do to/for the woman who refuses to sign such a piece of, er, info?