Bottles after 3 hours - page 3
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... Read More
Dec 13, '02Occupation: RN in L&D Joined: Nov '01; Posts: 720; Likes: 185Update.
I have yet to see a written policy but did have a few upsetting days. I had one baby I tried and tried to get to breast and just couldn't, only to find out that the nursery had been giving it bottles and not told the mother. I had another that was so so close to latching on; I went to the nursery to grab some sugar water and a suringe to give it a little incentive to latch. The nursery nurse assigned to the baby told me to have the lactation consultant go in and assess the baby, she did and came back looking for sugar water and a suringe and was told by the nursery nurse to give it a bottle. I couldn't believe it but our hands were tied we had to follow her orders (I refused) but the baby was given a bottle anyway (why? I have no idea). All I needed was 30 seconds and that baby would have been nursing. I guess it may have been a show of power and to put me in my place but poor baby and mom =(
I do have some good news though.. Yesterday I took care of one of our pediatricians and her baby. We got to talking and she was shocked. The new policy was supposedly decided on by the nursery nurses and pediatricians. However, my patient (who was at the meeting) had adamantly insisted that it was insane to force babes to eat Q3 and had believed that the policy was going to be that at 10 - 12 hours a judgment would be made as to weather or not the bottle was necessary. We spent about an hour talking about it and I think she is going to talk to the director. =)
Thank you all for your words of support. You have given me the assurance I need to fight harder. With all the opposition I have experienced I started to doubt myself. I too would gladly risk my job to advocate for a patient.
P.S. (a few of you asked about our lactation consultants) We have 3, 2 are RNs and 1 is just an LC. they are very upset but decided it was best to wait for a backlash from upset patients. Becuse they are afreaid they would lose their program alltogether, if they protested to avidly. I think they made the right choice there are 30 nursery nurses and administration sees lactation as costing them money (which it does) they overlook the patient satisfaction and reffereal bussness they create. I think if they had fought too hard they would have all been fired and the lactation program closed.
Dec 13, '02Joined: Apr '02; Posts: 38,756; Likes: 16,288DAYRAY you ROCK...keep fighting the good fight and know you are RIGHT. This policy is insane and has no useful purpose with well breastfeeding couplets, period. GOOD FOR YOU!!!!
Dec 13, '02Occupation: L&D RN Joined: Jul '02; Posts: 75Totally inexcusable policy. They are so very lucky that I do not work there. There is no way that I would comply with this policy and I would be telling everyone that I know about it.
Dec 14, '02Joined: Mar '02; Posts: 1,843; Likes: 1,237smiling blue eyes, i have been a maternity nurse since 1990, but was a cardiac nurse for 3 years when i had my first two kids (1988 and early 1990). the nurses were not mean to bring the baby in so often. they had a job to do , they just did it in a b*tchy way! they had a rep of being old bags throughout the hospital! that was so many years ago , those nurses (i don't work at that hospital anymore) have mostly either died or retired. yup i bring babies to moms q 2-3 hrs all the time, but i don't do things like call them "my babies" or say they "don't have a good temperament." i try to be helpful and polite. sorry if you thought i was ragging on nursery nurses today (i'd have to include myself in that). i must've been unclear. this feeding policy is a real step back in time to somewhere we don't want to be, like back w/ those nurses.
Dec 14, '02Joined: Apr '02; Posts: 38,756; Likes: 16,288imenid? ?????? what did I say that prompted you to defend yourself this way? only thing i have attacked here is this dogmatic and useless policy; not people. confused....
Dec 15, '02Occupation: registered nurse Joined: Nov '01; Posts: 1,083; Likes: 14I would be furious that is a ridiculous policy and can not see how they can get away with it. My way around it was to do like we did with my last baby. it never left our room, if it did i went with it no exceptions allowed.
I fight (kindly ) with our nursery nurses all the time. Because i firmly believe in breast feeding and no supplemenntation with bottles unless really needed which is rare. they tease me all the time but the know that the babies of my breast feeding moms get no bottles. thyey even made special signs for (my babies) cribs.
Dayray keep up the good fight we need to fight for our patients rights
Dec 15, '02Joined: Mar '02; Posts: 1,843; Likes: 1,237smiling blue eyes, sorry i didn't mean to take it in a grumpy way. i thought you meant i was raggin' on the nurses for q 2-3 feedings. i know some pts. are upset their babies are eating this often, until they figure out this is wnl. i even had a mom tell me 7 or 8 years ago. i don't want my baby every 2-3 to feed. i want him only every 4 and i want to sleep BUT i don't want you to feed him anything. i want you to hold him and rock him until i am ready. i politely told her her baby needed food, preferably breastmilk as all of his hunger cues are there. i thought you thought i was coming from this mentality. sorry, but thanks for clarifying your position. yeah this is a real dumb policy. it seems like something from he 1970's.
Dec 15, '02Joined: Apr '02; Posts: 38,756; Likes: 16,288Oh yes, we do have to deal with Moms who tell us "I want my baby in the nursery after 9 and I want a good night's sleep, so don't disturb me til I call. ".....So I politely tell them, that is not possible with breastfeeding (or any, really) babies and while I am HAPPY to take them and rock/hold them in the nursery whenever possible to allow for rest I CANNOT keep them out for more than 3 hours so as to allow them to eat. And I remind them that while I am more than happy to help, I do NOT go home with them so they must get used to living on BABY's schedule NOT THEIRS anymore. Those days ended the day baby arrived.
I question the commitment to breastfeeding such parents have when they insist on not being disturbed to feed, even upon explaining the needs of the newborn to them. I really do. Fortunately, they are not too many in number. But never do I give bottles/formula or pacifiers to breastfeeding babies unless the moms specifically request it; and then ONLY AFTER I explain how these very likely will sabotage their breastfeeding efforts and why.
But it's up to them after I educate them.......some are not as committed as I would like to see. But not for me to decide how they will feed....only to try to educate. NEVER EVER WOULD I STICK ANYTHING INTO A NEWBORN'S MOUTH without knowledge and consent of the parent. THAT IS WRONG and UNETHICAL to me.Last edit by SmilingBluEyes on Dec 15, '02
Dec 23, '02Occupation: Level II Nursery RN Joined: Aug '01; Posts: 265; Likes: 3I would never bottle feed a babe without the mother's consent..
But, If mom wants the tyke in the nursery overnight she needs to rethink her priorities. Some get very annoyed when we return a screaming babe to them 30 minutes later. Unless I begin lactating, the breastfed babes need to stay with the mom (thats why its called couplet care)
As for nursery borders (mom has been discharged) They feed Q3 if less than six pounds or under phototherapy. Others feed Q4. Unless the mother is willing to stay camped out in the nursery all night, I have no choice but to bottlefeed. I have listened to many screaming babies because the mother shows up late and won't allow any bottles and refuses to pump.
I have also had to start an IV and push D5 on a baby with a bloodglucose of 27 that was too lethargic to nurse because the mother refused to allow formula.
I love and support breastfeeding, but sometimes I fear that the mother's are provided with scare techniques to make them loath the very idea of supplementing.
Jan 2, '03Occupation: R.N. Specialty: 27 year(s) of experience in cardiac, diabetes, OB/GYN ; Joined: Feb '02; Posts: 1,947; Likes: 418My question has always been whether or not infants were breast fed every two or three hours out on the prairie....In any case, I just read a list of the pregnant patient's rights, and one of them clearly states the pregnant pt has a right to decide what and how often her infant is fed whatever the hospital policy states....
As for the breast fed infants and nipple confusion, I have to say I have never run across that. I think thats nuts, but of course, will honor what the parents prefer...Sometimes when I am alone in the nursery with 9 or 10 babies I even consider cup feeding the pokey bottle feeders....
Anyone can tell who gets bottle fed by the stool they produce...
If a mom wants the baby to have a pacifier, we explain why the breast feeding community doesn't encourage them, and if a mother is exhausted and wants her infant formula (or pumped breast milk fed) for a feeding if the infant isn't willing to follow the 4 hour respite one is allowed with breast feeding, I will document that she desires it and do so. If the mom is exhausted then breast feeding won't be something she sticks with. I personally don't have a problem with breast moms who need to, supplementing every once in awhile, although I teach them the current guidelines... Not every one is the same, and we have to deliver our care individually. While it is nice and even commendable that people want to promote and teach exclusive breast feeding ( me included, by the way), I still feel we have to deal with our patients needs first. If they don't take care of themselves first, or if they are made to feel guilty, then the whole experience is tainted. I tell people that they will be given quite a bit of information and some of it may contradict others attempting to teach, so take what is useful and works for you, and use that...
Breast feeding shouldn't be about consciously or unconsciously making the pt feel guilty....It is about promoting the best sort of bonding there can be.....
Jan 5, '03Occupation: registered nurse Joined: Nov '01; Posts: 1,083; Likes: 14You 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
Jan 5, '03Occupation: RN Joined: Dec '02; Posts: 1252 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!!!"
Jan 5, '03Occupation: R.N. Specialty: 27 year(s) of experience in cardiac, diabetes, OB/GYN ; Joined: Feb '02; Posts: 1,947; Likes: 418None 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......