Watch Your Language - Breast Isn't Best!

SmilingBluEyes · Jul 28, 2005

we don't have a well baby nursery either. And I have heard some people right here say we are wrong to expect moms and babies to room in 24/7----someone actually said that is a way we justify less staffing (hah).

I say, couplet care and rooming-in are best for both, unless mom or baby are sick-----or mom is just recovering from surgery and has no one to support or help her. Babies belong with their parents, even in the hospital, unless one or both are truly sick. We hate nothing more than separating them for any reason.

allnurses Guide · Jul 28, 2005

we don't have a well baby nursery either. And I have heard some people right here say we are wrong to expect moms and babies to room in 24/7----someone actually said that is a way we justify less staffing (hah).
I say, couplet care and rooming-in are best for both, unless mom or baby are sick-----or mom is just recovering from surgery and has no one to support or help her. Babies belong with their parents, even in the hospital, unless one or both are truly sick. We hate nothing more than separating them for any reason.

We don't have any kind of nursery really - just a room to bath, weigh and footprint the babies. I guess in a pinch we could put the bassinets in there but we have no staffing for that.

Mom and babe are in the same room unless the baby goes to have a bath.

There have been times (shhh, don't tell) when in the middle of the night the baby is crying and the mom is exhausted and crying too and we've taken the baby to the nurses station. But that is rare and never during the day when bigwigs are roaming the halls. :)

steph

SmilingBluEyes · Jul 28, 2005

We don't have any kind of nursery really - just a room to bath, weigh and footprint the babies. I guess in a pinch we could put the bassinets in there but we have no staffing for that.
Mom and babe are in the same room unless the baby goes to have a bath.
There have been times (shhh, don't tell) when in the middle of the night the baby is crying and the mom is exhausted and crying too and we've taken the baby to the nurses station. But that is rare and never during the day when bigwigs are roaming the halls. :)
steph

sounds much like us, Steph. (shhhhh) :)

gauge14iv, MSN, APRN, NP · Jul 28, 2005

I AM a nurse - and I will say I have heard other nurses spout things thing like - "Just bottle feed in the hospital. You can breastfeed when he goes home". "There is no difference between breast milk and formula". "You must clean your nipples with alcohol so that they are sterile for the baby". "Your baby needs 2 bottles of water a day since he is breastfeeding" (Yes, these are all recent comments)

I don't blame them - Fact of the matter is, most of us MAYBE get an hour or two of info on breastfeeding in nursing school. Same with docs - even pediatricians, they don't get much more in medical school. There is so much other stuff to learn. That doesn't mean though that you don't need to know it.

We as professions DON'T know everything there is to know about breastfeeding, nor do we always know up to date info since it has been a few years since most of us have been in school.

IF this is something we are responsible for educating patients about then it is our responsibility to KNOW it - take a CE course, read a book - what ever it takes. It is NOT "One more thing added to the load of already overburdend nurses" IT's PART OF THE JOB IF YOU WORK WITH WOMEN AND INFANTS. PERIOD. WHETHER YOU LIKE IT OR NOT! Frankly - I don't think most nurses know enough about formula either!

You know - hospital policies do a poor job of supporting breastfeeding - thin staffing models have a LOT to do with that.

RNnL&D · Jul 28, 2005

Fact of the matter is, most of us MAYBE get an hour or two of info on breastfeeding in nursing school.
.........
IF this is something we are responsible for educating patients about then it is our responsibility to KNOW it - take a CE course, read a book - what ever it takes.

Are other hospitals not requiring breastfeeding ed? Our LC does a breastfeeding class as part of our annual competencies.

gauge14iv, MSN, APRN, NP · Jul 28, 2005

They offer a class at our hospital, but it is not required, and there are no documented competancy requirements that insure that nurses learn anything new about it.

bellaluna · Jul 28, 2005

Hello. I've not posted before, but have been reading and enjoying for years. Felt compelled to reply, as many have said this is near and dear to many. Please forgive me if this gets lengthy, but feel I should give a little history first, and please don't take offense, may be a bit opinionated but it is an emotional subject. I am an OB nurse in a small hospital. We have wonderful breastfeeding success...approx 90% of our moms leave BF, and maybe one a month will plan on bottle feeding. Over half our RN's are lactation specialists and educators, and all are very committed and well educated. I have a breastpump rental and lactation supply business, and planned on becoming an LC. So of course I planned on breastfeeding. Then I had my son 8 ½ months ago. 9lbs7oz. Latched immediately, good latch by all who evaluated, nursed 24/7 for first 3 weeks of life, milk came in at 4 days. By 3 weeks he was steadily losing, voids and stools decreasing, increasing jaundice, and readmitted. No pathologic reason, just a supply issue. The problem was not education nor assistance. Had educators/RN's/midwives at my house daily evaluating and giving feedback, and personal phone consults with the west coast's leading BF expert. It should have been working. Had friends pumping because I was in tears not wanting to give my baby a drop of formula. Went home supplementing breastmilk, continuing to pump frequently, still eating oatmeal and atole by the pound, popping hundreds of fenugreek tablets, even finally taking reglan which caused a dystonic reaction that nearly sent me to the ER. Seemed to be picking up a little at a time. I had faith. At 5 weeks he was losing again, bili rising, stools and voids decreasing, and he was nearly re-admitted. I finally gave in and began supplementing with formula. My fussy, yellow, wiry baby became, pink, well rounded, and happy.

I know many of you are saying what was she thinking? Obviously the poor thing needed to be fed. But my sleep deprived hormone filled mind was thinking what I and the others had taught thousands of patients....it is rarely a supply problem....it is a persistence problem, a frequency problem ....an early supplementing, poor latch, etc, etc. I was thinking if I just keep doing it right(which every expert I knew was telling me I was), my milk would come. I just had to be patient. Would not become one of those mom's who I smiled knowingly at as she said, "I TRIED to BF my first. My milk wasn't enough...wasn't good...wasn't whatever."

I guess what I'm trying to say is this...to the many who would teach the dangers and pitfalls of formula feeding more forcefully...Please acknowledge the possibility that it is a supply problem, I think more often than we teach. Please know that yes there is a difference between the mom who chooses to formula feed and the mom who is forced. The mom who is forced is well educated, knows formula can harm her baby, knows the risks. Probably cries with every bottle as I did for the first few months. An earlier poster said basically, "Formula is SUPERIOR to those who can't feed their baby any other way." Please try to remember this in your teaching.

I know I teach differently now. I still believe formula feeding is harmful...should be the third or fourth choice(milk banks are not an option in many small communities, though friends can be wonderful)...I still give all the facts...unvarnished, and unweighted toward one side or the other. I am no longer pushy with my pro-breastfeeding agenda(though it never felt pushy before. I now teach that if a mother is not able to breastfeed for whatever reason (I now teach that It DOES actually happen), it is not her fault, any more than having to have a c/s would be. And it is really no different...before c/s women died if they were unable to deliver lady partslly...babies used to die if wet nurses or alternate food was not available and their mothers were unable to BF. C/S and formula are both developments we would prefer not to use, but sometimes they are necessary.

I know I no longer look at a woman bottlefeeding and think ,"She just didn't care enough to breastfeed"(I know many of us have thought this, and I imagine many of you have too, even just in a little part of your heart. I know I felt the looks in my pro-breastfeeding community, especially from those who knew I was a nurse.) I now look at her and think, "I have no idea what this woman has gone through, but right now she is feeding and caring for her child, and what a wonderful mother that makes her."

SmilingBluEyes · Jul 28, 2005

I AM a nurse - and I will say I have heard other nurses spout things thing like - "Just bottle feed in the hospital. You can breastfeed when he goes home". "There is no difference between breast milk and formula". "You must clean your nipples with alcohol so that they are sterile for the baby". "Your baby needs 2 bottles of water a day since he is breastfeeding" (Yes, these are all recent comments)
I don't blame them - Fact of the matter is, most of us MAYBE get an hour or two of info on breastfeeding in nursing school. Same with docs - even pediatricians, they don't get much more in medical school. There is so much other stuff to learn. That doesn't mean though that you don't need to know it.
We as professions DON'T know everything there is to know about breastfeeding, nor do we always know up to date info since it has been a few years since most of us have been in school.
IF this is something we are responsible for educating patients about then it is our responsibility to KNOW it - take a CE course, read a book - what ever it takes. It is NOT "One more thing added to the load of already overburdend nurses" IT's PART OF THE JOB IF YOU WORK WITH WOMEN AND INFANTS. PERIOD. WHETHER YOU LIKE IT OR NOT! Frankly - I don't think most nurses know enough about formula either!
You know - hospital policies do a poor job of supporting breastfeeding - thin staffing models have a LOT to do with that.

And then...

.......there are those of us who have spent HOURS in post-nursing school lactation teaching education and classes. We have the WHO classes. Some of us have LC credentials of our own....and we all have had STABLE, NRP and other classes, too.

And you have to balance it all out. If a baby is dropping sugars rapidly (esp in diabetic mom cases) you don' t often have a lot of time to dinker around about it, you know? So ---what do you do??? Let's examine our possibilities:

Start an IV, and all the trauma that THIS presents to mom and baby both???

OR.....

"torture " the baby and mom with a few teaspoons of that evil formula, heading off the need for IV and the horrendous pain and potential for infections created by this process? Not to mention, how much more difficult it makes for moms and dads to feel comfortable and breastfeed with a drip going into their newborn's scalp, or something??

Sometimes, you have to weigh it all out----it can be a complicated clinical picture. This is where nursing judgement comes in......... :)

"Who benefits MOST From what interventions"? We nurses ask ourselves this question mentally all the time, if we are doing our jobs with any care at all.

To me: It makes zero sense whatsoever to stick babies (potentially multiple times, as they begin to shunt down due to pain response and stress, as well as low sugars), when you can cup feed a whole 30ml. or so of formula after allowing a mom to nurse and head all of this off!!

And the real kicker: some of the same folks who say we should start IV over formula would tell me not to use a pacifier or other device to comfort this same infant during a very painful and stressful procedure, go figure. :rolleyes:

I have to ask: What caring nurse or dr. thinks it makes more sense to increase the stress and pain of a newborn and her family doing something like IV sticks; when you can cup feed here and there until the baby stabilizes out and her pancreas quits producing so much insulin----usually within 24-48 hours? Really, if you think about it, no one is supporting the formula industry in these actions. I have no stock or stake in the formula industry. No one is saying "breast is not best "; we are trying to head off the true problems prolonged hypoglycemia can bring about, early on. An "ounce of prevention" and all that.......

And excuse me, but WHO ever said it was not part of my job to help moms/babies nurse? If you think it was me, you need to go read my passionate posts again about how some of us bend over backward to make it happen. You are preaching to the wrong choir, I am afraid. Cool down a bit.....

Being a nurse, you then know what I am saying when I tell you I have lots of things that require my attention and prioritizing on any given shift. Did you bother to read the part in my other posts about how I have patients come in and work with them after discharge???? Yep, I have done that; I am not lying or making it up. I do consider it part of my job to help moms and babies nurse successfully whenever possible. But if it's between, say, an unstable postpartum hemorrhage or PIH complications, etc. (you know other problems in OB)---- and someone asking for help nursing, and I have both patients in my care, who's going to see me first?

So let's understand what some of us are saying as nurses----we are in fact, credentialed, educated, and do care to try. Now, you see why I have been saying all I do on this thread, at the risk of being "defensive"--------because someone always seems emboldened to opine we don't care or try---or are not educated. Granted, some may not be. Those issues should be addressed by individuals and hospitals. But dont' lump us all together, thank you.

And, I can't personally control hospital staffing patterns, either, whether you like it or not. I can't control who is coming in our doors with what situation at any given time, either. We can't always staff for "what if" situations. That is the nature of obstetric nursing----and controlling staffing patterns is way above me as a staff nurse. If you want to tackle that one, become an administrator. Believe me, I would be the first to shake your hand and applaud your making headway in our favor there........

Now---- I am sorry if I come off defensive or angry. I admit readily, I am a bit impassioned, but truly, not angry. I , however, will absolutely NOT sit still, being accused of under-education or lack of caring, regarding this issue. What does anyone here truly know about the next person's educational background........ and why draw a line of division, making unfounded or unfair assumptions?

As an obstetric nurse, I have a lot to weigh out---- a bit more than the "evils" of the formula industry in the cases of poor feeding and hypoglycemia----and I have to act fast, sometimes---sugars can drop precipitiously and dangerously. I have seen this enough to know to watch out. This is my job, too. I know you are passionate about breastfeeding; and I applaud that. I am, too. Give me some slack and benefit of the doubt, too , ok? :)

SmilingBluEyes · Jul 28, 2005

Welcome to the boards, Bella!!!! So glad to have you.

fergus51 · Jul 28, 2005

I'm with you Deb. Every place I've ever worked has included breastfeeding education as a requirement and every place has LCs if the nurses are having trouble. Our NICU has two LCs who are specialized for our population (both are former OB and NICU nurses). Most hospitals are extremely supportive of breastfeeding in my experience. We don't all meet Jack Newman's standards, but we are all trying to do what's best for our patients.

LilPeanut, MSN, RN, NP · Jul 28, 2005

The LC in the hospital when I gave birth to my son was pretty ignorant about how to overcome difficulties and how to start after a NICU stay. She just kept telling me to keep trying. I finally just asked her for the supplies to finger feed.

A pacifier is not your only option for non-nutritive sucking, a gloved finger dipped in glucose also will work without interfering.

There of course is a risk of infection when you put in an IV - but there is a risk of NEC and other gut issues if you introduce formula to an infant, even just a couple of ounces. Neither side is without risk.

With my DD, her BS was low and I consented to a bottle to help raise it, but she wouldn't take it and so she went on an IV.

I know the nurses don't plot against the parents, but I do also know that it is easier for them to get their work done (especially in the NICU) without having to deal with parents and stuff. Plus, the nurses in the NICU tend to be so protective and loving to the baby, they sometimes can lack patience with the parents. Again, I'm not saying every NICU nurse (heck knows, because I want to become one) is like that, but it does happen sometimes.

fergus51 · Jul 28, 2005

I'm sorry, but I have NEVER seen a term infant get NEC and that's what I was referring to earlier (a term infant of a GDmother). The kids we see get NEC the most often aren't even feeding yet (I HATE indocin....).

OT, but why is a gloved finger different than a pacifier for short term pain control during procedures? I've always wondered about that... I do it for bigger babies when parents are anti-paci and when it's logistically possible, but on some smaller babies even my pinky finger is too big and we use our premie pacis.

I had to add, the parents who are most concerned about formula and NEC sometimes want us to delay feeding until their milk production increases. The thing they don't consider sometimes is that this means we have to keep giving the baby TPN and lipids via PICC longer this way which increases their risk for infection (and we see A LOT more infection in our unit than NEC). Everything is a tradeoff.