Nineteen84

Woah, woah. Let's break this down another way... It's fact that prenatal care reduces infant mortality. Is it a coincidence that places with better prenatal care have higher incomes? Or that mothers with access to more financial resources get better prenatal care and thus have healthier infants? And that those same mothers are more likely to breastfeed for a longer period of time? I'm not saying breastmilk isn't the best option (it is). I am saying that studies frequently tie a direct link to breastfeeding and healthy babies when there are many many other factors in play. As nurses we have to look at our patients as whole people and not push our perfect world scenario on them when those ideals are unrealistic for their situation or when our agendas just aren't the same as theirs.

Fact based can sound hard and uncaring and result in parents feeling inadequate. If a parent is unsure about breast or bottle I'm more than happy to provide information on BOTH. If they have made up their mind I don't go in and tell them all the risks of bottle feeding. Also, I have found that many lactation studies are VERY biased. Think about where breastfeeding rates are higher (at least in the US)....upper middle class. Of course an upper middle class family is on the whole going to have fewer medical costs - it's very likely not the breastfeeding but preventative care, access to nutritious foods, etc. that's skewing these results.

For what it's worth here are my two cents: I am a nurse with mental illness and I think the main thing to note is that you have to be really really aware of how you are. If you can't do that, then you can't be a nurse with mental illness. It's not safe. For example, I have a wonderful psychiatrist who knows that my job is my all in life. He knows I do better when I'm working. Yet he also knows when to tell me to take a break. A couple of years ago (while I was a nurse) I underwent electroconvulsive therapy. Being under anesthesia and seizing 3x/week and trying to work would not be safe. In fact, after I returned from my leave for ECT I had to go through orientation again - I had forgotten some major aspects of my job. Likewise, being at work when I was very acutely suicidal was not safe - too much access to too many things. But working with my psychiatrist closely and having my family remind me of when I wasn't functioning at par has allowed me to be the nurse I had always wanted to be. You know yourself the best. If you can (honestly, 100%) stay on top of your illness even when you're at the worst point to make sure you're not harming patients then I see no reason why you shouldn't become a nurse.

Second all the previous posts. We don't blink an eye unless we hit 10% and I believe I read somewhere that 12% is even used as a limit in some locations. And like they said, it's not just the number with there being so many other factors to consider. In addition to above responses, I might consider having a mom pump. Yeah yeah the pump isn't as good as baby but if she can get something, it boosts her up, you show her how to give it to baby. If she doesn't get anything remind her that's totally normal but the stimulation is a good thing too. Maybe she can feed baby, put kiddo skin to skin while pumping (hands free with a belly band and baby tucked inside is wonderful), and then pump after unsuccessful or all feedings (depending on the situation).

I agree with both of you actually. The RN’s in my hospital (myself included) all jumped exactly to your concerns when they initially went nuts over this Baby Friendly Initiative and we've all learned to adjust to meet everyone's needs. First, with the pacifiers. They get a little wild. Pacifiers can be a good thing - especially with our preemies. On the other hand, I've seen parents who use a pacifier in place of on-demand feedings, and we all know that's not appropriate. As far as formula goes; it has its place and time as well. I've actually had a pediatrician cause a mother tears and given her the impression that the reason her baby was in Special Care (what we call level II NICU) was because the baby was not getting breast milk. The mother asked multiple nurses if she was a bad mother for not breastfeeding. Totally uncalled for and the pediatrician was later "educated" (gag me). On the other hand...formula is not the poison they make it out to be. Overall, I find myself asking a lot more questions and probing for their thoughts on feeding and so on more than before. I frame it as wanting to know their thoughts rather than pushing the hospital agenda on them. Are you bottle feeding or breastfeeding? If it's bottle, did you consider breastfeeding? If yes, why did you change your mind? If no, is there a reason? At this point if they either have a solid reason they are or are not going to breastfeed I say great and move on. If they're hesitant I continue the conversation about why they may want to consider breastfeeding and promoting the help we can offer them to do so if they should decide to go that route with THEIR baby. I always, in everything (pacifier, bottles, nursery, etc.), reinforce that this is their child, they make the decisions, not us, so they should never feel they are pressured to do something they do not want for their child. I remind them that we are simply there to help by giving them the most information possible and supporting them in their choices. And honestly, are we that self-absorbed to think that 2 days of our pushing breastfeeding is going to change what happens later at 3am when that now colicky 2 month old is screaming bloody murder? BUT 2 days of our helping Mom learn to problem solve feeding issues and 2 days of our teaching her that baby will be just fine even if everything’s not perfect 100% of the time can make a difference. Having said that, there are times when it is simply not appropriate to go into a long presentation about what we know and making decisions this second. A baby can wait a half an hour while you sit with, comfort, and talk with Mom (and if they can’t wait due to blood sugars or other distress that becomes a different scenario entirely). A baby can go to the nursery for a couple of hours if she's having a mini breakdown that only sleep will cure. If a mom wants to hold off on making a decision for a couple hours it’s not the end of the world. That young of a baby is (most of the time) going to be just as happy skin to skin or swaddled well as it is actually nursing. It’s a balancing act that involves good old human compassion and nursing judgment. It’s not doing what we do because that’s how we do it. It’s not making anyone feel bad for choosing a different method. Baby Friendly or not, my job is about doing what needs to be done to make sure that these parents go home with the knowledge they need to care for their infant to the best of their ability today and that they have the places and contacts and support to reach out when they find they don’t have all the answers later on.

I've been working as a med surg RN for 1 year. OB is where I really want to make my career however. I've started applying for jobs but have had very little luck. I'm afraid it's because I have no experience in OB but it's that old catch-22 of how to get experience without being able to work in that area. Any suggestions? Thank you in advance.