Bottles after 3 hours

[Dayray, RN]

It seems that our lactation nurses and the nursery nurses are at odds with each other. Many of the nursery nurses feel that a baby must eat Q 3- 4 or they will starve. Lactation takes the view (which I share) that babies do not need to be bottle feed, if Mom wants to breast feed, until 24 hours after birth or if the BG is low.

I have had allot new mothers in tears because the nursery nurse made them feel so terrible about breastfeeding.

2 weeks ago the nursery (with the support of our director) changed the feeding policy. Babies will now be bottle-feeding every 3 hours. If the mother is having trouble breastfeeding and is unable to breastfed, the baby will be given formula regardless of mother's wishes. Cup feeding, supplemental feeders, spoon feeding and all other alternative methods of feeding are not allowed unless done by a lactation specialist (of which there are only 2 and none on weekends or evenings) the only expectable feeding methods are bottle or gavage (sp?).

I was called into a meeting with the director, because I am known to be a "problem" when it comes to compliance with these new polices. In other words I take a little extra time to allow mom and baby to learn how to breastfeed. I was told that feeding is nursery's job and that sense I am a post pardom nurse (even though I'm a couplet nurse as well) I am to refer all questions regarding feeding to the nursery.

I know that most hospitals have an "us and them" attitude between NSY and L&D but I don't think my feelings are based on that. Our nursery is continually apathetic toward the mothers, they call them stupid (not to their faces), don't let them hold their babies, shove bottles in their faces and constantly complain about them. They seem to think that they care more about their babies then the mothers do.

I gave my director some examples of the things I have seen and her response was "well as a director what would you do? If everyone except a few people think one way and you, a new LPN think another way what would your decision be" My response was " I would do what was right for the patient". After that she listened to me a little more and admitted that I had some valid points but still said she was going to side with NSY and that I needed to communicate more with them.

I am not a confrontational person and have never argued with the NSY nurses, but I do work with patients and get them breastfeeding after NSY has given up.

I have been more careful but continue to teach my patients how to breast feed.. Iv only had a few rare cases that I was not able to get the baby latched after 1 shift. I know that eventually I will get caught and turned in but I feel I have to do what is in the best interest of my patient.

What do you guys think? Am I just being opinionated and causing problems?

What are your hospitals policies regarding feeding?

[fergus51]

Regardless of the mother's wishes?! That is absolutely outrageous. I would want to see some evidence that babies must be supplemented if mom doesn't breastfeed every 3 hours on the dot or I would challenge the policy. I have heard older nurses say they used to not feed babies at all in the first 24 hours so I find it unlikely a baby will starve if not fed every 3 hours. They are not machines on a schedule.

Our policies regarding feedings are that we keep mom and baby together under all but the most unusual circumstances and that the mom can either feed according to a schedule or feed on demand. We rarely supp bf babies unless they are having any medical problems or are losing a lot of weight. We normally try to supp with breast milk that mom gets from extra pumping after feeds, and only use formula in bottle feeding babies or when moms insist. When we do supp we usually avoid using a bottle and use an eye dropper or cup feeding instead.

[Anaclaire]

This is incredibly disturbing for me to hear!

Whatever happened to "evidence-based nursing practice"?!!!!!

Your lactation nurses should have TONS of literature in the form of studies written up in journals to use to show that term and near term babies need to be fed on demand rather than on a schedule with a bottle!!! It completely makes it nearly impossible for a baby to learn to breastfeed when being confused with a Mama nipple and a bottle nipple. They flow completely differently and the baby has to suck, breathe and swallow completely differently. Breastfeeding is more difficult but is clearly the better way to do things if possible... the studies prove it!!!

And where are your pediatricians in this? Don't they care about the parents wishes and the health of their newest patients?

The Le Leche League would probably have a fit if they were aware of your hospital's practices!

Let me restate, "Evidence-Based Nursing Practice" is the only thing you will have to save you from these barbaric practices. The proof is in the pudding and the pudding is in the studies in the journals. Check out MCN (Maternal Child Nursing), Mother-Baby Nursing Journal, Neonatal Network, AWOHN, etc.

I will also say I've worked in a Wellborn Nursery when we had a seperate Post-Partum unit. In 1991 we went along with the rest of the civilized world and combined to become a Mother-Baby Unit. No more Nursery nurses and Post-Partum nurses.... we all took care of adults and babies. It was rough at first as we all learned our new roles and how to care for our new patients, but after a year or two it all worked out great. Thank God in Heaven we had certified lactation nurses and pediatricians who agreed with the World Health Organization and the American Academy of Pediatrics to encourage breastfeeding for the first 12 months for all moms and babies that can do it.

God bless you!!!!

I wish I could say something to help you in your everyday work, but without changing the policies it looks like you will eventually end up getting in trouble for being a patient advocate... one of a nurses number one reasons for living is being a patient advocate.

Like I said, God bless you!!

Most sincerely,

Anaclaire

[memphispanda, RN]

I would be outraged as a parent if I was told the hospital was going to feed my baby by bottle because it was their policy. I would probably choose to go elsewhere to have my baby. My second child I was ADAMENT she would not have a bottle even though the doctor and everyone else insisted on it because she was extremely jaundiced. We ended up giving her an NG tube for extra fluids. The policy your hospital is setting up is detrimental to breastfeeding. Babies will be getting accustomed to the mechanics of sucking a bottle and the rate of successful breastfeeding will plummet. Contact La Leche League in your area for support of NOT having this policy. Do babies at this hospital not room in with mom?

[Anaclaire]

I do have one word of encouragement...

You can continue to encourage your moms to continue breastfeeding when they get home, and encourage them to read books on breastfeedng where they will be able to read for themselves the importance of keeping bottles away so as to not cause the "nipple confusion" problem. Hopefully when they get home they can become successful with the tips and practice you've helped them with. Anyway, most babies don't truly figure it all out until they are 2 to 3 full days old anyway. Also, encourage the breastfeeding moms to have their baby checked at the pediatricians office within a week of discharge just for a quick check-up rather than waiting for a 30 day routine check-up. I hope your pediatricians are asking their breastfeeding babies to come for their first checkups earlier than 2 weeks after discharge...

Just do the best you can. You are my hero!

God bless!

[ayemmeff]

Please,please continue to stand up for your patients!!! a nurse gave my first-born a bottle in his first 24 hours(with my husbands permission,not mine-i wasnt asked!and the nurse told my husband and mom,that the baby was "starving".At 9lb2oz and less than 8 hours old I DON'T THINK SO!)I am convinced that this was one of the reasons i was unable to get breast feeding established. i had a big hungry baby,and he learnt fast that it takes no effort to feed from a bottle! It took me 18 months to get over my disappointment(i also had a crash c-section so felt i was a failure in all directions) and even now,9 years to the day(Happy Birthday C.!) i still get the guilts!

You sound like a very caring,patient person,and i wish i'd had someone like you to stick up for me back then!!KEEP BATTLING ON!!!!!!

[OBNURSEHEATHER]

That's absolutely unbelievable! Regardless of what the parents want? Where are the pediatricians on this matter? That is so insane!

What a hindrance! Yes, you can continue to encourage moms to breastfeed when they leave, but I think the odds of them being successful decrease when you take their primary support, the nurses and lactation concusltants, out of the picture. They really need those first couple of days in the hospital to build a good foundation of what is a good feeding, latch, swallow, positioning, etc.

Do you have LC's there? WHere do they stand on this matter?

I wish I had some wonderful words of advice for you, but in all honesty, I couldn't work at a hospital that took so much power away from the mother.

Heather

[sbic56, BSN, RN]

Wow...what a load of crap! That manager of yours is totally misinformed. I would find out what the pediatricians want. They should certainly be able to override this hairbrained policy. It's downright irresponsible. The American Academy of Pediatrics has always endorsed breastfeeding over bottle. I'd definitely try to get this changed, but then I would gladly lose that job over it too...so be careful, but please do advocate for you patients on this one!

[Hardknox]

Where on earth is your hospital located? This bottle feeding policy is from the dark ages!!! I agree with everything everyone has said here. We only bottle fed if the infant had a low acucheck, required if the were unsuccessfully breast feeding. Most times the accuchecks were fine!!!

And where are the pedi's in all this? Ours are vehemently PRO breastfeeding and would never allow this policy to stand. God help you, you are fighting an uphill battle! I feel for the lactation consultants! This policy is NOT baby friendly and sabotages breastfeeding attempts. I would be a VERY unhappy Mom if I was at your facility. Keep fighting the good fight on behalf of these families.

Let's hope the posters at breastfeeding.com don't get ahold of this thread....:chuckle

[OBNURSEHEATHER]

:rotfl: :rotfl: :rotfl: :rotfl:

[mother/babyRN, RN]

These "breast feeding" moms that choose not to room in don't seem to me often, to be serious about it , HOWEVER, if anyone did ANYTHING to my child against my wishes, I would consider a lawsuit very seriously ( and this is from someone who breast fed AND was nearly wiped off the planet due to a med error, and DIDN"T sue) I have seen breast feeding infants who are not fed within that 24 hour time period, develop severe dehydration, though that is not the norm. I think there are no black and whites in this area. For instance, after having had 4 children, I know the lactation consultant is not totally on target, and neither is anyone else. I tell people to listen to all the varied teaching and opinions and do what best works for them an their children. We have no set policy on hourly intervals between feedings, although it shouldn't take a rocket scientist to figure out when a baby is hungry OR when he or she is too sleepy from jaundice or a low blood sugar, to act in that way...Nursing judgement goes a long way, and I can see both viewpoints, however NO ONE has the right to instigate such a stringent policy..

And, their are exceptions to every rule. If breast feeding moms are totally exhausted, cup or bottle feeding their children either pumped mild, which is optimal, or formula, which is not but won't kill them, is better than overstressing the mom, or causing her to give up nursing all together....And, in our case, it isn't unusual to have 7 to 10 babies in the nursery with no second. Who is going to feed all these babies every 3 hours? Not me, for sure....Are we going to force them to room in too? Just s/p csection, that isn't very safe with not enough staff to at least hand the children to their moms during the allotted time frame....This is nuts...

[canoehead, BSN, RN]

Feeding every three hours seems like overkill to me no matter how they are fed, what about that sleepy period that starts about an hour after birth and lasts up to 6 hours. I've had babies not really interested until they've had a good nap, and then they latch on like they've been doing it for days. Moms are going to feel like failures, and all because of what the hospital has been doing to their child behind their back...

Any hospital that makes up a policy with so little research, let alone the attitude you've experienced toward pt advocacy- I just couldn't deal with it. If you stay though, there is nothing wrong with photocopying some breastfeeding teaching materials and supplying moms with information and encouragement. Let them know that once they get home, with some privacy and patience they can do it.