Watch Your Language - Breast Isn't Best!

Published

And because I love to stir up the winds of controversy, I'll share this article with everyone and see what they think.

http://www.bobrow.net/kimberly/birth/BFLanguage.html

What do you all think of this article?

Alison

"how should we raise breastfeeding rates?"

I'm not sure that we should raise breastfeeding rates.

I think most people are perfectly happy with the decisions they've made.

I don't want government, or a nurse, dictating how I feed my child.

Why must we advocate for one method of feeding over the other?

Inherent in that position is that if a mother chooses bottle, she's making a 'bad' choice (pack your bags, your going on a guilt trip!)

I say, present the unbaised facts, the pros and cons of both methods of feeding, answer questions, tell them that when they make a decision, you will give them all the information/support/referrals they will need.

This whole topic kind of reminds me of the phrase: 'let ye without sin cast the first stone'

Ok, overweight nurse, you're gonna tell me that if I bottle feed that I'm endangering the health of my baby. Right.

Or, I smell smoke on your clothes lactation consultant, but you're telling me that formula is 'artificial and inferior'. Right.

My point, unless you're perfect, stop pushing your own agenda.

Be factual, be non-judgemental and be suportive.

Kind of like the rape prevention motto: if a woman says 'no', it means 'no'.

Don't probe for reasons, don't try to change her mind with more facts, relate personal success stories etc.

Knowing something and doing it are two very different things.

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Specializes in ICU, ER, HH, NICU, now FNP.

I don't think anyone has an issue with factual information presented in an unbiased way. The problem is that MANY nurses - yes even those who work in post partum and newborn - perpetuate MISinformation and myths based on opinion, tradition and experience rather than evidence.

Once you put all the opinionated emotional baggage aside (sometimes difficult to do in our society where boobs are thought of as a pleasure palace for men) there is no issue with respecting whatever decision a woman makes as long as she has all of the information on which to base that decision.

Lets say a woman comes to the pediatrician and wants antibiotics for her child because the neighbors kid has an ear infection. Do we write her the scrip and send her on her way? No. Nor do we tell her how stupid she is for wanting to prevent her son from getting sick by putting him on antibiotics he doesnt need, Instead we offer her evidence based factual information in a format and approach that make sense to her. We educate her, we give her the opportunity to make an informed decision that supports the health of her child. She leaves with a better understanding and feeling grateful that she good information! Now - if she is insistant will some docs write her a scrip anyway? Possibly. Might she ask her neighbor for any extra amoxicillin she has on hand? She might - but there again, she has been presented the information - what she does with it is up to her. It is an informed decision THAT is to be respected. The same holds true for breastfeeding.

The problem with the breastfeeding is that people carry a lot of personal baggage around about it, this often influences the way they talk to patients about it. (Yes I know in an ideal world this would not happen but we are all humans here!) Or since it is something they had a negative experience with, they assume others will too. As nurses, it is not our job to decide who will and who won't breast or formula feed. It IS our job to present parents with accurate factual evidence based information.

Whatever decision a parent makes then is to be fully respected. Families do what works for THEM - but they need to know enough to make a good decision about what that will be. No badgering, guilt inducement or other underhanded tactics are necessary. If we withhold iniformation from most in fear of making a few feel guilty, then we are not serving the majority well.

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Specializes in OB, lactation.

What do you guys think about Baby-Friendly? I did a lit review on studies relating to it since 1998, for a research class of mine & 100% showed improved bf rates with it.

Yet, it is very poorly utilized in the U.S. Ironically I suspect this is because it would cost money for hospitals to become certified.... the reason I think this is ironic is because the program is extensively utilized in many (if not most) countries worldwide, some of which are very poor compared to us.

http://www.babyfriendlyusa.org/

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Specializes in ICU, ER, HH, NICU, now FNP.

The thing about baby-friendly is this: In other countries the WHO code for the marketing of breastmilk substitutes is enforced. In the US it is not. Big Business (namely formula companies) run policy in the US. Part of the incentive a hospital gets to NOT be baby friendly designated is that they get free formula and supplies from the formula manufacturers. If they are baby friendly, the hospital has to buy the stuff. It's really all about the bottom line.

Formula companies purchase pieces of equipment, fund research, provide free meals and CE's, provide transportation and expense scholarships to conferences, and other stuff to docs, hospital staff and admins. It can't be argued that the hospitals, staff and some patients benefit from this...but I can't help but think that ultimately - babies and mothers would be better benefitted by cheaper formula being available because they werent footing the bill for high dollar marketing!

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My point, unless you're perfect, stop pushing your own agenda.

Well, I am perfect so....... :rotfl:

Seriously though, I think most women have made up their minds before they get to L&D. THose that are on the fence are really the only ones we can affect. I think it needs to be focused on more in the OB's office. I'm not really sure they cover that in their office visits. :rolleyes:

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Specializes in OB, lactation.
Well, I am perfect so....... :rotfl:

Seriously though, I think most women have made up their minds before they get to L&D. THose that are on the fence are really the only ones we can affect. I think it needs to be focused on more in the OB's office. I'm not really sure they cover that in their office visits. :rolleyes:

I think you are right, at least in part. But then again like I wrote above, Baby-Friendly hospitals (or probably other very breastfeeding-friendly hospitals as well) have much higher initiation rates, so something is happening to change at least some patient's minds as compared to lower rate hospitals.

Alot should be happening in OB's offices... also Peds offices. They don't refer to proper help (or find out what to do themselves) when there is a problem breastfeeding. Way too many people think that when they encounter a problem, that's the end of it. Most problems can be fixed with appropriate help.

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Specializes in OB, lactation.
The thing about baby-friendly is this: In other countries the WHO code for the marketing of breastmilk substitutes is enforced. In the US it is not. Big Business (namely formula companies) run policy in the US. Part of the incentive a hospital gets to NOT be baby friendly designated is that they get free formula and supplies from the formula manufacturers. If they are baby friendly, the hospital has to buy the stuff. It's really all about the bottom line.

Formula companies purchase pieces of equipment, fund research, provide free meals and CE's, provide transportation and expense scholarships to conferences, and other stuff to docs, hospital staff and admins. It can't be argued that the hospitals, staff and some patients benefit from this...but I can't help but think that ultimately - babies and mothers would be better benefitted by cheaper formula being available because they werent footing the bill for high dollar marketing!

But the whole money thing is exactly why I think it's so ironic... I'm sure poor underdeveloped countries like Gabon and Tanzania would love to have the formula company freebies MUCH more than any hospital in the U.S..... surely to you-know-what if they can do it, we can too! I'm not saying Baby-Friendly or any other single approach is the end all, be all, but it's frustrating to me to actually see something that works quite well just be so ignored by the powers that be. For example, Kenya has 232 Baby-Friendly certified facilities, SUDAN even has 25, yet we can't do it? Know what I mean?

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My only problem with baby-friendly designation is that it often isn't (baby friendly that is). I actually worked at a rural hospital in Canada that wanted to get that designation and it led to some lunatic actions (including locking up formula like narcotics, nurses being told to place NG tubes when they could be avoided, some people wanting to start IVs to give boluses for low BS rather than let a baby have a drop of formula, etc). Initiation rates may increase with this designation, but what about once mom gets home and no longer feels the need to please pushy nurses?

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My only problem with baby-friendly designation is that it often isn't (baby friendly that is). I actually worked at a rural hospital in Canada that wanted to get that designation and it led to some lunatic actions (including locking up formula like narcotics, nurses being told to place NG tubes when they could be avoided, some people wanting to start IVs to give boluses for low BS rather than let a baby have a drop of formula, etc). Initiation rates may increase with this designation, but what about once mom gets home and no longer feels the need to please pushy nurses?

I also worked in a facility that was trying to be Baby Friendly and found similar zeal and fanatacism. One of the ob docs I know said it best..."Breastfeeding is great for what it is, but it is no more a religion than natural childbirth." While I agree breastfeeding is great, in general, I often feel like we are putting just one more responsibility to be the perfect mom on women who may already have a full plate. We do make smokers feel bad, but smoking and bottle feeding are not equal health sins. Slam me if you want, but formula is less desireable than breast milk. It is inferior. It is not inherently harmful to everyone as smoking is. It is appropriate and more desireable to bottle feed under some set of circumstanes, one of them being ill or unavailable mother, for example. It is never a good thing to smoke. It is never more healthy to smoke than not to.

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Specializes in OB, lactation.
My only problem with baby-friendly designation is that it often isn't (baby friendly that is). I actually worked at a rural hospital in Canada that wanted to get that designation and it led to some lunatic actions (including locking up formula like narcotics, nurses being told to place NG tubes when they could be avoided, some people wanting to start IVs to give boluses for low BS rather than let a baby have a drop of formula, etc). Initiation rates may increase with this designation, but what about once mom gets home and no longer feels the need to please pushy nurses?

That is disheartening to hear. Some of them probably had a misunderstanding of the guidelines because there is nothing in the requirements that would necessitate any of that (i.e. formula is fine when needed or the desired choice of the mother). As I'm sure you already know, the 10 steps are simply:

The Ten Steps to Successful Breastfeeding

1. Have a written breastfeeding policy that is routinely communicated to all healthcare staff.

2. Train all healthcare staff in the skills necessary to implement the breastfeeding policy.

3. Inform all pregnant women about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding soon after birth.

5. Show mothers how to breastfeed and how to maintain lactation even if they are separated from their babies.

6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.

7. Practice rooming-in, allowing mothers and infants to remain together 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no artificial teats or dummies to breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Do you know more about why they felt they needed to do the things they did? Was it misguided enthusiasm or ???

The rates do generally remain higher even after going home.

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#6 is a problem with many because many feel it isn't "medically necessary" to ever give a baby formula. The allknowing Jack Newman says it's better to start an IV in a hypoglycemic infant than to give him a drop of formula, so it must be true right? ARGH!!! Jack Newman was the bane of my existence at that hospital sometimes....

#9 is also a BIG pet peeve with me. If I have to put a baby through any sort of painful procedure (like IVs, NGs, heelsticks, etc) I don't see any harm in giving them the comfort of a pacifier with a little sweetease on it. Not doing that is not baby friendly, it's cruel.

Otherwise all those things on the list are routine in every hospital I've worked at in Canada so I don't get the push for getting designation. (I do see less rooming in here in the US).

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Specializes in OB, lactation.

I guess the push is that it works (even though I personally don't see a push at all, there are only 50 in the entire US that are certified and about 4 in Canada). Don't get me wrong, I'm not trying to be pushy about it personally, I just haven't seen anything else that appears to work like it does.

That's why I was asking about ideas for improving the rates/desire to breastfeed - I'm open to anything! What do people here find is helpful/works for them?

There are a lot of moms out there who never thought they would want to do it who, for one reason or another, ended up doing it and loving it! My sister and my best friend used formula with their firsts and went on to nurse their second babies and loved it and wished it had worked out that way with the first (by the way, both specifically blamed their hospital experience for the first time (bad info, and then also weren't told where to get help after going home), & likewise one of them also attributes her second time around success to a nurse at the hospital who persuaded her to just give it a try - something she never would have done if she weren't encouraged to).

I think an IV for glucose instead of giving formula should be the mother's choice with informed consent. IV's stink, but there are long-lasting physiological consequences to the GI system of a baby who would be otherwise exclusively breastfed if they have formula introduced, so I think it should be up to the parents.

http://www.health-e-learning.com/articles/JustOneBottle.pdf

But that's more of an individual battle than a Baby-Friendly thing anyway.

The pacifier debate is one I ain't even going to jump into right now! LOL

Gotta go finish dinner!

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