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"Baby Friendly"

Specializes in MSN, FNP-BC.

Is anyone else going through the Baby Friendly designation at their hospital right now? We have done all of our training and are now waiting for the visit. I'm having some issues with it though.

Not much has changed in our unit as far as our practices, which I'm thankful for. What I am noticing is an increase in admissions from NBN of babies who are dehydrated because the nurses and/or practitioners are refusing to give breastfed babies formula when needed.

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.

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.

I am really feeling that the designation of "Baby Friendly" is being misapplied or some education is missing.

I want to talk to someone about this. I'm probably going to start with my unit director becuase this really bothers me.

Has anyone else experienced this? What are your thoughts?

How would you present this as a concern? Ideally I'd like to bring this up with the unit directors and the medical directors to find out what exactly is going on.

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

Specializes in NICU, PICU, PACU.

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, ADN, BSN, PhD

Specializes in NICU.

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

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

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU.

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

Specializes in MSN, FNP-BC.

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, ADN, BSN, PhD

Specializes in NICU.

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

Specializes in NICU, PICU, PACU.

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

Specializes in Babies, peds, pain management.

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

Specializes in NICU.

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...

Edited by sirI

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...

Those first hours of nursing are important for baby. Colostrum is extremely valuable for newborns, and that time is formative for bringing your milk in/establishing supply, for bonding, and to help your uterus return to normal size. I can't personally imagine not wanting to room in with my newborn that first night unless I was recovering from a serious complication; you can never get it back. All I wanted to do those first nights with my babies was snuggle them and touch them and get to know them!

That said, the issue the OP mentioned does sound like it would be hard to deal with on the fly right after delivery. So much about successful breastfeeding starts with prenatal education and support in the early postpartum period, and having an inflexible policy can be problematic when you are dealing with moms who aren't committed or prepared or even interested in nursing. However, how many mothers and babies are rooming in and encouraged to nurse before baby shows advanced signs of hunger? If your practices haven't changed much, how would they need to change to make sure those babies are getting what they need from mom? Breast milk is highly digestible in addition to newborns having tiny tummies, and those babies should be nursing on demand. I'm sorry, but if those moms really do plan to nurse when they leave the hospital, avoiding bottles as much as possible in those early days and supporting the mothers can make a big difference. I've seen the flip side so many times--mothers who want to nurse but didn't have the support in the hospital that they needed, their babies were given bottles and their confidence in their milk supply was compromised right away due to supplementation which also kept them from establishing a good supply, and it can go downhill from there. Clearly this isn't every mother, or even the majority; I understand many do not plan to breastfeed. But for those who do, you can make an enormous positive or negative difference in those early days.

I hope the hospital can address your concerns; the problems you are describing are definitely frightening and concerning, and given unlimited resources I would say there are ways around defaulting to formula supplementation except in extreme cases, but I understand that may not be feasible in many settings, including yours.

babyNP., APRN

Specializes in NICU.

trauer, I said I'm a NICU RN. Do you think I don't know the importance of colostrum? That's what a pump is for! I'd much rather pump than fall asleep with my kid and possibly smother them. I've seen it happen and the kids that come to our unit are already gone, just need an EEG to confirm. I should note that I'm not at a delivery hospital and we're 100% referrals so we get kiddos all over my region. Somehow I don't think that being hopped up on pain meds, lack of sleep, soreness, and middle of the night feeding is ideal in the first 24 hours. If women want to do it, more power to them. But women shouldn't be shamed if that's not something they want to do. Formula isn't evil.

I think the kid and I will survive if mama gets some rest after her long athletic event...

BabyRN, it certainly wasn't my intent to offend--apologies if I did so! I was just trying to respond with what my experience has been, which is pretty vastly different from yours, and doesn't make either of us wrong. More power to you; I'm all for doing what works for you, and certainly not interested in shaming a mother for making an informed decision for herself or her child. But in the same vein, if a mother really wants to nurse exclusively, encouraging her to supplement (or even pump) right off the bat may not be the right choice for her. Formula isn't evil (just sub-par nutrition for most babies), but women who choose not to supplement aren't necessarily masochists either. ;)

My experience with baby friendly is largely negative. I worked on a baby friendly unit and in the SCN for almost 5 years. I can only speak towards the unit I worked on, but having 4 kids myself...all delivered at a non-baby friendly accredited hospital, I felt the level of support and the focus on mom plus baby made it a better environment. I breastfed all my children. I believe in breastfeeding and have written a few different research papers on the topic while pursuing my BSN degree. I feel that baby friendly actually fails the mother. So many nights I worked and had mom's who were train wrecks...overtired, emotional, having pain issues. However policy at my hospital prevented me from offering to take their baby out to the nursery and bring them back for feeds. If they asked, I could possibly say yes if the SCN was open or wasn't busy, but they had to ask and after getting the baby friendly talk prior to or at delivery, most didn't. Then the heartbreak when they did ask and I had to tell them no because we don't have a healthy newborn nursery and the SCN was closed or too busy. Ugh. We also were a small community hospital and only had minimal lactation support...2 part-time LCs, that's it. If a parent wanted to offer a bottle we had to try to talk them out of it. I'll be honest, I'd give the speech half-heartedly and preface it with a..."IT'S YOUR DECISION". I know there were rumors that one of the LCs was telling parents that formula is poison! Only a rumor, but how scary and sad...not to mention a horrible way to promote breastfeeding.

Switch to the hospital I delivered at. A much larger hospital with plenty of lactation support. A level III NICU and a healthy newborn nursery. I devised a plan with the help of my nurses so I could exclusively breastfeed and still be able to rest. My husband had to be home caring for our other kids and I was a section with all my kids. I had lactation bring me a pump to increase my supply as I'd had issues with that each time. I'd feed, then pump. At night I'd send my baby off to the nursery after a feed and giving the colostrum I'd pumped throughout the day, no guilt, and he or she would be brought back to me when signs of hunger occurred or within 3 hours. Most often I'd have had enough sleep to then just keep the baby in the room with me but if I didn't we would do the same thing. I was able to function better, my baby didn't suffer and we were able to be sent home exclusively breastfeeding and do so for months.

I've thought this through and one important thing I've seen I'd the fact I'm educated regarding breastfeeding. I'd say a large population of women in the hospital I worked at were not. Obviously socioeconomic status are different to as this was an inner city hospital that catered to a large hispanic population. I just feel there are so many influences such as culture, age, socioeconomic status, education etc that effect someones decision to breastfeed and none of that is taken into account. All that is looked at is what's best for the baby, and while that is hugely important other things do come into play that help or hinder successful breastfeeding. I also feel baby friendly focuses mainly on the number of couplets that leave exclusively breastfeeding, but not so much in the community. I'd say a vast majority of those families go home and begin offering formula almost immediately. You can almost predict which ones.

Sorry, this is long...but one more thing. I was lucky enough to land a temporary job doing homecare with preemies recently discharged from local NICU's...and many of them were still receiving EBM or going to breast. That showed me that when you have a captive audience for a decent amount of time, you have the opportunity to teach. These mom's could rattle off the benefits of breastfeeding better than I could. The best one was a 9 month old who was born at 29 weeks and mom was exclusively offering him the breast. He was huge and chunky and adorable...they were also a very poor family. So to all NICU nurses, keep up the good job!! Your educating these parents during their extended stays is paying off in the numbers of babies receiving breast milk post-discharge!

Edited by RN*mommy

MrsNicuNurse

Specializes in Med-surg, NICU.

If our moms who are breastfeeding have low supply our neos put the baby on D10W while mom keeps pumping and working on her supply. meanwhile we put baby to breast ad lib and baby doesnt require formula.

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU.

You put IV's in kids for that? What if they are a bad stick? I'd rather give a kid formula than put in an IV which is a source of infection. I don't see that as baby friendly at all!

I don't think I would have agreed to my kids getting an IV either! My kids were, fortunately, all full-term and didn't require a NICU stay. As we all know, supply isn't really an issue those first few days in the hospital. My concern was establishing a decent supply from the beginning. Maybe I'm confused. Was this in the NICU where babies stayed for a longer time? Were there sugar issues with the babies? I've never heard of such a practice! I can't imagine an IV being placed and fluids given for feeding issues. I have to agree that's not baby friendly at all!

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