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?

[semstr]

that would mean instant kick-out here!

that is something we did 25-30 years ago!

No healthy newborn will dry out in the first 24 hours after birth!

No bottle in the mouth of a newborn when mum doesn't want it.

When baby needs (very seldom) fluids, we give H2O on a spoon, never formulas!

[mother/babyRN, RN]

Well, it is ONE quick way to determine who has a formula intolerance. And for the cardiac nurse above who thinks maternity nurses are mean, we are TOLD to bring babies out and they are SUPPOSED to come out ever 2 to 3 hours....Course, there is a nicer way to bring the baby in, I agree....I was a cardiac nurse too and I have to tell you that this is the scariest place I have ever worked.....One 12 hour labor gives you an energy expenditure of up to two marathons. And that is BEFORE you get to pushing... Hmmm.........

[Dayray, RN]

Update.

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.

[SmilingBluEyes]

DAYRAY 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!!!!

[NurseyNursey]

Totally 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.

[imenid37]

smiling 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.

[SmilingBluEyes]

imenid? ?????? 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....

[mark_LD_RN]

I 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

[imenid37]

smiling 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.

[SmilingBluEyes]

Oh 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.

[BBnurse34]

I 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.

[mother/babyRN, RN]

My 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.....