"Baby Friendly"

umcRN, BSN, RN · Mar 19, 2013

I would talk to your unit manager and your educator if possible. I don't work at a birthing hospital so we get out of the baby friendly thing but that just sounds dangerous. You should not be admitting and needing full workups on otherwise healthy infants whose moms supply is a little slow to come in. And what about those moms who don't want to breastfeed? Are they allowed to give formula?

NicuGal, MSN, RN · Mar 19, 2013

Wow, there is something really wrong there! What does the director of your unit say? Sounds like they need to meet up with the director if the nursery.

Are the nurses on the floor making sure those kids get to breast every two hours? Are they watching wet diapers? I hate to say it, but one day there is going to be a lawsuit, especially if you really are getting kids with seizures!

TiffyRN, BSN, PhD · Mar 19, 2013

The hospital where I work is certified. Those guidelines have impacted the NICU very little except perhaps much more support for mothers who want to breastfeed their sick/premature infants. Our Neos are not very open to dehydrating the infants or allowing them to become hypoglycemic.

I know we've had kids admitted that could have been kept with their mothers if they had been allowed a couple bottles of formula. Heck, I bet we could have spotted them a couple bottles of donor milk but the artificial bottle/nipple is the biggest hang-up seems like. Of course, I know we can't measure the damage done by formula feeding that comes later in life, but I digress (I could get really tacky here).

I saw some interesting research about Baby Friendly Certification and I will post the link below.

Hospital accreditation doesn't ensure breastfeeding | Reuters

Marymoomoo · Mar 19, 2013

I'm really concerned that with this training, people are learing to become very inflexible and not giving formula when really medically necessary.
I can understand not wanting to give formula for the majority of breastfed normal newborns but sometimes the mother's milk supply isn't sufficient enough and the baby suffers for it.

It is doubtful that so many mothers have difficulty producing enough, especially in the first few days when the newborn's stomach capacity is small and their caloric needs are not much bigger. More likely, the mother has enough milk and the baby is having difficulty getting it. Why? Are mom and baby rooming in? Are mom and baby skin to skin? Are visitors minimized, even just for "nap time"? Are there enough IBCLCs on the floor to visit every dyad? Who is checking in to assure that baby is latched on well, nursing frequently enough (or given plenty of opportunity to do so)?

Are your mothers taught hand expression? Moms can assure their baby's get enough milk, especially if they are "sleepy" or not nursing frequently, by following up feedings with hand expression, then feeding colostrum by spoon. Here's a video that explains: Hand Expression - Newborn Nursery at LPCH - Stanford University School of Medicine (click proceed to see the video--the warning exists due to demonstration of the technique)

We have seen an major increase of babies being admitted because of low blood sugars and lethargy and/or seizures. When we do our lab work, we are finding that these babies are dehydrated but before we get that diagnosis these babies are getting full septic workups including urine caths and lumbar punctures.

Again, the question is why. If babies are given lots of opportunity to nurse, mothers know how to tell their baby is nursing well and understand the normal course of breastfeeding, someone is watching to assure baby is showing signs of nursing well (and intervening if not), then this kind of thing shouldn't happen.

Here's some info from the Academy of Breastfeeding Medicine that might be of help:

http://www.bfmed.org/Media/Files/Protocols/hypoglycemia.pdf

http://www.bfmed.org/Media/Files/Protocols/Protocol_5.pdf

Marymoomoo · Mar 19, 2013

Here's a protocol on supplementation in the hospital, too.

http://www.bfmed.org/Media/Files/Protocols/Protocol%203%20English%20Supplementation.pdf

NicuGal, MSN, RN · Mar 20, 2013

I think part of the problem is that there is not enough support staff at many institutions, not enough prenatal education.

We are a 50 bed level 3, we have 2 large postpartum floors and only 2 LC's . Yes you read that right. Both PP floors are chronically short, have a huge number of clientele who do not self educate about anything. It is a huge challenge. Our hospital also will not allow cup/spoon feeding due to a few incidents in the past (per our legal department), so we are having a hard time with baby friendly items. I am all for BFing but I just don't have the time to help 3 people at one time, especially if they really don't want to put forth any effort to learn about breast feeding and pumping, etc.

Always a new challenge.

aerorunner80, ADN, BSN, MSN, APRN · Mar 21, 2013

Marymoomoo, you bring up some valid points as well. The problem is that we are not sure right now where the breakdown is. I know when I had my child at the same hospital in 2011, I had plenty of support from IBCLC's and staff nurses but things change. I really feel there needs to be a full review of the policy and the support for mothers, and education.

TiffyRN, BSN, PhD · Mar 22, 2013

OK, a little trouble for "baby friendly". . .

Newly published research (in Pediatrics, but how credible are they anyway?) shows that not only are pacifiers not detrimental to rates of breastfeeding, but they may actually decrease rates of breastfeeding. I know this is only one component of the whole "baby friendly" initiative, but though rooted in good intentions, the pacifier restriction thing really riles me. Especially when infants admitted to the NICU and denied exclusive access to a breast are further tortured by being denied a pacifier by sincere, well-meaning (but misled) parents.

Pacifier Restriction and Exclusive Breastfeeding

NicuGal, MSN, RN · Mar 23, 2013

We tell parents that we are not going to listen to the big NPO PPHN kid scream like mad and get worse and worse. The pacifier thing is going a bit far.

asher315 · Apr 22, 2013

I work in a Level 2 NICU and we deliver approx 1800 babies a year. With the new Medicaid changes, we are really being pressured to improve our breastfeeding numbers, especially no supplementation, AT ALL, (despite a mother's request) only with a doctor's written order (not happening here on night shift!) and for with a medical indication. That would be great, if it were a perfect world. Some mothers want to BF during the day but "just give my baby a bottle tonight", they don't want to room-in so they can learn their baby's cues. They don't read or attend classes. They think it is "natural" so it must be easy! We've had babies with a 10% weight loss in less than 48 hrs.

I know that BF is best and I will help any mother to BF. But I think something is wrong with the whole picture. (We have 1 FT lactation specialist and 1 PT, not enough to go around!). Okay, felt good to let it all out.

babyNP., APRN · Apr 22, 2013

That would really **** me off. I've heard of facilities taking away pacifiers that the mother bought herself and throwing them away.

I'm a NICU RN and will breastfeed when I have kids and I completely believe in it. But you can bet your dollar that first night after pushing a bowling ball out (or recovering from a major abdominal surgery!!) that I will not be feeding my kid with the breast and will be giving them a bottle. I would probably fall asleep with them and having a code blue called...A bottle will not kill them...