Bottles after 3 hours

[Dayray]

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?

[mark_LD_RN]

You Go DayRAy!

keep fighting for your patients rights they have the right to refuse. I never give babies bottles or pacifiers with out parent's consent. It is totaly ridiculous to say a healthy baby is starving at 8 -12 hours of age. Hell i see some sleepy ones for 24 hours or so before they wake up and nurse. I usually don't worry until after 24 hours unless the baby shows signs of dehydration distress or hunger. even then i may suggest the let us feed it with a syringe depending on how baby is latching.

I have had to many have diffuculty breast feeding after getting a bottle. nipple confusion does happen( not with all babies, it seems to just happen with the ones that are already having problems or are not good suckers).

Dayray i know the feeling of someone giving a bottle to a baby you have been working so hard with. just recently I had a breast feeding mom i worked with all night finally got the baby to nurse, well i came back that night and mom was in tears baby was not nursing would latch suck 2-3 times and cry. come to find out nursery nurses during the day gave it a bottle 2 times during the day. so it left me to fight with the problem all over again. in the end baby did fine and nursed, i let the nursery nurse have it and told my manager about it. and put one of my signs on the crib. "NO BOTTLES ALLOWED"

DAYRAY keep us posted i am curious to see how that turns out. I would love to take a tour of your hospital one day just to see what it is like,and to meet you:)

[KELLYGIRL]

2 WORDS "NIPPLE CONFUSION" - -

"OK, IF THE BABY DOESN'T BREASTFEED....HMMM....LET'S GIVE IT A BOTTLE......THEN WHEN HE'S DONE....HMMM....PUT A PACIFIER IN HIS MOUTH TO REALLY SCREW HIM UP!!!"

WTF

[mother/babyRN, RN]

None of my four kids ever had a problem doing both when I had to go to work....AND, we have docs coming from huge facilities to pick up our bad babies who ENCOURAGE these moms to introduce a bottle in the first 6 weeks every once in a while so the baby can figure out how to do both.....No offense to the guys, but though I find it great that you are such advocates, until you actually breast feed someone and "been there done that" you have a little less to go on.

Personally, if a pt takes out an iv and refuses to have it put back in, you are not, if this pt is alert and oriented, going to chase him or her down and stick a needle back in their arm. You are, however, going to do your level best to explain why this IV is necessary and promote this pts health. If the pt continues to refuse, or then,God forbid, signs out AMA, the police aren't going to be called (usually), and the world isn't going to stop...I am merely promoting personal decision. If a mom wants to have some rest time, so be it, AFTER I give the heartfelt spiel and info about what is best. I then document everything I said or taught, and her reaction to it....In this area, we have Puerto Rican and latina/Asian women who tell us they are breast and bottle feeding (just as their mothers and grandmothers before them). They do both though the breast feeding facet is thankfully, the main component. They tell us this is a cultural thing because all the family cares for the infant...It happens so often that they know our speech before we give it, and we respect what their culture dictates. I know I sound as though I am against exclusive breast feeding. I am not and did it as often as I could personally before finances snuck into the equasion, however, I have been a nurse long enough to be a pt advocate in unpopular areas as well, and "pushing" exclusivity on to someone who is too exhausted or upset to follow it, is NOT a good nursing (no pun intended) policy.....That is all I was trying to convey...I think it is great when we are successful totally...Individualism has been the lesson of my career...THAT is what I strive for and promote. Pt advocacy comes in all ways, shapes and colors....Breast feeding included...And I don't ever do anything the parent doesn't want or give permission for. I would never introduce a pacifier ( we don't even carry them) or supplement a child without consent, and then not until I have done as much teaching as possible to the contrary. I will also not remove a pacifier a parent has brought in, or "push" something on a pt in tears or just attempting to breast feed because her husband, mother or significant other wanted them to. If I suspect that particular scenario, which unfortunately happens often enough for me to be concerned, I simply relate that breast feeding is doomed if it wasn't her idea...That is the truth for sure....New borns are hopefully a source of enjoyement....We try to make it so as much as possible......

[mother/babyRN, RN]

kelly girl...."Nipple confusion" is a misnomer invented by a lactation consultant who perhaps feels much the same you do by your above "WTF" post.....I imagine you haven't been a nurse for a couple of decades so can be forgiven.. And, as one psychologist once humorously told me, if an infant is "confused", how the hell do you measure that? Probably the same way they would measure the scale of pain (1-10) a baby has after a circ, simply by asking...) I didn't intent to introduce an idea that you needed to attack, but hey, that is how many of our lactation consultants are and THAT is why many people STOP breast feeding exclusively. No one wants to be railroaded or felt they are forced into one way or another.....Thanks for the "lovely" point, however.....(however wrong or misguided it might be...)

[mark_LD_RN]

I see we disagree on a couple of points mother baby:)

you know i don't buy the line that i am at a disadvantage by not having nursed, i do not believe a person needs to experience something to be able to do it or relate to it. I have the highest success rate and satisfaction ratings on my unit. and after doing much research,helping many patients, and listening to their views. as well as going through it with my wife with all 3 of our children( by the way she had every imaginable breast feeding problem so i got a lot of experience from her) also get a lot of input from her first hand. I feel all this considered I am just as capable as any female to assist wit hbreastfeeding ,and better than a lot of them actually. because i actually care and want whats best for my patient.

on the topic of nipple confusion i know that is just a term made up by lactation consultants but it fits even if in is not totally accurate.

I think you have missed the point here, we are not forcing exclusivity here . i especially do not. what we are talking about is the patients wishes and rights. most of my patients come in that want to breast feed with the idea they do not want to supplement. if that is their wish I will make sure it is honored. It is wrong to slip a baby a bottle or pacifer against the parents wishes.

can you honestly say you have never had a baby that was diffucult to get to breast feed, that giving it a bottle just made it worse?

when a bottle or supplementation is needed i explain why and ask permission. my patients trust me and usually will do as i suggest.

the patient that was in tears i was refering to, was in tears because breast feeding was not going well. after baby was given a bottle. you see by slipping the baby a bottle that nurse was not being the patient advocate. that is my whole problem with this policy at dayrays hospital.

we too have a large asian population and the ones by us will not breastfeed in the hospital they bottle feed in hospital and breast at home supposedly. I have no problem with it. i do my teaching for both bottle and breast. I never force my veiws on anyone. ( forcing ones views on a patient is a sore subject for me as you might be able to tell from my posts.)

we need to always remember the patient has rights even if we do not agree with them. in the end i want to make sure each persons experience was as good as it could be:)

[SmilingBluEyes]

Originally posted by mark_LD_RN

I I have the highest success rate and satisfaction ratings on my unit. on the topic of nipple confusion i know that is just a term made up by lactation consultants but it fits even if in is not totally accurate.

:)

I agree, Mark. To say a man cannot relate to Obstetric nursing or Breastfeeding issues is really equivalent to saying we must personally experience an MI in order to be effective CV ICU nurses! Ridiculous. Just curious, how they track NURSE BF satisfaction/success rates at your institution? I have never been a place this was done. NOT challenging you, just asking cause I have never heard of it done! Thanks!:)

[SmilingBluEyes]

Originally posted by KELLYGIRL

2 WORDS "NIPPLE CONFUSION" - -

"OK, IF THE BABY DOESN'T BREASTFEED....HMMM....LET'S GIVE IT A BOTTLE......THEN WHEN HE'S DONE....HMMM....PUT A PACIFIER IN HIS MOUTH TO REALLY SCREW HIM UP!!!"

WTF

will ya PUUUHLEEZE turn OFF those capitals?????? THANK you.

[SmilingBluEyes]

Originally posted by vashka25

(*pardon my inexperience as I'm only a student*)

Oy what a row this will create when I bring it up in conference on Sat....

NO such thing as "only a student" cause we are all one another's teachers...and I have LEARNED things from student and grad nurses. I am always open to learn!

[mark_LD_RN]

we have an follow up survey done it covers a lot ot topics from hospital stay,experience with hospital, staff etc. also questions about baby and feeding. as well as a bunch of other questions. our patients fill out a short one page survey upon discharge as well as one mailed to them couple weeks later and a telephone follow up survey which also allows them to ask questions, by the way it is an RN that makes all the calls and if needed we can refer the patient to appropriatre sources for help

[maureeno]

I read this entire thread tonight and it made me happy and proud. The thoughtfulness and care shown in these posts will give me sweet dreams.

[Cheerio]

My 2nd DS was given a bottle in the nursery. He was rushed there after birth, and I was bedridden. However, I had told the NICU nurse and my PP nurse that I wanted to breastfeed, no nurse would take me down to see him They claimed that I should rest and that my BP was still too high to get up and walk around. He was born at 03:40, and I didn't get to see him until 10:30 when my Mom came and wheeled me down. I even asked for a pump, and they dismissed me. When I finally got him, he refused to latch on, even the LC freaked when she heard he was given bottles. I worked at trying to bf him for 2 weeks, and gave up too easily. Our hospital is supposed to be 'breastfeeding friendly'

[mother/babyRN, RN]

I stand by my opinion and consider to respect all of yours. Period. We will have to agree to disagree, but the day individualism is the component taken out of the art of nursing (patients, that is), is the day all of us should seriously consider retirement. There are NO areas of black and white in any area of medicine, nursing or otherwise, and anyone who thinks there is just hasn't been in the field long enough, or seriously enough. As I said, I respect patients wishes and promote current guidelines with as much vigor as those of you folks who disagree, but I cannot and will NEVER remove individualism from the equasion.....That about speaks for my stance. Thanks to all of you for sharing your opinions and thoughts. It isn't up to me or anyone else to attempt to change someone's point of view. Mine is as educated as anyone elses....It takes courage to stand up for patients, and that is what I intend to continue to do....But, it pleases me that all of you are so devoted to the well fare of these moms and patients. What you fail to see and understand, is so do I....Thanks for the discussion...Anything more heated would just be an argument, would it not? Lets agree to disagree and continue our spectactular care of our patients! {{}}:)