Breastfeeding support by HCPs

Posted
by mappers mappers Member

Specializes in Med/Surg/Tele/Onc.

Hello Everyone,

I hope you don't mind me popping in here. I'm a nurse but do Med/Surg Onc, so haven't been here before. I also participate in a debate board on another website for Breastfeeding vs. Formula feeding. It's a fun diversion.

I frequently see statements on that board that breastfeeding efforts are sabotaged by healthcare professionals. This could be anything from OB/GYN offices handing out free sample formula, to nursery nurses giving babies bottles without the parents permision, to Doctors advising new moms to switch to formula instead of getting LC's involved, to Drs unable or unwilling to diagnose nursing problems and help a mother through them. The general concensus is that most (not all) women who fail at breastfeeding could have been successful if they just had the right education and support.

So what is your experience? How supportive is your hospital/practice/environment toward breastfeeding? How much education do MB nurses get in breastfeeding issues and support? How many LCs does your hospital have and do they see everyone? If you don't work in a hospital, what are your experiences/insights? And, if you want to share, what are your own personal views towards breastfeeding vs formula and how the healthcare system supports one or the other?

When I hear people "blame" nurses (blame is probably too strong of a word) my hackles get up and I want to defend them. But I don't really know what goes on. My only experience is my own DDs births' 13 and 11 years ago. So I thought I'd ask for your thoughts and opinions.

BF vs. FF is a very personal choice and a lot of women who aren't successful at BF become very defensive and accuse the "lactivist" of being mean and judgemental of them. In reality, however, it seems that people are critical of themselves for their "failure" and tend to project those feelings onto others. Terms like LLL Nazi is thrown around in the media, when in reality, no one has ever met one. It's an unjustified image, since most people say their LLL experience is warm and accepting and positive.

Well, I think the nurse who rolls her eyes at a new mom insisting on not giving a newborn a bottle is also an unjustified image. (Think "The Office" when Pam had her baby). So tell me, am I right?

If anyone is interested in viewing that board, let me know and I'll post a link.

Thanks in advance for your insight!

Mappers

I<3Nursing

I<3Nursing

110 Posts

I will share my personal experience just 7 short months ago. My daughter was born at 36 weeks and had to stay in the NICU. When the ok was given to let her nurse she latched perfectly once. Then kept refusing to latch. The nurses there just kept saying try it or maybe she will be bottle only. I remember a kind nurse said maybe she wil be bottle here and then breast at home in a more comfortable environment. The lactation consultant was not there when I needed her because it was a weekend. I decided to take the advice of the nurse and give her bottles to meet her quota so we could go HOME. When she got home she immediately latched on and has been nursing perfectly ever since! So I would say it's a mixed bag. Also it was Christmas day when I needed a breast pump to go home with and the nurse caring for my daughter did not want to help me get one but the nurse practioner talked her into it. I used that pump for 6 months when it stopped working while I was at work on a Sunday night I called the 24 hour phone line where they told me it was not considered an emergency and to call on Monday! Well my supervisor is a huge breastfeeding supporter and she let me leave 30 min early to get home after 9 hours without nursing! Baby got her fill and thankfully no clogged ducts or mastitis! Well the next da I went and bought my own and returned that pump! If not for my unwillingness to give up then yes those people/problems could have stood in my way. I will continue breastfeeding and working nights for as long as my baby girl wants it! It's amazing how much love and joy it brings! Thanks for bringing up this very important topic!

redessa

redessa

80 Posts

Well, in my own experience, I think the hospital nurses prevented me from getting a good start with my firstborn. She was having trouble latching so I was working with a lactation consultant. The nurses took her to the nursey for a little while and when they brought her back, told me they'd given her formula. This was not discussed with me ahead of time.

I was quite upset about that but the nurses said she wasn't getting enough from me. This was within the first 48 hrs of her birth. My milk had not come in yet. She wasn't supposed to be getting much from me. But they decided to have me use one of those little tubes (can't remember right off what it's called) so that she could get formula while nursing.

By the time we got home, I was so insecure about my ability to feed my own baby adequately that I continued to supplement with formula. I told myself at first that this was just till my milk came in. But even after that, she never went a full day without at least one bottle. I don't know if I really wasn't making enough milk to satisfy her or if she was just too "lazy" to nurse knowing a bottle would fill her up more quickly and easily. Whatever the reason, we got off to a shaky start and it was only about 4 months before I gave up entirely.

With my next baby, he was not gaining weight well and the dr had me supplement with formula (as well as charting his feeding and lots of other things). The formula made no difference in his growth rate but he decided by 6 months that it was not worth his time to try to nurse anymore and self-weaned.

My next 3 had no problems. Well, my 3rd wouldn't even take a bottle so there was NO supplementing, pumping, or going out for more than a couple of hours till she was almost a yr. That was hard in a different way.

My 4th nursed for over a year. And I weaned my 5th at 8 months. He was starting to lose interest and I'd been pregnant and/or nursing for 8 years and was anxious to finally have my body back. So that worked out for both me and the baby.

But yes, when I was having issues, I do not feel that any medical staff supported me in working things out so I could continue to breastfeed. Turning to formula was the quick and easy answer that was given to me with both children who had problems.

BTW, my "failure to thrive" 2nd baby will be 11 yrs old in a few days and is still a super skinny kid (weighs less than 55 lbs) but completely healthy. Some people are just small.

schack

schack

Specializes in med/surg, tele, OB. 76 Posts

I work L&D and M/B... I NEVER give formula or a pacifer to a breast baby without mom's permission. If a doc orders formula for a medical indication (baby won't latch, more than 10% weight loss, low BS, increased bili, etc) then the doc and I disuss it with the parents. Baby may be bottle feed or finger fed formula. We have a LC who sees all our moms (she is wonderful, btw!). I take breastfeeding very seriously- I will spend as much time as needed to help a mom latch. And if I can't I get help for her. My experience has been way more mom's send baby to the nursery at night and want formula given so they can sleep all night (despite being told about the need to breastfeed for stimulation)... then they complain if the baby struggles to latch back on at 9am when they are ready.... so I think it can go both ways. Just my personal experiences....

Kelson87

Kelson87

Specializes in Rural nursing, OB & OR. Has 29 years experience. 2 Posts

I really hate to say this but the main resistance to breastfeeding in our facility is our nurses. I have been one for many years and feel that breastfeeding is the best way to go but even more than that, despite our personal preferences, we as nurses are obligated to provide information to our patients to allow them to make the best decisions of their choice! I have taken several of the breastfeeding courses and am currently investigating the feasibility of obtaining my LC. I have tried everything I know to increase the nurses interest in assisting our mothers to breastfeed if they choose to do so but our rate of mothers leaving our facility breastfeeding exclusively is practically zilch. The overwhelming attitude of disintrest is such a downer. The Docs give lip-service only to breastfeeding. The entire atmosphere here seems to be "If they want to, good luck to them but don't look at me to help." I guess I would definately say that HCPs do not provide the support for the breastfeeding mothers they could and should! :crying2: (Know please I speak only from my own experiance in nursing. I had the La Leche League come see me 27 years ago and had it not been for those women, none of my children would have been breastfed, as it was, they were awesome and I'm sooo grateful they were there for me!):yeah:

mappers

mappers

Specializes in Med/Surg/Tele/Onc. 437 Posts

Thanks for the replies. I hope to see some more! I guess it saddens me that the lack of support being touted is true. I'm glad there are nurses out there who are willing to buck the trend and really try to help women be successful at bf.

I'm not a nurse (yet) but can share my personal experience as a breastfeeding mother of 3. I have had three very different experiences with varying levels of support from health care providers.

My first baby was born via unplanned c-section under general anesthesia. There was at least a 6-hour delay before I saw my daughter so I'm fairly certain that she was given formula in the nursery. I had to ask repeatedly to see the baby and be very assertive about my desire to attempt breastfeeding with her. Due to overcrowding at the hospital, I ended up on a different floor than most post-partum couplets. I was fortunate to have nurses with *some* experience coaching breastfeeding while in the hospital but I really struggled for those first few weeks until an infection had me making a desperate appointment with a lactation consultant. Oh, how I wished I would have had that available to me in the hospital! Once the painful latch was fixed, I breastfed my daughter for about 15 months virtually problem-free. If I didn't have supportive family and been-there-done-that friends cheering me on, I would have given up earlier. At one of our early well-baby checks, I expressed some first-time mom concerns about how many wet diapers my daughter was having each day and the NP wrote the name of a formula brand on her prescription pad without even asking me about how breastfeeding was going. I promptly terminated our relationship with that clinic and that was one of the main reasons. Our next pediatrician was extremely supportive of breastfeeding, though we had already worked out our issues by the time we found her.

Baby #2 was born via repeat c-section at a different hospital. My nurse in the recovery room had me breastfeeding him almost immediately. She was able to suggest helpful positions that made it less painful and was literally very hands-on while I was in there. Since I was actually experienced with it the second time around, I knew when to ask for help with latching and the initial discomfort was short-lived. My biggest breastfeeding issue was that my 8 lb 12 oz son dropped 10% of his weight and the on-call pediatrician was very pushy that we start supplementing immediately. I didn't want to because my milk was starting to come in (I would have if I had only been producing colostrum at that point) and she told me that if I didn't supplement with formula, it was on me if my son ended up with brain damage. Are. You. Kidding. Me? Almost three years later, it still irritates me that she tried to use scare tactics like that. If I had been a first-time mom, I would have been freaked out and probably sabotaged what was otherwise a perfectly fine breastfeeding relationship. I don't have it handy, but I think we left the hospital with him at just under 8 lbs and at his weight check a few days later he was over 9 lbs. By 3 months he was 18 pounds on breastmilk only. I'm glad I trusted my gut and stood up for myself with the pediatrician. It is worth noting that at least one of my nurses was very supportive of my decision to refuse formula and I will always remember how nice it was to have someone in my corner. I breastfed my son until about 13 months.

Baby #3 was also a repeat c-section, same hospital as #2. Recovery room nurse wasn't too supportive or helpful, she pretty much ignored me and told me (when I was in tears because my pain drugs from the OR were wearing off) that if I was in that much pain I should have asked for something earlier and that it was more or less my fault for not knowing that pain drugs were by request only. Perhaps if she had actually spoken to me during the recovery period and made an attempt to assess my pain level, we could have avoided that misunderstanding. But, I digress. Postpartum nurses were helpful with establishing breastfeeding, though I didn't need/want much help with it this time. Baby #3 left the hospital at her birth weight + a few ounces, then ended up with failure to thrive issues at 4 months old. Our pediatrician was VERY supportive of desire to breastfeed and I really appreciated that she didn't push formula. When she lost weight over the next month, I agreed to pump and bottle feed, supplementing with formula to make sure that she was drinking enough ounces each day. That was all it took. We theorized that my daughter was a lazy little nursing - she drank just enough to satisfy her hunger but not enough extra calories to grow - and it tanked my supply temporarily. A rigorous pumping schedule increased my supply and I was eventually able to wean from the bottle back to the boob with my pediatrician's support. I did consider weaning at that point - it would have been so much easier to switch to formula. I am so grateful that our pediatrician encouraged me to try continue breastfeeding - my daughter is now almost 11 months old and you wouldn't even know she had weight gain issues a few months ago. I am, however, counting down the weeks until she is one year because she is by far the most frustrating baby to breastfeed. It's like wrestling with an angry cat at every feeding.

The amount of misinformation out there about breastfeeding boggles my mind. When nurses and/or doctors pass along misinformation about breastfeeding or immediately jump to using formula instead of trying to help a new mother resolve a latch or supply issue, it really gets my goat. I was just stubborn enough to breastfeed despite having varying levels of support from my health care providers. Sometimes babies do need formula, but my impression is that a lot of healthcare providers (and new mothers) unintentionally sabotage breastfeeding by giving it when it may not be medically necessary.

mamamerlee

mamamerlee, LPN

Specializes in home health, dialysis, others. Has 35 years experience. 949 Posts

I believe that if more nurses breast-fed their own kids, then they would be more likely to encourage and support moms who were interested.

I worked with a nurse who was very private in many ways, and she 'knew' that she just couldn't breastfeed, it wasn't something she even wanted to discuss.

One of the nurses in the delivery room simply told her that the baby needed that colostrum, it was good for both of them (mom & baby) to breast feed, etc, and took her silence as agreement. Placed the baby at her breast, and she never said a thing. Fourteen months later, this same woman cried when her daughter self-weaned. Became a major advocate.

My first child was a mere 6lbs 8 oz at birth, doubled his birthweight by 10 weeks on breast milk alone, and never looked back! I had to return to work at 10 weeks, but I gave him twice a day feeds for about another month.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery. 17 Articles; 5,259 Posts

It's a mixed bag, really. Sometimes it's moms/families that have unreasonable expectations. We have SO many people that read and plan and read some more about labor and do absolutely no learning about breastfeeding, and expect it to go perfectly. Or that the baby is going to stick to a strict q3h schedule. Or the "I want to sleep 8 hours tonight so I'm sending her to the nursery but I am exclusively breastfeeding and don't want her to get any bottles or formula." (Fortunately the last bit is rare where I am.) Or they are having issues that require some hands-on help but don't want me anywhere near their breasts....in that case, only so much I can do.

And sometimes it's nurses that don't want to/don't have time to take the time to work with them. We have up to five couplets and let me tell you, if even one of them has breastfeeding issues, the other four get the really raw end of the deal. (I am a huge advocate for lower ratios, mostly for this reason.) And we do have the occasional nurse that just doesn't try to help, or it's not their forte' or whatever.

One thing that frustrates me is that there seems to always be this staff nurse vs. lactation consultant war at my place; some of the LCs it seems think we don't do enough to promote breastfeeding/help BFing moms. We do the dang best we can with no backup (no LCs, no techs, nothing) on nightshift, and none of us (night or day) are in the business of bullying our moms into breastfeeding. Our patients complain to us that some of the LCs are overbearing and militant, and that shouldn't be happening. (This is in no way a swipe at all LCs, because I have worked with some great ones and LOVED them. We just happen to have 2-3 out of about 5 that can make things miserable.)

Personally, I tell patients that I won't decide for them how best to feed their baby, so if they want to bottlefeed that is okay by me. I also tell them that if they want to breastfeed it is going to take some effort and sacrifice on their part, and I am willing to help as much as I can for as long as I can if they're willing to make that commitment. There are occasions where supplementation is indicated but most babies don't need it, which is how nature intended.

Edited by ElvishDNP

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 25 years experience. 20,949 Posts

I have another issue that really bugs me as a nurse: Now, I will break my back (literally) to help ANYONE truly dedicated to breastfeeding. I get a fair share of women who are NOT committed, 100%. Either they are doing it because they feel pressured by friends or family or to please us (the staff). I am very much pro-breastfeeding, but if you are NOT committed, I would much rather you tell me and let me spend my time working on others who desperately need my help. Just ONE couplet having major issues with breastfeeding can take hours of my shift. I am glad to spend that time, but only if the commitment is real. Otherwise, just tell me and I will be happy to support your decision to bottle-feed, for whatever reason. Sorry if that is controversial, but it's a very real problem I run into frequently and it is frustrating for everyone concerned.

I Do teach in my childbirth classes, that breastfeeding , while the most NATURAL way to go, does not mean it is EASY. It requires dedication, practice and work and there is a learning curve for some moms and babies. They need to be prepared to face the issues and frustration with a positive attitude or it won't work out. I try hard to prepare them because we have a good number of moms who think, because breastfeeding is natural, it should just come easily, automatically and quickly. It's a rude awakening for many who are not properly prepared and have the right mental and emotional attitude for it.

Edited by SmilingBluEyes

wannabemw

wannabemw

Specializes in Lactation Ed, Pp, MS, Hospice, Agency. 284 Posts

don't quit! Hang in there GF! Go to an LLLI meeting... in my experience babies don't bf for the milk when they get into their toddlers yrs, its more comfort in my experience. Going to an LLLI meeting will help u to meet another mother who is probably feeling the same way you do. And remember: just bc they turn 1yr doesn't mean they suddenly stop being a baby. Either way: congrats on making it to 1 yr! Good job!

symmetry

symmetry

4 Posts

I work days on a Newborn Nursery unit as an RN. Our hospital has several LCs and at least one is scheduled every day shift. Unfortunately we never have an LC on nights. In general, night shift nurses at our facility seem to be less interested in supporting breastfeeding. Our policy is not to give formula to breastfeeding babies unless there is a medical reason or if the parents request formula. I think nurses can feel pressure to give formula (especially on nights) if the baby is nearing a 10% weight loss or hasn't had a void in 24 hours. Some of our patients want formula fed overnight and the night shift nurses are only too happy to comply. I don't think there is much education given by night nurses regarding why that's a bad idea.

The day shift nurses and LCs work well together to promote breastfeeding but these nurses have had the benefit of this collaboration for a long time. Night shift nurses have to deal with feeding issues on their own. I really feel if there were LCs consistently on night shift breastfeeding promotion among night shift nurses would improve. LCs generally aren't asked to work nights. There are so few of them that they hold the power to say "I'll only work days".

I do feel frustrated handing off a patient to a night shift nurse who I know doesn't care about breastfeeding when I've worked all day to get her baby to breastfeed. And yes, "eye-rolling" does occur during report, trust me.