Breastfeeding support by HCPs

[mappers]

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

[wannabemw]

I work as a CLC on a pp unit. I get called off more than you would realize. I would love to come in on NS & need to start working on making that happen. You r right about the eye rolling & the nursery nurses! We had a required lecture last month for breastfeeding. Perhaps you could recommend this to your NM? Rumor has it that JACHO is going to be looking for CORE measures for breastfeeeding in the near future! Perhaps this is how you could address this?

Signed,

happy to no longer hear "your baby is using you as a pacifier & your letting him (her)!"

~MJ

[mappers]

Thanks to everyone who responded.

I guess I'm hearing several different things. There really is an issue with BF support in the hospital. Sometimes it boils down to the old chestnut of nurse/patient ratio and the lack of LCs available to PP units. I can totally understand how a nurse with a heavy patient load cannot effectively help a mom and baby who are having BF issues. Sometimes it boils down to the nurse's attitudes. A lot of it is really what the mom's want...(8 hours of sleep at night, etc.)

I wish we lived in a society where breastfeeding was expected and the support was there to make it happen.

[dseem13]

I work in a baby friendly hospital (breastfeeding is strongly encouraged) on the mother baby floor. About 80% of our patients breastfeed. The only time their infants get formula is if the mom wants to supplement, their blood sugar is low, infant's weight is below 10% (and significantly), or if the infant is very jaundiced. If mom's milk is in, then very rarely do we supplement for the last 2 mentioned situations unless it's severe. There may be some other medical indications, but those would usually be seen in the NICU, not on the mother baby floor I work on. Our nurses would NEVER supplement with formula or give a pacifier to a breastfed baby without the mother's consent.

The nurses on our floor watch quite a few in depth videos on breastfeeding. We also follow the lactation consultants around for 2.5-3 shifts. We start helping with breastfeeding as soon as we are taking care of our patients (so during orientation). Following the lactation consultants was very helpful, because we learned a great amount of teaching that we need to do when we are showing our patient how to breastfeed (correct latch, positioning, breast compression, expressing colostrum, how much babies are getting, when your milk comes in, etc).

We have 2 LCs on the weekdays (7a-3p), 1 LC on weeknights (5p-10p), and 1 LC on weekend days. They ALWAYS see a patient if it is their first time to breastfeed (usually more than once), if their baby is in the NICU, if they have any anomalies that would affect feeding (cleft lip, palate), and they give home talks to these patients as well. If they are a multip and the nurse gives them report they doing well they will not see those patients unless they want to talk to a LC. How often the L.C. sees a patient depends on how they are nursing and the report they get from the nurses.

I believe breastfeeding is the healthiest choice for moms and babies, but that doesn't mean anything is wrong with formula feeding. I believe it is a personal choice, some mom's have medical reasons for being unable to breastfeed, and some just don't want to do it. The most important thing is that baby is being fed, and mom is not going to resent herself or her baby whichever choice she makes. Patient's often expect breastfeeding to be a piece of cake, and it's a rude awakening when most of them find out how much work it is. I think the HCP need to do more with education BEFORE the infant is born. Too often parents aren't educated and are very frustrated when they think their baby is getting no food, or they have a screaming baby and just want him/her to be quiet. Babies cry for other reasons than being hungry. That's another area that needs education.

Overall we're kind of known as the breastfeeding nazis in our city, but we never force anyone to do something they aren't comfortable with. All that matters is that mom and baby are both physically and emotionally well. :)

Edit: I think I forgot to mention the nurses are required to see at least one latch per shift. Often we are helping each time someone is breastfeeding, so we stay VERY busy!

[Zookeeper44, RN]

My personal experience is that I encountered ALL of the things you listed in the OP as ways healthcare professionals are unsupportive of a mother attempting to BF. And this was in a "baby" hospital. Dr. told me baby had lost too much weight before going home (he was under 10%), they loaded me up with formula, had given him formula in the nursery without my prior knowledge or permission, and one tech even mocked me when I answered "yes" to the question of whether or not I was going to BF...she actually laughed and said "yeah, right, that's what a lot of people say"...then when baby had a nursing strike at 7 mos., people were clueless as to what was wrong w/ my baby, I finally figured it out w/ help of a LC over the phone after unproductive ER visits and phone calls to doctors.

*Fortunately*, all of this happened with my 2nd baby and I knew better. I had very successfully BF my first baby for a year (with help of LC's) so I knew what to do. Just kept plugging along and grinning and nodding to folks. Had all of this happened with my first, I may have never known how or had a fair chance to successfully BF...it was hard and w/o help I'm sure I would have thought I was doing it wrong, no matter how badly I wanted to BF.

It almost seemed that the LC's in the hospital were working independently of all the other staff and that they almost counteracted each other. I would love to see an improvement and I am even interested in working in this area when I graduate.

[CrunchyMama, ASN, RN]

I'm only a nursing student so I don't have any experience as far as what's the norm. However, I've considered myself a lactivist for years now and nursed my daughter until she self weaned at 20 months after regretfully formula feeding my 1st. I also endured my maternity rotation last semester. I've talked to plenty of moms over the years and it all comes down to education! We are so ignorant when it comes to one basic human need...feeding our young. Unfortunately while doing my clinical rotation I seen such bad advice and things going on. I even corrected a nurses advice after she left the room of a new mom. It's really sad! During lecture, the prof. NEVER went into great detail about breastfeeding, the benefits for mom and baby and the dangers of formula feeding. It's sad to know that's what's being taught at my small school and most likely what's being taught at other schools...NOTHING. I have 2 kids and both times (2 different hospitals) I had a less then adequate experience regarding breastfeeding. The 1st time, I knew nothing so I gave up after an LC told me some babies just won't suck. @@@@@@@@ BUT he had no problem sucking down a bottle. Then with my 2nd (luckily I knew what I was doing at this time), this nurse rudely encouraged a pacifier and wouldn't leave the issue alone for almost the whole time I was there. The rest of the staff couldn't answer any of the questions I had about the pain I was having. It was an awful experience and I even complained about it on the hospital survey....didn't do any good, that same nurse was still there over a year later trying to give bad advice to my sister who chose to leave her son intact. It's just awful that these nurses (and Drs.) are in the profession of caring for new moms and babies and they know little about certain topics.

[MrsEd]

It is because of my own personal experience with the nurses and lactation consultants that I am currently working towards becoming an LC.

[cherokeesummer]

We support it at our facility BUT often are over worked and understaffed and do not have the time we would like to devote to it. BUT when someone asks me to help latch a baby I do it, even if it takes time that I don't have at that moment I do it b/c its important and even if it is someone who really doesn't want to do it but is feeling pressured. I've had a patient ask nurses to tell her spouse she was unable to nurse b/c of a breast surgery b/c she didn't want to nurse and didn't want to just tell him that. Frustrating. It is frustrating when I tell ppl over and over again that colostrum is small in quantity and huge in quality and that its important to try to latch if they want to breastfeed and then they give up immediately b/c the baby is crying. I try to explain that it does take work, dedication and its a personal choice, i will support them either way.

On the flip side I get frustrated when I have a baby that has a HUGE decrease in weight and increase in bilirubin and the parents will not budge on giving a supplement and only try to nurse the baby when its awake and only for a few mins. I suggest at that point finger feeding/syringe feeding pumped milk and formula. I want to support moms but at the same time, I want their babies to be able to go home with them so I try to get them to breastfeed successfully and offer alternatives to supplementation that do not involve a bottle. If they want a bottle I will give it to them without lecture and I explain that it is still possible to switch from breast to bottle, it may take more work but it can be done.

I was one who tried, could not get it right, my son had a bottle from the start b/c of hypoglycemia and when I tried to latch I couldn't and I gave up too quick and didn't seek help. I pumped and gave that to him for a bit. I still feel bad about that 4 years later and try to help my patients so they can work harder at it if they want to. I wish I had worked harder at it but I know that he is happy and healthy and thats what counts.

But no I do not think that HCP are against breastfeeding, but there are those who will be hardcore one way or the other as well.

[cherokeesummer]

PS and I do not give formula unless mom asks me to. I have gone in a room in the middle of the night to make sure its what they wanted if they sent the baby to the nursery for the night but have been otherwise breastfeeding. I will ask if its an out on demand infant (feeding in the room when hungry) or if we are to feed in the nursery and many moms choose to feed formula at night.

[DebblesRN, ASN, BSN, RN]

Wow. It's terrible the bad experiences you guys have had.

I want to add my 2 cents since I am a nursery/NICU nurse.

People always want to blame the doctors, the nurses, the hospital--anyone they can, when they are unsuccessful at breastfeeding. It frustrates me TO NO END when I have dedicated an hour at every feeding to help a mother breastfeed ALL NIGHT LONG (yes--I am one of those dreaded night shift nurses) to come back my next shift and find out the mother has given a bottle all day because she had visitors, or she couldn't get her baby latched on (but did not bother to call for help when the nursery and IBCLC's number are on the dry erase board in front of her face and she has been told repeatedly to call for help) or daddy/grandma/baby sister wanted to feed, or mom just didn't feel like it.

Or how about the moms that come in and refuse to bf in the delivery room when it is the best time to nurse because HELLO--there are 900 visitors in the waiting room and each one has to hold the baby so it will be exhausted and won't feed when mom finally decides it is convenient. Then, they nurse one time--and say--take the baby to the nursery and give a bottle for the rest of the night because I am exhausted and need to rest. When baby has difficulty latching the next day, it suddenly becomes MY FAULT even though mom was educated about the situation, and chose to have the baby fed in.

Or the mothers who learned from some INSANE person that you only feed the baby on demand. LOVELY. Lets let the newborn go 12 hours without eating because some moron told you that is what you are supposed to do, and hello, the baby is ASLEEP (per the mother) even though it is desperately trying to suck a pacifier down its throat. There is usually someone holding the infant in this situation who is making sure to hold said paci in place because the baby screams when it comes out of his mouth.

There are times when HCP are unsupportive, or complacent about the whole breastfeeding thing. In my experience, there is a whole lot more "let's convenience the mother" attitude from family and the mother than staff sabotaging the breastfeeding process.

There are situations where we need to give formula for the baby's well being. Like when the baby actually DID nurse in L&D for 45 minutes, then comes to me with s/s of hypoglycemia, and when I check the sugar, it is 23. That baby is getting some formula. The alternative is a running IV of D10W and then mom has to come to the nursery for every feeding.

The doctors where i work all recommend formula after each BF session if an infant is under photo Tx to help lower the bilirubin levels quicker.

If an infant is septic, it is going to need extra calories and may get formula or fotified EBM until mom has a good milk supply. Of course she is encouraged to nurse the infant FIRST then follow-up with the bottle, and we also use SNS to keep from HAVING to give the bottle as much as possible.She is educated to pump at home and given the resources to do so.

It does not matter where you go--there is going to be a bad apple that does not want to be bothered with assisting with breastfeeding. It is not localized to one department or one particular shift. I have to say that 90% of the nursery nurses I work with, day or night shift, do everything we can to help our moms be successful at breastfeeding. Request the help you need. If you can't get your baby to latch, call the nursery, postpartum, or lactation nurse and ASK for help.

People think that when their baby comes out, it will magically attach to their nipple and the angels will sing. LOL It doesn't happen that way. I have YET to encounter a mother and her newborn that did not need assitance or advice at least once during their hospital stay. This includes me, and I nursed two babies, and have been assisting bf mothers for about ten years.

[CrunchyMama, ASN, RN]

It is because of my own personal experience with the nurses and lactation consultants that I am currently working towards becoming an LC.

After swearing I wouldn't do that to myself, I've recently decided again that I want to become an LC eventually. There just needs to be more people out there giving good advice, and good LCs are definitely lacking it seems. Good luck to you!!

[dcampbell]

DebblesRN:

Thank you so much for addressing the visitor situation. Really, that is the big problem that I see consistently. Number two would be lack of staffing/time.

I wish I had a nickle for everytime a baby was just starting to latch on well and eat and there would be a knock on the door and visitors arriving with gifts and squeals of delight over the new baby. The pt. usually stops nursing to greet everyone and let them hold the baby.

Also first time new moms have visions of relaxing in their beautifully appointed post-partum suites, receiving visitors and opening gifts, taking pictures, wearing gorgeous nursing gowns with perfectly applied makeup and styled hair. Many are not prepared to do the real work that is required to initiate and maintain breastfeeding. When latching on or other issues occur it really seems to throw these young women for a loop.

I hate to say this, but in many ways I feel that breastfeeding is a "head game". Women need to be educated, supported, AND have the focus and determination to do just about whatever they need to do to make BF work.

I KNOW that for a good number of women, they did everything possible and things still did not work out. (Including myself with my firstborn.) But I think that many of us can tell as soon as we walk into the room to assist a mother, we can "feel" the difference between a woman prepared to do what is needed to be done to make BF work and the new mother who probably won't be able to go the distance.

[Catherinebt CNM]

I suggest that you check out http://www.babyfriendlyusa.org

Here you will find the latest, evidence based best practice standard of care regarding breastfeeding in the USA today.