baby friendly questions

[Rhee]

The hospital that I work at is in the process of becoming baby friendly, and I have some questions about how the baby friendly initiative is implemented in other hospitals.

I want to start by saying that I think that breastfeeding is a wonderful, healthy, mutually beneficial thing, but I wonder if the experience where I work is typical. If a patient says she intends to bottle feed, or a breastfeeding mother requests a bottle, we are supposed to try to persuade her to breastfeed. We've been given a script to follow that basically seems guilt inducing to me. We are supposed to use this script on everyone from a exclusively breastfeeding first time mother to a patient who has had her sixth baby and has supplemented every single child. I've had patient's tell me that they have asked for bottles and the previous nurse acted as though she didn't hear the question and some mothers actually crying and begging for bottles. I feel that my job is to help my patients do whatever it is that they want, not to guilt people into breastfeeding. I will go over the benefits of breastfeeding, how babies need to nurse frequently, how frequent nursing will encourage milk supply, I will tell my patients who want to supplement during the first 24 hours that it is not necessary, I will talk about baby's nutritional needs and stomach capacity . . . I will give my patients all the information I can, but I try to do it in an informative way. And this isn't good enough. If a patient is still requesting bottles, I don't feel that I should tell them no, but the next day our lactation consults are telling me (and other staff, too) that we should try harder and that we must be pushing formula. I will help my patients do whatever they want to do, but I refuse to tell them that formula is basically poison, which seems to be what the hospital wants.

I work at night and the other issue is the night time nursery. We are being asked to make our patients sign a waiver before their babies will be allowed in the nursery. The waiver lists an entire page of reasons why baby should room in and at the bottom it says something like "I would like my baby to be separated from me despite all of the benefits of rooming in. I give permission for my baby to go the nursery despite the fact that we will not receive the mutal benefits of rooming in." This form should only be given to parents once they've asked for their child to go to the nursery. I feel awful taking this waiver in to a sleep deprived woman with hormones surging through her body who has finally decided that it's okay to let us watch her baby between breastfeedings. There has to be a better way.

We have also been told that we will not be able to give out pacifiers even if parents ask for them in the near future. Pacifiers are only to be used for comfort during circumcisions and then thrown away.

For many people, they already feel guilty asking for a bottle or for the baby to go to the nursery. I don't really know what to say to parents who are literally so exhausted that they can't keep their eyes open or patients who have had the baby to breast so much that their nipples are so tender that they are crying. Since we've started going through the baby friendly process, we've had more babies dropped during the night, babies in bed with mothers--I found one baby half hanging off the bed next to it's mother's knees, and one completely covered with the blankets over its face next to its snoring mother. These situations are not typical, but we have been noticing that they are happening more and more frequently.

I don't think that formula and mandatory night nursery are the answer either, I feel that my patients are adults who should have the ability to make informed decisions. I would like to know what other nurses experiences with baby friendly are. I feel like the my hospital is taking it a bit far and that breastfeeding has become more important than anything else, it's almost become as if lactation services have more power (for lack of a better word) than anyone else, and the relationship between the LC's and the nurses has become so adversarial, to the point where they are telling our management that we are collecting the babies every night and taking them to the nursery to feed them bottles. Actually, it's easier for me if the baby is in the mother's room and she and dad are caring for the baby and feeding him or her and changing the diapers . . . the nursery isn't for my convenience, and most of my coworkers have this same opinion.

Anyway, I'm sorry this is so long, and I thank anyone who reads all my rambling and gives me some opinions and advice.

~Rhee

[babyktchr, BSN, RN]

I feel for you.....much of what you said is what I thought when we started the journey. It does feel as if lactation has become this giant entity and all else be damned. Even medically necessary feedings are being scrutinized by the LC. While I am all for breastfeeding and believe it is best, when will it be enough? There will be patients that insist on supplements and pacifiers (it is THEIR BABY, right?) and this certifiying body will scrutinize your every move. I am not all that fond of the name either. It somehow gives a derrogatory tone to those who choose not to breastfeed. If you are a bottle feeder are you somehow not baby friendly.

I have mixed emotions about the whole thing. I don't think you need to pay a lot of money for a certifcate that says you will promote breastfeeding. I think most do. I have no answers...just wanted to sympathize.

[mamabear85]

Not a nurse yet but I just watched my cousin go through something very similar as a new mother in the hospital. She looked like death warmed over 2 days after her c-section and was really trying to breastfeed. I said she should ask them to keep the baby in the nursery for one night so she could try to get some rest. She said she asked two nurses and they both said no. My heart broke for her and eventually one of her nurses said yes so she was able to get some relief. My cousin was made to feel like a horrible mother because she wanted one night apart from her son. I think hospitals are going too far especially when dealing with hormonal, exhausted mothers. Just my

[RunnerRN2015, ASN, RN]

Not a nurse yet but I just watched my cousin go through something very similar as a new mother in the hospital. She looked like death warmed over 2 days after her c-section and was really trying to breastfeed. I said she should ask them to keep the baby in the nursery for one night so she could try to get some rest. She said she asked two nurses and they both said no. My heart broke for her and eventually one of her nurses said yes so she was able to get some relief. My cousin was made to feel like a horrible mother because she wanted one night apart from her son. I think hospitals are going too far especially when dealing with hormonal, exhausted mothers. Just my

After my second son was born via c-section (not an easy delivery--I had a horrible reaction to the epidural, he had fluid in his lungs and needed time in the NICU) the nurse brought him to room in with me on the first night but I declined. I was feeling soooo sick and could barely take care of myself let alone be up all night with a newborn when I couldn't even sit up by myself yet. This momma needed her sleep!

[klone, MSN, RN]

I'm a board certified lactation consultant and am all for the Baby-Friendly Initiative, but the OP just has me going "Eww!" I think that's awful. Not all LCs are guilt-inducing fascists.

[melmarie23, MSN, RN]

I get being tired and all and wanting rest (I am a newish mommy too-my son is 7 months), but IMO having the baby sent out to the nursery sets a bad example. You don't just get to send your baby "out" when you take them home. You care for them around the clock. If you are lucky, which I hope most are, you have help at home with the baby duty. But rooming in is essentially what you do when you are home. And in terms of breastfeeding, it is preferable because it assists in feeding on demand, which in turn helps with milk production and sustainability and the duration and exclusivity of breast feeding.

Now do I think that after multiple requests by the mother to send the baby out for awhile should be repeatedly denied? No way. But you betcha that I am going to encourage that they remain in the room (and I can do so without being a jerk).

[tma0312]

I get being tired and all and wanting rest (I am a newish mommy too-my son is 7 months), but IMO having the baby sent out to the nursery sets a bad example. You don't just get to send your baby "out" when you take them home. You care for them around the clock. If you are lucky, which I hope most are, you have help at home with the baby duty. But rooming in is essentially what you do when you are home. And in terms of breastfeeding, it is preferable because it assists in feeding on demand, which in turn helps with milk production and sustainability and the duration and exclusivity of breast feeding.

Now do I think that after multiple requests by the mother to send the baby out for awhile should be repeatedly denied? No way. But you betcha that I am going to encourage that they remain in the room (and I can do so without being a jerk).

I think most mothers understand that they will be taking care of their baby 24/7 when they go home, but seriously....one night of getting a break after giving birth? Is that such a crime? Will the baby be detrimentally affected by this for the rest of their life? No, I don't think so. And as for breastfeeding, its THEIR CHOICE.

When it comes to patients who choose to refuse the way hospitals are providing care, I've given up making them feel guilty. It doesn't work. I educate them and move on. It is not our place to assert our own values on to other people.

[LaughingRN]

I think that because birth is suppose to be a natural process, a lot of people forget that the "westernized birth" sometimes is not.

I mean, a C-section is major abdominal surgery.

Anyone who has had abdominal surgery should very easily understand this, and this goes beyond having a laproscopic procedure...This is an open abdominal surgery.

Sometimes I think society tries so hard to recreate a "natural environment" in the hospital that we are throwing the baby out with the bath water.

Some women, simply need a break and a little help.

Btw, I roomed in with my son after a lady partsl delivery, and on the second night I was emotionally exhausted, physically exhausted and sore from all those dang sutures...and alone.

Hospital visiting hours over, I became desperate at one point because I didn't know what I was doing, it was dark, and my son wouldn't stop crying. This hospital didn't even have a nursery, and the nurses were matter of fact about telling me that I had to deal with it.....I feel that at least if I had been at home, I would have been surrounded by mom's, grandparents, sisters and friends to help out.

[feisty]

I was going to write a long post on my observations, but I have decided against it. I will say that each couplet is different and one broad approach is not always baby friendly. Will be interested in the longterm results of this. Will there be an increase in incidents when the mother is suffering from extreme fatigue? Will a positive result occur? Will we see larger numbers of successful breastfeeding? I guess time will tell.

[Esme12, ASN, BSN, RN]

In the history of giving birth....women were put to bed by the female members of the family and the female mambers cared for the infant until the mother was strong enough and recovered enough from delivery and brought the infant when the mother requested. While the family cared for the household.

I breastfed both of my children and that was my personal choice. After delivery I roomed with both of my children but on the first night I did sent my baby back to the nursery for a few hours after taking 2 percocet for my fourth degree tear, episotomy and cervical tear from my 11 lb precipitious delivery of, I live far from family... and my husband ahd taken our 11 month old daughter home....so I was alone. Why should I be bullied by another nurse by making me sign a waiver that I would rather not bond with my child? I tell you what....If I was ever given that by a hospital I would start a one man smear campagin against that facility. What about the bill of rights and the right to refuse. Wow, as a nurse I'm not sure I could comply with this mandate if I was employed there....I'd probably start looking for another job.

"I would like my baby to be separated from me despite all of the benefits of rooming in. I give permission for my baby to go the nursery despite the fact that we will not receive the mutal benefits of rooming in."

Really???? Wow.....talk about intimidation tactics......

When did some nurses get the right to bully people into our beliefs. I find this "Baby Friendly" an agenda a bit extreme. If I listened to La Leche League I'd still be breast feeding my son at 14. I take issue with ANYONE shoving their agenda down my throat because THEY believe it's better.

I think some nurses need to be very careful to encourage healthy choices through education and support and not shove their personal biases and agendas down someone's throat because we know we are right. It sounds to me like your lactation consultant isn't promoting health and good habits for a healthy baby......she has an agenda and she going to use any platform she can to shove it down anyones throat. I get the "baby friendly" stuff but I still have the right to give my kid a pacifier it I so choose....it's my child right????

I have to say I would NOT have a child in that enviroment that bullied instead of nurtured it's beliefs and as a nurse......I think I would have to find another hospital to be employed by with a less militant approach that nurtured it's patients not bullied them.

OP ........I feel for you as I can see you are conflicted. YOu want to encourage what is the best practice but agree it's a personal choice and one night in the nursery beats an exhausted Mommy and an injured baby on the floor. I feel for your dilemma........:heartbeat I don't have any advice other than follow your gut:hug:.

[mamabear85]

I'm sorry if this is a dumb question- Is there a database of these "baby friendly" hospitals? I would love to know this before I have my next child, I don't think I would want to deliver in that environment.

[Twinmom06, ASN, APN]

the hospital I delivered in 5 years ago would not allow you to room in with your baby at night - if you were breastfeeding they'd bring you the baby every 2-3 hours to nurse and then take the baby back to the nursery for diaper changes etc...they apparently had one too many dropped babies due to maternal fatigue...

as for shoving bf'ing down my throat - never would have happened - while I give kudos to any mother that wants to breastfeed - was not for me - and I would have brought in my own bottles and formula if I had to...