Our hospital is just beginning to look at becoming baby friendly. I personally don't have much hope in our achieving such status because of our "baby goes to the nursery" policy. We have a hard time getting babies back out of the nursery once they go in, nursery nurses here are generally more interested in following their protocols than in getting babies to the breast.
Anyone here got baby friendly status? How did you do it?
Notice I said, " if a breastfeeding mom" chooses to supplement.... what I am saying, by just one example, is that we have mom's who breastfeed first and then choose to supplement right after bfg. until their milk comes in. Many of these mom's have done this with each child, no problems when switching to breast only. If our county, ( not private )hospital becomes "baby friendly" then these moms will not be allowed to give formula unless medically indicated. To deny the mother her right to feed her baby however she wants, whatever her reason, is very disturbing to me.
Specializes in Nurse Leader specializing in Labor & Delivery.
The *mom* can choose to feed her baby however she wants. She may have to bring her own formula from home. Once again, nobody can FORCE a woman to breastfeed her baby.
HOSPITAL PERSONNEL cannot give babies anything other than breastmilk unless medically indicated.
Specializes in Emergency Dept. Trauma. Pediatrics.
Our hospital is baby friendly, I don't know what all went into it because I am a student and I just did my clinicals in L&D and WCU so we were told alot about what it means but that's it. Anyway, we highly encourage breastfeeding but they don't impose on a mothers choice and will follow what she wants and we have formula of all types if she does go that route. We have a lot of education and a program called WeeSteps that is free and does follow up care with RN's and breastfeeding help after mom is released for as long as she needs. They don't accept anything from drug rep companies and don't promote formula feeding but again, they don't deny or guilt about it either. They do rooming in with the baby and if mom wants baby to go to nursery a lot of education is given. In the end if mom still says she doesn't care and she wants baby in the nursery they will follow it for short periods of time so mom can rest.
Here is a suggestion of something that you could initiate that might help your hospital get just a little closer to being "baby-friendly". It might take some time and convincing of your coworkers, but with the right presentation, you could succeed. In the last year at the large hospital I work at, we initiated and promoted skin-to-skin with baby for the FIRST HOUR of life. We discuss it with mom on admission, explain reasons for doing it (promotes bonding, helps with successful breastfeeding, eases transition, calms baby......) and almost EVERY mom wants to do it. I don't want you to think that this change came easily....it did not! Nurses who were used to whisking the baby off to the warmer for immediate head-to-toe and shots and footprints, weights and measurements initially had a hard time warming up to this. Doctors who wanted to fill in there progress notes with baby stats learned to wait. There are still a few nurses and doctors who begrudgingly go along. But the response from moms and families has been so positive that this is now our new "norm". Don't give up! Even if this is all you do and the baby still "needs" to go to newborn nursery, at least you've done something to help this couplet start out right.
Specializes in Geriatrics, L&D, Medsurg, Mom/Baby.
We are in the process and it has been a bumpy road. We get to deal with starving Infants during the night. I don't care what the experts say. I know a hungry baby when I see one and many ARE hungry. Not all mom's produce colostrum right away... the ones who are able to pump 10 ML's the day of delivery are few, but their Infants are the happiest. During the day, lactation is there, at night the Nurses have to deal with many issues, concerning breast feeding, ON top of our regular duties... when you have a mom who just had a c section, cant get OOB, and has been told formula is basically poison and paci's are evil... you are in a terrible situation. Count on spending a lot of time in her room.
I work in the NICU of a baby friendly hospital. I can't say which one or it will become obvious who I am and my opinion is NOT popular.
I do support keeping baby in mom's room when possible, and getting baby skin to skin within the first hour of birth along with putting baby to breast during that hour. The longer you wait to breastfeed, the harder it is to do it.
After working there for three years and having my own child there, I think the hospital has lost all sense of why we sought baby friendly status in the first place...which was to do what was best for infants and their families.
Mothers who arrive in labor at the hospital are being harassed about their feeding choices. Yes, I am sure you will convince that woman who takes Lithium to switch from formula to breastfeeding while she is in the throes of active labor. I am sure her OB, Psychiatrist, and therapist would love to hear that bipolar disorder can be controlled by breastfeeding. I almost fainted when I heard the LC say that. (there are mood stabilizers that can be used in breastfeeding, but they don't work for the mom, read the chart) The poor mom was in tears, because Lithium is the only thing that controls her disorder and she didn't want to risk another crippling postpartum depression.
Half of the time moms love our extensive lactation help, therefore I love it. The other half of the time I have the mothers of my primary patients in NICU ask me to never tell lactation dept that they are in their child's room, that they are being told that if they loved their children they wouldn't mind the sacrifice of pumping every three hours with no sleep breaks. I explain that frequent emptying of the breasts is what drives milk production and if they take a sleep break at night they must pump even more during the day to keep the same supply. I suggest they use a pumping log to see if the altered pump schedule is hurting or helping supply. If the baby can go to breast at all I maximize that opportunity, the baby is better than the pump.
Moms with delayed onset of lactation are told that their child won't learn the breast if they bottle supplement while waiting for milk to come in. Yes, because when I get a readmit who has lost 15 percent of birth weight and has a bili of 22 while fingerfeeding for 5 days that is a desired outcome, right? The SNS would have helped here...but mom was told to only use 10 cc in it per feed....
I support baby at the breast, but I just can't say breastfeeding comes before all else. I sure hope other Baby Friendly hospitals are better at it that we are.
We are in the process and it has been a bumpy road. We get to deal with starving Infants during the night. I don't care what the experts say. I know a hungry baby when I see one and many ARE hungry. Not all mom's produce colostrum right away... the ones who are able to pump 10 ML's the day of delivery are few, but their Infants are the happiest. During the day, lactation is there, at night the Nurses have to deal with many issues, concerning breast feeding, ON top of our regular duties... when you have a mom who just had a c section, cant get OOB, and has been told formula is basically poison and paci's are evil... you are in a terrible situation. Count on spending a lot of time in her room.
At last, someone who has observed the same thing I have.Breast fed only babies are starving in those first couple of days before the milk comes in. (See my first post.) When was the last time the "experts" worked night nursery?
The only Baby Friendly hospitals that possibly could be succeeding are those where the moms know what is involved and are willing to make the sacrifice.
At our hospital, moms (most are indigent and uneducated) haven't got a clue what's going to happen to them if they say they want to breastfeed. The fact is, most of them want to do both (breast and bottle) and don't realize their wishes will not be respected by our one lactation nurse, who literally forces her will over the wishes of the mother by discouraging the mom from supplementing,with all the so called " horror stories" of bottle feeding, pacifiers, etc.
As I stated in my first post, the Baby Friendly movement is just another attempt by an organization to take away a woman's right to feed her infant the way she wants. They may say they are not forcing a woman to breastfeed only, but when you forbid formula except for medical reasons, I call that taking away her choice and thereby forcing her to comply, at least while she's in the hospital.
Seems our once great country that respected the rights of the individual is slowly, but surely moving to becoming a nanny state. Notice that most of the countries that have Baby Friendly hospitals are countries with socialized medicine. What does that tell you?
I work on a mother baby unit in a hospital that is increasingly more baby friendly. We have a seperate L&D unit, but mother and baby are transferred together unless there is a NICU admission or a maternal special care admission (once mom is stablized, baby can stay with mom). I think becoming a baby friendly hospital is a slow process that involves changes over months, if not years.
At delivery, babies are placed skin to skin and babies temp is taken while baby is on mom's abdomen. After roughly an hour of skin to skin and breastfeeding initiation, baby will be weighed, measured, given vit k (if mom desires) and any necessary labs done (at mom's bedside). After 2 - 3 hours, couplets are transferred to our unit. Until about a year ago, infants were whisked to the nursery for an assessment. Now, moms and babies go to their room together and initial assessments are bedside. On some occasions, a baby may need to go to the nursery for an O2 check. We are now in the process of starting to perform baths (which are done 6 hours post delivery) at the mom's bedside and then put in skin to skin for warming. I think these are wonderful things, but many mothers do not comply with kangaroo care, which makes me nervous. All in all I think it is a change in culture (nurses, patients, physicians, etc) that will take some time, but will reward us all with multiple benefits.
Is there anyone out there who can give me an unbiased answer as to why breastfed only babies are screaming their heads off by day 2? Like Daisy Child said, she knows a hungry baby when she sees one and so do I. When babies are frantically sucking their fists, crying incessantly, and not sleeping, even when they have been on the breast for sufficient time, then what do you call that? If they aren't super hungry, then why, when the mom finally gives formula because she is exhausted and in pain,does the baby suck so vigorously, it could drink the whole bottle down in about a minute?
Specializes in Nurse Leader specializing in Labor & Delivery.
Certainly. This is a cut and paste of what I wrote in a different thread ("torn about breastfeeding", a few pages back):
Yes, it is statistically true that babies who are supplemented generally aren't nursed as long, or that their moms give up because their milk supply is not adequate (either real or perceived).
Are you certain that these babies are latched on correctly? When they nurse, are you hearing and seeing active sucking *and* swallowing? Are you teaching the moms to use an asymmetrical latch (nipple pointed towards the roof of the mouth)?
Babies like to suck. And colostrum, while perfectly adequate for their nutritional needs for the first few days, is low in volume. So it stands to reason that those babies may need to eat much more frequently.
If you ate a small snack, say a handful of peanuts or blueberries, you will get hungry again soon after. If that's all you're eating, you will need to eat it every hour or two in order to feel satiated. OTOH, if you eat a Big Mac and supersized fries, then you're probably not going to be hungry again for several hours.
Wanting to nurse frequently is not a failure of breastfeeding, it's a simple fact of breastfeeding, especially in those early days. Babies who are supplemented may SLEEP longer, but that doesn't mean that they're "doing better."
Unless there is a medical need for supplementation (too much weight loss, high bilirubin levels) then IMO you're doing a disservice to these moms by supplementing their babies. You're sending them the message that their breastmilk is not adequate. And in the cases where supplementation IS medically indicated, the root cause needs to be addressed and fixed, the mother should also be pumping to preserve milk supply.
If the baby is fussing and rooting after an hour of breastfeeding and the mom needs some rest, ask if you can give baby a pacifier. Or take a gloved finger and let baby suck on your finger. I will try to appease the baby for about an hour that way, but if baby is still acting like he needs to eat, I will bring him back out to mom and explain that baby really needs her. I will assist with latch, making sure that baby is latching correctly, and I will point out to mom when I hear/see a swallow, assuring her that means baby just got a mouthful of milk. Sometimes just letting these moms know that what they're going through is normal, and baby is not starving and IS getting milk, but that it's in small quantities at first and therefore needs to eat frequently, will give her the self-confidence she needs. These moms who insist they are "not producing anything" I like to actually hand express some colostrum (with her permission). When they see the colostrum bead up on their nipple, they almost always react with amazement. Yes, there IS stuff in there!
Also want to add - when a mom says "he nursed for an hour!" did he actually NURSE for an hour, or was he asleep at the breast with the nipple in his mouth for an hour? Newborns are VERY flow dependent - when it slows down, they fall asleep. Making sure the baby is latched correctly, and teaching the mom breast compression, will help make sure the baby is actually actively nursing, not just dozing at the breast.
Here's a link to the explanation of breast compression - teaching this to your moms is a very valuable tool to help baby get more milk and be satisfied for longer after feedings: Breast Compression
WRT babies "guzzling down a bottle in a minute"
Many times during a baby's fussy time they will refuse the breast. After several frustrating attempts at nursing, the parents may "break down" and offer a bottle of expressed breastmilk or formula thinking that the fussiness is related to low supply or something wrong with mom's milk. Kathy gives a better understanding of this particular concern here, as well as explaining what happens when baby is offered a bottle and "guzzles" it down:
Parents who don't know this is "normal" frequently respond as you did by giving a bottle because they think the baby isn't "happy or satisfied" with the breast. When the bottle goes in the baby's mouth the mouth fills with milk, the baby is obligated to swallow and the action of swallowing initiates another suck. The suck again fills the mouth and the cycle repeats, giving an appearance of the baby "gulping the bottle down hungrily".
This of course only contributes to mom and dad's fear that the baby wasn't getting enough at the breast and they keep offering more and more bottles (understandably). Which then causes a true low milk supply. Often the baby falls asleep peacefully after this episode which also reinforces to the parents that the bottle was just what the baby needed. What has really happened is the baby has by coincidence come to the natural conclusion of the fussy spell (most parents give the bottle as a last resort which means the fussiness has been going on for awhile) and/or the baby has withdrawn because "gulping" down the bottle was actually stressful and NOT what the baby wanted but she could not stop the flow, so exhausted, she falls asleep. So don't offer bottles during any fussy time.
A baby's stomach capacity in the first two days is only about 7-15 ml. So clearly, while a baby MAY guzzle down an entire RTF bottle provided by the hospital (60 ml), that doesn't mean the baby actually NEEDED or WANTED that entire bottle. By day 3, infant stomach capacity increases to about 25 ml. Again, WAY less than a bottle of formula.
Like I said above, "at the breast" does NOT mean "getting breastmilk." Breastfeeding, especially in the first several days before secondary milk production really kicks in, really needs to be an interactive activity, with the mother keeping baby actively sucking. A newborn who is not getting a flow of milk will fall asleep. But that baby may still be "at the breast" as you said. Doesn't mean baby is actually getting anything though.
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klone, MSN, RN
14,857 Posts
If a mom is not breastfeeding, then formula would be medically indicated. The baby has to eat.
Nobody can force a woman to breastfeed.