Watch Your Language - Breast Isn't Best!

fergus51 · Jul 26, 2005

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!

As far as IVs go, it doesn't just stink for the baby. I won't even go into all the problems that can happen with IVs, but at that particular hospital a doctor would have to start the IV since the nurses didn't start IVs on neonates and frankly it wasn't like the docs were really good at it. So we could have made the doctor come in at 3 am to poke a baby 3 or 4 times to give a bolus. By that time the baby would have been separated from his mother for a good hour with his low blood sugar and probably too tired out to be able to feed well at his next attempt at the breast which would only compound the problem. Barring that, the baby would have to be transferred to another hospital while mom stayed behind. That ain't "baby friendly". Even at my current hospital (we're a level 3 NICU), the baby would have to be transferred to the NICU to have this done. All that rather than give a baby a teaspoon of formula with a lactation aid at the breast in his mother's arms? That's crazy. It's painful and risky for the baby. It's medicalizing breastfeeding, turning it into something so complex and risky that a baby can't do it without a trip to the NICU and an IV inserted. That doesn't help a new mother's confidence. It is completely counterproductive. That's my problem with some nurses: they don't look at the big picture. All they see is: BABY CAN'T HAVE FORMULA AT ALL COSTS and ignore the rest.

As far as pacifiers go, I'm not talking about sticking one in a healthy baby's mouth every time it cries. I'm talking about providing pain control and comfort during painful procedures. Parents don't have the right to subject their children to needless pain because of fear propagated by fanatics. Do you think we'd insert a chest tube without medication if mom or dad didn't want us to medicate the baby? By the same token, there is no way any of the nurses I work with would participate in a circumcision and not give the baby a pacifier (I don't participate in circs at all, so it doesn't really affect me :chuckle ).

Like I said, the vast majority of the baby-friendly guidelines are already in place in most hospitals. The vast majority of nurses I've worked with in OB and NICU are very pro-breastfeeding. We just want a little bit of wiggle room when it's needed. We all encourage women to breastfeed. I think it's important to acknowledge that there is a fine line between encouraging a woman and coercing her.

Know what I think would improve breastfeeding rates in the long term (cause initiation rates mean nothing if they stop breastfeeding 2 weeks after they go home)? Good education and good maternity leaves. Women in some states get only 6 weeks mat leave and then have to go back to work. For most of these women it will not be possible to breastfeed exclusively for 6 months like we recommend. In Canada women get a year off. It was rare there to have a woman who didn't want to breastfeed.

SmilingBluEyes · Jul 27, 2005

As far as IVs go, it doesn't just stink for the baby. I won't even go into all the problems that can happen with IVs, but at that particular hospital a doctor would have to start the IV since the nurses didn't start IVs on neonates and frankly it wasn't like the docs were really good at it. So we could have made the doctor come in at 3 am to poke a baby 3 or 4 times to give a bolus. By that time the baby would have been separated from his mother for a good hour with his low blood sugar and probably too tired out to be able to feed well at his next attempt at the breast which would only compound the problem. Barring that, the baby would have to be transferred to another hospital while mom stayed behind. That ain't "baby friendly". Even at my current hospital (we're a level 3 NICU), the baby would have to be transferred to the NICU to have this done. All that rather than give a baby a teaspoon of formula with a lactation aid at the breast in his mother's arms? That's crazy. It's painful and risky for the baby. It's medicalizing breastfeeding, turning it into something so complex and risky that a baby can't do it without a trip to the NICU and an IV inserted. That doesn't help a new mother's confidence. It is completely counterproductive. That's my problem with some nurses: they don't look at the big picture. All they see is: BABY CAN'T HAVE FORMULA AT ALL COSTS and ignore the rest.
As far as pacifiers go, I'm not talking about sticking one in a healthy baby's mouth every time it cries. I'm talking about providing pain control and comfort during painful procedures. Parents don't have the right to subject their children to needless pain because of fear propagated by fanatics. Do you think we'd insert a chest tube without medication if mom or dad didn't want us to medicate the baby? By the same token, there is no way any of the nurses I work with would participate in a circumcision and not give the baby a pacifier (I don't participate in circs at all, so it doesn't really affect me :chuckle ).
Like I said, the vast majority of the baby-friendly guidelines are already in place in most hospitals. The vast majority of nurses I've worked with in OB and NICU are very pro-breastfeeding. We just want a little bit of wiggle room when it's needed. We all encourage women to breastfeed. I think it's important to acknowledge that there is a fine line between encouraging a woman and coercing her.
Know what I think would improve breastfeeding rates in the long term (cause initiation rates mean nothing if they stop breastfeeding 2 weeks after they go home)? Good education and good maternity leaves. Women in some states get only 6 weeks mat leave and then have to go back to work. For most of these women it will not be possible to breastfeed exclusively for 6 months like we recommend. In Canada women get a year off. It was rare there to have a woman who didn't want to breastfeed.

Thank you...that is the first time I have heard anyone say they would prefer IV over formula. I am shocked.

LilPeanut, MSN, RN, NP · Jul 27, 2005

Obviously, most women aren't "fine" with their choice if they are feeling guilty and are upset about people saying formula is inferior (not just the 2nd choice, but the 4th choice in infant feeding)

There's lots of things in life that we do that are inferior and we are ok with it. I will buy inferior clothing because I only want it for one occasion and don't have much money. I will eat inferior food because that's what I feel like eating.

Are you going to make me feel guilty about getting that cheap shirt or that hamburger and fries for lunch? Heck no. I know it's inferior and I feel my personal reasons outweigh the reasons for choosing the superior item.

Part of the issue is so many women use "I couldn't" as an excuse for why they didn't nurse (when in truth the reason was "I didn't want to") so the women who truly couldn't nurse, for whatever reason, feels she has to justify herself to prove that she isn't choosing to give formula. For the mothers who truly can't nurse, formula is superior.

If you want to formula feed because you want to be away from your baby more easily, because of whatever reason, then own that reason and if be satisfied with it. You chose to give your child something that is inferior (again, not the moms who COULDN'T, but the moms who WOULDN'T) and you felt your personal reasons outweighed the benefits. Own that and don't try and push it off on other people for "making" you feel guilty. Perhaps some of your issues could have been helped, hindsight is always 20/20. Or perhaps no matter what, you would still choose the same thing. That's your call as a mother and you will have to deal with it.

In a way, I think about it like helmets on bikes. Very few kids actually get into a bike accident that would threaten their life. Some parents/kids decide it's not important to wear helmets and the vast majority of them are "fine". But, there's no way to know in advance which child is going to have the devastating accident and so most parents feel the annoyance of a helmet (increased heat, lack of aesthetics etc) are far outweighed by the potential that their child could be one of those unlucky few who has a terrible accident.

SmilingBluEyes · Jul 27, 2005

And the point about maternity leave is well-taken. This country has its priorities so screwed up.....

I think that is the bigger problem. You see, probably at LEAST 90% of our moms start out breastfeeding at the hospital.... and darnit, we bend over backward to help them, even in the face of a real and obvious lack of commitment on many of their parts----- only to find out a month or two later, they are back to work and feeding babies formula anyway. Many have no desire or are given NO time to pump at work, anyhow. I find that a bit discouraging myself.

I think if moms were given the choice to remain home longer (more like 6 months) and some of the stipends to stay home longer as they are in some other countries, breastfeeding would be MUCH more enduring and attractive a choice for more mothers. VERY GOOD POINT fergus.

jkaee · Jul 27, 2005

And the point about maternity leave is well-taken. This country has its priorities so screwed up.....
I think that is the bigger problem. You see, probably at LEAST 90% of our moms start out breastfeeding at the hospital.... and darnit, we bend over backward to help them, even in the face of a real and obvious lack of commitment on many of their parts----- only to find out a month or two later, they are back to work and feeding babies formula anyway. Many have no desire or are given NO time to pump at work, anyhow. I find that a bit discouraging myself.
I think if moms were given the choice to remain home longer (more like 6 months) and some of the stipends to stay home longer as they are in some other countries, breastfeeding would be MUCH more enduring and attractive a choice for more mothers. VERY GOOD POINT fergus.

I couldn't agree more! (This from someone who has to sneak into the shower room bathroom at my job to pump....sometimes I work a 16 hour shift and only get to pump twice! NOT GOOD for my ta ta's....

:uhoh21: )

mitchsmom · Jul 27, 2005

Thank you...that is the first time I have heard anyone say they would prefer IV over formula. I am shocked.

Are you talking about Dr. Jack Newman or me? If me, I did not say that I would prefer IV over formula - I said I think it should be the parent's choice based on informed consent. Personally, I don't know what I'd do, I would have to evaluate my own situation - obviously if it were a situation like fergus described, it probably wouldn't be the most prudent choice. But sure, I would consider a painful procedure like an IV if I thought the long-term benefits outweighed the short-term for my baby. Why would that be shocking? If it's shocking then am I right to assume that we don't agree on the long term benefits or the short term risks or both or ???

I think that alot of the general public doesn't understand how big the differences are between the two substances, they hear "breast is best" but I don't think they really understand the physiological differences are much bigger than most people would think. For me to really appreciate it took more learning than most people are probably interested in in a million years. Again, that book 'Milk, Money & Madness' is an interesting introduction to a lot of this. But since everyone isn't as fascinated by the subject as I am, I think it just has to slowly become a societal norm which takes a lot of time (and the last numbers actually showed a slight decline in rates).

I agree about the maternity leave (on many fronts), but I'm not sure if that alone would do it because it seems that most people who quit when they get home do it before they have to go back to work (at least in my experience). What role do you think follow up care and information has in the picture? With 48 hour hospital stays, lactogenesis II isn't even usually started before patients leave and then they often aren't in contact with anyone until a peds appointment maybe a week later (where the ped is usually not a lactation specialist to help a complex issue). We are a fast food society and it's easy to quit when the going gets tough (especially with lack of support/help/info/going back to work/you fill in the blank)... which is one reason I try not to make it sound like all roses when I discuss the early weeks with pregnant moms... I think it sets them up for disappointment & a sense of failure if it isn't all dreamy and wonderful.

As for procedures, why not have the baby nurse on the real thing instead of a pacifier? If they are comforted by a pacifier, and pain control and comfort are the priority, we are going to get even better pain control with that. I did it when my last baby got his hearing test and PKU and he didn't make a single sound and the nurse said it was the easiest one she'd ever done! It could probably also be argued that there are more effective pain control measures than a sugar dummy anyway - I know studies show it's better than nothing but dang you wouldn't make me feel much better getting skin cut off my bottom by giving me a pacifier (not to mention the AAP recommends real pain relief for circs). Is EMLA an option for some other procedures? I think there are sometimes alternatives, and I feel like that is looking at the big picture.

I certainly hope that I haven't given the impression that I believe in 'no formula at all costs & ignore the rest', because I don't feel that way at all. As a matter of fact, just as an example, we have a couple of peds in our town who I felt innappropriately & dangerously told new mothers to abruptly quit formula supplements and go straight back to breast recently. I personally have never met anyone in my lactation circles who didn't adhere to the "Feed The Baby" mantra - baby has to eat! That is really unfortunate that you (fergus) have had so many bad experiences with people with a lack of judgement in that arena. At the same time, it is awesome that you have worked at places where the 10 steps were pretty much in place already ... the hospitals I've been exposed to (through my own births, those of friends, and my clinicals - I know that doesn't hold a candle to what you guys know clinically of course) have not.

And SBE, likewise that your place has such an incredible initiation rate!!! I can see it being frustrating to do a bunch of work with someone who you know is going to bottle the second they get out of sight - I do know how that feels, sometimes I sort of think "why are you contacting me (a volunteer, mind you) & letting me use this perfectly valuable time to share with you if you already know you aren't going to use it one iota???" But I just have to get past it, it serves some kind of purpose for them & it's just part of the "job".

fergus51 · Jul 27, 2005

EMLA isn't an option for our neonates unfortunately. I've had babies nurse while getting an IM, but it isn't an option with some of the other procedures I mentionned (NGs, IV insertions, etc). Although I don't participate in circs, I can't imagine it working there either. When the breast isn't available and the baby has no other comfort measures available, sweetease works wonders sometimes. I've started IVs without a baby making a peep with sweetease. I even worked in a hospital where we had to have parental consent before giving a pacifier (in the NICU where there are HUGE advantages to pacifiers!!!! It wasn't healthy post partum!). There, we would just put sweetease on a gloved finger and use it as a pacifier.

Unfortunately, I have a lot of experience with people who don't realize that feeding the baby is the most important thing. You wouldn't believe the number of NICU admissions I've seen because of it (and the risks of kernicterus are a LOT worse than any long term risks of formula). The pendulum has swung too far in some places. I do think the US has a ways to go when it comes to encouraging rooming in and providing good maternity leaves though.

fergus51 · Jul 27, 2005

Thank you...that is the first time I have heard anyone say they would prefer IV over formula. I am shocked.

Jack Newman. He's an interesting man, but IMO can go a little overboard in his books and his disciples can be absolute nuts. He's a very good clinician from what I've been told.

RNnL&D · Jul 27, 2005

Many have no desire or are given NO time to pump at work, anyhow. I find that a bit discouraging myself.

As a L&D nurse, promoting bfing and pumping, I have very little opportunity to pump for my own child. You would think this line of work would be a bit more understanding, but a busy night is a busy night. I worked 8p-7a last night and pumped once at 2:30 am. That does nothing to boost my supply, and leaves little in the fridge for my little guy. :uhoh21:

SmilingBluEyes · Jul 27, 2005

As a L&D nurse, promoting bfing and pumping, I have very little opportunity to pump for my own child. You would think this line of work would be a bit more understanding, but a busy night is a busy night. I worked 8p-7a last night and pumped once at 2:30 am. That does nothing to boost my supply, and leaves little in the fridge for my little guy. :uhoh21:

It was that way for me too. I had very little time to pump and had to "steal" time to do so. My breasts used to leak when I heard newborns crying (not fun) and that was my signal to PUMP or ELSE rofl. But it was hard to find time on busy shifts. And stressful, knowing I had to "hurry" because my coworkers were too busy to cover for me on some shifts. I tried to use my meal breaks to do so, but we dont' necessarily get those, either.]

Like fergus and I have said, priorities and attitudes will have to shift dramatically if breastfeeding is to endure, improve and be more attractive for all mothers in the USA.

SmilingBluEyes · Jul 27, 2005

Jack Newman. He's an interesting man, but IMO can go a little overboard in his books and his disciples can be absolute nuts. He's a very good clinician from what I've been told.

I have never heard of Jack Newman. Mark me as ignorant, who is he? A prominent pediatrician or something?

SmilingBluEyes · Jul 27, 2005

And SBE, likewise that your place has such an incredible initiation rate!!! I can see it being frustrating to do a bunch of work with someone who you know is going to bottle the second they get out of sight - I do know how that feels, sometimes I sort of think "why are you contacting me (a volunteer, mind you) & letting me use this perfectly valuable time to share with you if you already know you aren't going to use it one iota???" But I just have to get past it, it serves some kind of purpose for them & it's just part of the "job".

It's sad but I have to admit, we often have so little time for "problem nursers". But believe me, I have had the backaches and sore muscles some nights to PROVE how I have tried to help. We are always busy with SO many things, and sadly, helping moms breastfeed is just ONE of our tasks. I find myself silently groaning when I see flat nipples and poor sucking combined in a mom who desperately wants to nurse......

Now: Have more than couplet having problems w/initiating breastfeeding, and you have your hands full. I believe we all do our best. But I do get discouraged when moms seem totally turned off or non-committal when it comes to breastfeeding and I will admit (gasp) that I have been sorely tempted on more than one occasion to hand them a bottle and say "for PITY'S sake, just FEED THIS BABY, stop with this insanity already". (these are for women who are not even trying or seem not to care----but can't make up their minds what to do, so they keep "trying" to breastfeed).

Like I said, and it's the truth: As nurses, we have a 1000 and 1 things to do. The paperwork/computerwork is nightmarish. Just giving meds can take 10 or more minutes to get into our stupid computer system, if things are not set up right. We have hearing screenings, PKU's, weights, assessments, paperwork, surgical issues to attend to, new admits, phone triage calls, rule-out patients, and paperwork, paperwork and more paperwork. Damn that paperwork (and our stupid dinosaur computer system). It takes much of my valuable time away when I SHOULD Be at the bedside, helping women care for their newborns, breastfeed and bond. MUCH more teaching should be going on. I love teaching new moms and dads about their amazing new babies. I wish I had the luxury of time to do more.

I feel guilty some shifts when I go home, knowing someone could have used more help from me. Knowing I did not do near enough for her and her family that night. I have seen more than one crying mommy who did not have any help on the prior shift because her nurses was way too busy to spend the time needed. Sometimes, our day shifts are pure madness in their pace----I know cause I have worked them. The one thing they have going for them is our lacatation specialist, who is indeed a gift and a pleasure for us to have.

I do my very best, I promise you. I have spent many a nightshift, just trying to gain trust and confidence from upset and anxious moms to help them. I just wish I could do more. And I wish I could follow up at home with them, you know, at 3 a.m. when they call us, literally in tears, baby screaming his lungs out in the background, begging us for ideas and help.

I have had more than one mom whom I told at 4 in the morning "can you come in now and let's try to see what's going on?" And I have had a few desperate enough to come in. I would take that mom into an empty room, get her in a rocking chair, grab a pitcher of water and work with her to nurse her baby. I would sometimes have to spend 10 or more minutes just calming the baby enough to try. I have done this, because I remember that feeling oh, so well----from when I brought my preemie son home and looked around the empty house and cried in fear and frustration. I remember the fear of the unknown, and not having any support once I was home. I remember the endlessly sleepless nights and walking the floor with my screaming baby, wondering how to make it work, having literally no one to call. No one I knew was breastfeeding. I was 1000 miles away from the hospital at which I had delivered, and my husband was working 12 hour days and had little time to deal with my colicky and premature son. I have a whole lot of empathy for these poor moms. So yes, I have had these moms come in and I have talked to them, listened to them cry it out, hugged them, and done all I could to help them. And I realized we did not have the time while she was in the hospital to head off nights like this.....it bugs me to no end--the guilt I feel.......

If I had my way, things would change dramatically. Breastfeeding moms (esp new ones) would be in the hospital no less than 48 hours, to ensure nursing was off to a good start. Staffing patterns would allow more time to work with them one-on-one for however many hours it takes to get it "right". I would have less paperwork and other constraints on my time to be there for them----

Once they were discharged, the new mothers would be off work for a minimum 6 months to 1 year , allowing time to take care of themselves and new babies. "Deb's perfect world" looks so different than the reality we stare down today. It will take a major change in our attitudes about breastfeeding as a country before the success rates rise all that dramatically. Meanwhile, I just do the best I can, with some strong odds stacked against those moms and myself as their nurse.

Ok---- The book is over, and I am off my soapbox. :) (aren't you glad) Before one more person says nurses don't try or care in helping moms breastfeed, I hope they read this. Because I am betting this is how many of us feel, and how hard most of us try. It's just so many obstacles getting in our way, really, that can frustrate us. :crying2: