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  • ElvishDNP last visited:
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  1. The issue is not with the BFHI, though; the BFHI steps are not that earth-shattering. The problem is when managers or admins or someone with an agenda misinterprets. The bit about rooming in? It says "allow mothers and infants to remain together 24 hours a day." Allow is the operative word. It doesn't say force, and unfortunately it gets taken that way. Nurseries get taken away completely and sore, exhausted mothers who can barely see straight are up for 48-72 hours straight caring for their babies. The part about giving infants no other food/drink except mother's milk unless medically indicated? Well, that doesn't mean you can never give it. If the baby is hungry or jaundiced above light level or dehydrated or losing too much weight or is hypoglycemic, that is a medical indication to feed them something. All the best reference texts, even the ones LCs have to study to pass LC boards, will say that rule #1 is feed the baby. Unfortunately - again - that has gotten twisted to mean that formula = poison and has no place in the hospital. Admittedly, it is 3rd best on the WHO preference list for maternal milk substitutions, behind pasteurized donor milk and then unpasteurized donor milk. But it is still considered an acceptable substitute and it can save lives. If I've got a newborn with a sugar of 25 who's already breastfed, God knows I'm not going to wait around for the pasteurized donor milk to thaw out before I feed that kid. I'll pop a bottle of formula and get him on his way. The whole point of the BFHI is to help mothers who want to breastfeed without undermining their efforts. It just means that hospitals can't do what used to be standard, which was take all the babies to the nursery all night and feed them formula...which definitely works against what we've plainly seen here can be a tenuous relationship, esp at first. It makes me sad that people hear baby-friendly and roll their eyes, because it doesn't have to be that way, but poor implementation and bad examples have made it that way.
  2. Anecdotes are fine for telling a story, but aggregate data are better when making policy. The benefits of breastfeeding have been demonstrated over and over and over and over - transcending race, culture, and socioeconomic strata. Considering how few absolute contraindications there are to breastfeeding, it's embarrassing that we as a society cling to archaic beliefs about what breastfeeding is and is not. There is no need to browbeat mothers who choose not to breastfeed. But there is a great need to support - actually support - mothers who do. I'm talking in-home visits, decent paid parental leave, a cultural shift that supports public breastfeeding (this includes more clean areas designated for mothers who wish for more privacy), and explicit employer support for employees who wish to breastfeed.
  3. I'm on mobile and can't get to it at the moment but the AAP's 2016 guidelines for SIDS prevention recommend breastfeeding as an A-level (read: supported by the best type of evidence out there) recommendation. Some breastfeeding is more protective than none, and exclusive breastfeeding cuts SIDS risk by up to 72%. The AAP of course still recommends supine sleep for every sleep but per the AAP, breastfeeding is protective against SIDS independent of sleep position. I have about 20 pages worth of articles backing up the risks of formula in my dissertation references. There's a time/place for formula and I'm not about to make somebody feel bad about using it. But the assertion that formula carries risks is well supported by decades of evidence. Using it is a matter of deciding for reasons that are your own that the benefits for you outweigh the risks. I did both with my kids; supply issues with kid 1, and kid 2 refused to drink breast milk from any kind of receptacle other than my breast. Flat out refused. Kid's gotta eat, Mama's gotta work. Formula in bottles it was from about 12 weeks on. She nursed for 3 years. I get it.
  4. I'm doing my dissertation on breastfeeding - specifically, how to increase population breastfeeding rates via education of staff. It's hard. Women don't choose to breastfeed (or formula feed) in a vacuum. Staff education and assistance is one component, but you're also dealing with culture, religion, family systems, job requirements (it's often hard to take pump breaks even if they're legally mandated), and a dozen other things. In doing chart reviews pre- and post-intervention I found that A LOT of women start out breastfeeding in the hospital and somewhere between days 4 and 30 postpartum, things often go sideways. I think we all kind of know that happens, but to see it in black and white that from the time women leave the hospital until about a month postpartum (in my case I am looking at WIC charts) the % of breastfeeding women dropped by half or more at the facility where I'm doing my project. They get home from the hospital and milk's not in, nipples are sore, the baby's screaming, and mom's exhausted, or pick your reason. It's easier to give a bottle. I really think we are failing new moms in a lot of areas, this being a primary one. We ask them to breastfeed but don't support them when they try, and when breastfeeding doesn't work we berate them. This is of course a generalization, but y'all get my point. Formula companies advertise their products way too much, IMO. Formula's good when we need it but we don't need it to be advertised to consumers. Everyone knows it's out there. Like everyone else trying to sell a product, formula companies are not above sleight of hand. The International Code for the Marketing of Breastmilk Substitutes has been out since 1981. It's not new. In the case of medical necessity, I absolutely agree - fed is best. That's what the leading reference texts say too. I'm glad to work in a place where the LCs are practical as much as they are passionate. OP, I'm glad you and your wife have found what works for you.
  5. Thanks for this reminder, traumaRUs. God be with you and your family.
  6. ElvishDNP

    Silly question about pregnancy!

    Unless for some reason your pregnancy becomes high-risk, or you have an underlying health issue that makes it high-risk from the start, there's no good reason to stop working at any point. Of course, all that is between you and your doc. Honestly, I couldn't have imagined sitting at home for 3-4 weeks doing nothing with this pregnancy. I'd have gone stir-crazy and been focused more on how achy and tired I was than anything else. Working helped alleviate some of that. Good luck to you!
  7. ElvishDNP

    Things you'd never have done before...

    I thought that would bother me too, but the lady I go to does it very professionally. I get a nice soft cloth drape to go over all the parts she's not massaging at the moment. There's never a time when something is uncovered unnecessarily.
  8. ElvishDNP


    You might want to check with your hospital's pharmacy. We have premixed bags that we keep in the pyxis of 20u/1000ml D5LR. I can't remember off the top of my head how long they are good but they are stable in a closed bag at room temp for a good while, IIRC. Spiked and hung is a different story.
  9. ElvishDNP

    March of Dimes: Less than 39 weeks

    I find this to be anecdotally true as well. I almost never see this among residents/attendings in the teaching hospital where I work. The private docs, on the other hand....it just depends on who's on. One of my RN friends who works in a community hospital has written docs up for blatantly fudging reasons to section/induce. I will have to say, though, I give my OB full marks on this one, and he's based at a community hospital. (I work at a different facility than where I'll deliver.) He is not into fudging reasons to induce (or section) and I am glad. I saw him yesterday at 39 weeks, still just 1cm dilated, and after all was said and done, he told me, "Okay, I'll see you next week if you're still pregnant." I'll be just over 40wks at the next appt, and he said we could talk about induction at that point, but didn't act like it was done deal by a long shot. This is not a 'rush to intervene' kind of doc and that's one of the things I like about him. (He is one of the ones that, if he sections you, it's because you need a section, not because he's getting impatient with you.) That was a lot of rambling to say: I have seen docs fudging medical necessity too, Hushi. But there are those who don't and I am grateful every day that they're out there.
  10. ElvishDNP

    Whats your specialty?What are the Pros and Cons

    Mother-baby/nursery/antepartum Pros: Mostly healthy patients. Lots of opportunity for education, if that's your thing, and most patients are very motivated to learn. Most of our antepartums hang with us for a while and buy their babies time (= a better chance of long-term survival). People are by and large happy about the babies they're having. I like helping people make breastfeeding work, too. That can be really rewarding. Cons: Fetal demises. My floor, not L&D, delivers the
  11. ElvishDNP

    So do you really...

    I work OB/nursery. For an adult: Listen to heart/lungs/bowel Assess breasts/nipples Assess bowel/bladder function (this includes checking for hemorrhoids) Check incision/perineum for sx infection or dehiscence Fundal height and lochia Assess pedal pulses, and check extremities for edema and/or sx of DVT If she is still pregnant, I check fetal heart tones Newborns are a different story altogether....
  12. ElvishDNP

    Mixing Breast Milk with Formula

    We've done it many times with our more puny kids who need Mom's breastmilk but also need extra calories. In our nursery (well-baby plus a little) we usually have a order for a specific amount. Sometimes it's just powdered formula we mix in with the breastmilk; other times it's the liquid form, it just depends on the baby and the peds.
  13. ElvishDNP

    I cry after I see a baby born-can you give me some advice

    The first several births I saw, I cried....a lot. There are still some moments at work that make me get misty-eyed in a good way. There's a good way to do it - with a couple Kleenex and staying in control - and a not-so-good way, which means breaking down into hysterics, becoming a blithering mess, and being unable to take competent care of your patients. The miracle of it will hopefully never wear off, but in time know that you will get better at managing the emotional aspect. Good luck to you! :)
  14. ElvishDNP

    splattered with CellCept in first trimester

    You should definitely do an incident report ASAP if you haven't already. The next person to contact is your primary OB. S/he is the one best able to assess your risk and advise you as to a plan of care. Beyond that, we really can't give medical advice, or tell you what to do. But I do feel your anxiety; I got my head, neck, and chest irradiated (CT and CXR) after a bad wreck early in my first trimester and it scared me to death. Best wishes to you. Closing this thread.
  15. ElvishDNP

    BSN Now or ADN Later?

    Personally, I'd go the BSN route just to have it done. It might or might not make a difference in your job search now but it will give you more options should you decide to move away from the bedside in the future, without your having to go back to school to do it. I don't regret my choice to go straight for a BSN for a second. Having said that - I will tell you what my stepfather has told me several times facing big life decisions: You make the best decision you can with the information you have in front of you. If it was the right decision, you'll know. If it wasn't, you'll be given the chance soon enough to correct it. (PS - It's not a matter of which degree makes a 'better nurse'....there are fantastic and atrocious nurses all stripes.)