Baby Friendly- getting a tad over the top

[PeepnBiscuitsRN]

My hospital is working toward becoming baby friendly. This entails that we promote rooming-in and breastfeeding, which I have no problem at all with- what I do have a problem with is how we are being presented with it- and how we must now interact with our patients. Our patients come from a very diverse spectrum of cultures who are set in their ways and I guess I don't really feel it's my place to be like "well welcome to America- this is how we do it, too bad so sad."

We have been ordered to move all formula, nipples and pacifiers to the back room of the nursery (which has also undergone a name change to make it less accessible and friendly sounding) so that NOBODY sees it, patients or family. We don't want them to think we promote formula or artificial nipples. We are instructed now to council every mother who has chosen to formula feed, or do breast/bottle combo on the "dangers of feeding formula to your baby". Yes, these very words were uttered and in writing. There's serious talk of making the mother sign an informed consent before giving the baby any formula- acknowledging that she is aware that she is causing harm to her baby by giving him/her formula, and that they understand that breast milk is superior to formula.

We must extensively chart WHY mom is choosing formula. We have to now keep all the shades in the nursery down so that people don't look in, and THINK it's a nursery and again to make it an in-accessible place.

This really seems out of hand to me. I love where I work, I love the field but boy, we are in for some troubles when a mom from another culture other than white-upper class wants to put their baby in the nursery so they can sleep, or can go for a walk, or wants to formula feed and then gets a 20 minute lecture implying that they're a bad mom for choosing this method. Is this true of any other hospitals out there that are baby friendly or are in the process? I feel like they're trying to brainwash us, or like it's becoming a cult-like atmosphere!

[morte, LPN, LVN]

this decision should have been before they were ever admitted, if someone approached me the way you sound/come across here on AN, they would be told to leave my room and not let the door hit your orifice.

this is intended for irish....

[IrishIzCPNP, MSN, RN, APRN, NP]

this decision should have been before they were ever admitted if someone approached me the way you sound/come across here on AN, they would be told to leave my room and not let the door hit your orifice. this is intended for irish....[/quote']

You have no idea what I sound like via a computer. Patients do not come in knowing the risks of formula. They also very rarely have accurate information about breastfeeding.

So it's simple...want formula you get it after a very brief conversation about risks without any pushing one way or the other. You sign form...you get formula. Done.

You can't tell how I speak to patients by anything posted here....especially when I've only said you provide facts, remain unbiased and then move to the next step. We need to have informed consent just like anything else.

I don't care what you feed your kid. You have to decide what you are okay with.

[nursel56]

Is this something your pediatricians are on board with as well? Seems like the groundwork as far as mom's attitudes and needs for education and help would make a much happier launch of the new mom/baby relationship.

[Spidey's mom, ADN, BSN, RN]

Baby Friendly happened at our small rural hospital over 10 years ago but we were not given a script and we snuck pacifiers out to some moms and had formula too.

I'm a huge proponent of breastfeeding but dislike the undo pressure I sometimes see put on new moms to not use formula and only breastfeed.

My daughter-in-law had a baby two months ago and knew ahead of time she might have problems breastfeeding due to a previous breast-reduction surgery. But she wanted to try. After 4 days and an 11 ounce weight loss plus mommy-exhaustion, her mom and sister sent her upstairs to bed along with my son and took care of the baby by feeding that kid some formula!

She's doing both now - breastfeeding first and then she does what she calls "topping off" with formula. The baby is fine.

We don't have a staffed nursery at our hospital so babies have to stay with mom. Our little "nursery" is where the baby gets a bath and weighed and measured and the boys get circ'd. There is a rocking chair in there and when it is slow, I have been known to take the baby for vital signs and then rock the baby to sleep. Then I quietly slip the baby back into the room where the sleeping parents lay. We try to give them a break.

[IrishIzCPNP, MSN, RN, APRN, NP]

Baby Friendly happened at our small rural hospital over 10 years ago but we were not given a script and we snuck pacifiers out to some moms and had formula too.

I'm a huge proponent of breastfeeding but dislike the undo pressure I sometimes see put on new moms to not use formula and only breastfeed.

My daughter-in-law had a baby two months ago and knew ahead of time she might have problems breastfeeding due to a previous breast-reduction surgery. But she wanted to try. After 4 days and an 11 ounce weight loss plus mommy-exhaustion, her mom and sister sent her upstairs to bed along with my son and took care of the baby by feeding that kid some formula!

She's doing both now - breastfeeding first and then she does what she calls "topping off" with formula. The baby is fine.

We don't have a staffed nursery at our hospital so babies have to stay with mom. Our little "nursery" is where the baby gets a bath and weighed and measured and the boys get circ'd. There is a rocking chair in there and when it is slow, I have been known to take the baby for vital signs and then rock the baby to sleep. Then I quietly slip the baby back into the room where the sleeping parents lay. We try to give them a break.

And this is a great example of breastfeeding issues...an 11 ounce loss isn't a meaningful piece of information. The baby's initial weight needs to be know, the amount of fluids given to mom in labor needs to be considered before looking at weight loss.

Also, "topping off" is a great way to ruin the breastfeeding relationship. If she wants to use formula...that's fine. If she wants to have continued to success with breastfeeding she needs to be careful with "topping off" because you can over-feed a baby and you can stretch their small stomachs. The baby should be able to get all the baby needs at the breast...if baby can't it is important to try and determine the issue whether it be a supply issue or an anatomical issue with either mom or baby.

That fact that the kid is fine isn't a reason to not educate parents. This is all about ensuring parents are making an educated decision.

The reality is that moms should be given more information at their OB appointments about breastfeeding and formula feeding...but sadly they aren't. So many moms come to the labor floor with a decision they made based off of information from a friend or a relative or something they found on google. These moms haven't been told the risks of formula. They also haven't been told ways to support their breastfeeding relationship if they decide to breastfeed. There is a lot of sabotage at the hospital level for breastfeeding moms and that is another key to the BFI...remove the barriers and the sabotage so that we can have more breastfeeding success.

Formula is still there. Moms just get to make an educated decision...just like every other medical issue they will be faced with in their life or their child's life. We do need to make sure the information is presented as factual and not biased. We need to make sure that after mom is given the information and she has signed the consent form that we then support her with formula feeding and give her the tools to use the formula properly.

The key is we are working towards educating these moms so they make an informed decision and also supporting and encouraging breastfeeding because we know the benefits.

[klone, MSN, RN]

Providing factual information on the health risks involved with not breastfeeding is NOT berating, calling someone a horrible person or making them feel guilty. Just as providing factual information that the risks to routine circumcision involve infection and hemorrhage is not berating, calling them a horrible parent for choosing it, or making them feel guilty. It's simply providing factual, unbiased informed consent on their choice. If they then choose to formula feed, awesome! I will hand them a bottle of formula and show them how to do it with a smile on my face. I have no dog in the race, my job is simply to provide information so parents can make a choice, and then support them in the choice that they make. Nothing more or less.

[Jolie, BSN]

All you want to do is list the risks just like you list the risks with medications or surgery. You do not talk about them being a bad mom or negligent or anything like that. You want to simple state the risks. Very fact based...leave opinion out of it.[/quote

I am asking how YOU present this information. Specifically what are the risks of formula use? Do they differ with supplementation versus exclusive formula feeding? Do the risks differ depending upon the age at which formula is introduced?

How do you counsel parents with special health considerations for whom breast feeding is contraindicated? (HIV, certain maternal medications, infants with severely restricted diets?)

What resources do you cite when teaching the dangers of formula use? Do you have handouts? A bibliography? A nutrition or pediatric text or website?

[mander]

I feel bad for all the moms who have some condition in which they can't breastfeed. I would feel like the smallest person in the world if I went past a room and heard a nurse lecturing someone about the "dangers of formula feeding."

[IrishIzCPNP, MSN, RN, APRN, NP]

I feel bad for all the moms who have some condition in which they can't breastfeed. I would feel like the smallest person in the world if I went past a room and heard a nurse lecturing someone about the "dangers of formula feeding."

It isn't lecture.

I can't understand why we are okay with people making uneducated decisions with this aspect of healthcare.

[IrishIzCPNP, MSN, RN, APRN, NP]

I apologize I didn't realize you wanted something that specific.

I can't provide it at this moment but I will so my best to get you something tomorrow.

I personally am not working in a baby friendly hospital so the education isn't expected. I can tell you what I would say. I also can't say that I would have a handout as I'm not working at a baby friendly hospital and I'm certainly not allowed to hand out whatever I want. I would expect a hospital to have a document or pamphlet for parents and it would be expected that it would provide information from reputable sources.

[Nineteen84]

Seriously? So because you think that some of the studies are biased and that healthcare is cheaper for upper middle class that maybe breastfeeding doesn't have the benefits? Seriously? Plus, this isn't just about the benefits of breastmilk but also about the risks that are associated with formula feeding. We know these risks are valid.

Woah, woah. Let's break this down another way... It's fact that prenatal care reduces infant mortality. Is it a coincidence that places with better prenatal care have higher incomes? Or that mothers with access to more financial resources get better prenatal care and thus have healthier infants? And that those same mothers are more likely to breastfeed for a longer period of time? I'm not saying breastmilk isn't the best option (it is). I am saying that studies frequently tie a direct link to breastfeeding and healthy babies when there are many many other factors in play. As nurses we have to look at our patients as whole people and not push our perfect world scenario on them when those ideals are unrealistic for their situation or when our agendas just aren't the same as theirs.

[Elle23]

Hey, I was fed cow's milk straight from the fridge as a baby, and somehow I lived to tell about it.

(Though I do admit to still wondering 40 years later what ON EARTH my mom was thinking...)