The doing your best is a very interesting discussion. I have enjoyed 
reading all the posts. I do agree that many nurses, doctors, LCs, really 
do put the client first. And I do agree that working in a hospital is 
often very stressful.

I would argue that there is a lot of "passing the buck" with 
breastfeeding to create a temporary solution and get the problem off 
your hands. It makes one feel or look good that you have done something 
for mom or baby but the reality is that what you do is actually harmful 
or not appropriate.

Passing the buck means making it look like you have helped someone but 
really you dumped the actions or solutions on some one else. There is a 
lot of passing the buck disguised as doing your best in breastfeeding 
and that is why so many women give up (in my opinion).

Some examples:

The nurse feels like she has to feed the baby something and this is 
often very correct for individual babies who are not nursing well and 
starting to lose a lot of weight and get jaundiced. Yet, if that nurse 
does not know how to latch a baby on or can't tell mom about active 
sucking, then suggesting formula really is doing her best because at 
least the baby is being fed something. But it passes the buck because no 
BF solution/help was offered.

What I see is NICU staff telling moms they have to pump (without 
assessing her feeding goals or commitment and making pumping look easy 
and not telling them how many times they really have to use the pump or 
what dedication it takes) but then they do not help mom learn to 
breastfeed at the breast before discharge. And her NICU discharge 
instructions say bottle feed! How helpful is that and who cleans up this 
mess when baby is home?

If NICU staff do not know how to pump, how often to pump, what 
commitment it takes, and how to assess mom's feeding goals, well then 
they are doing their best by at least getting some human milk for the 
baby, right? For WIC moms who intend to bottle-feed, well it really 
isn't the NICU staff's problem in retrieving the pump when baby is home 
and being bottle fed special formula provided by WIC.

Passing the buck is also at WIC when moms want BF help and are given a 
full formula package and told formula feeding is okay. Or maybe the BF 
Peer Counselor is feeling lazy or overworked that day and just tells mom 
to keep nursing without doing an assessment or hands on help.

Passing the buck is also at the doctor's office when mom is not given 
resources for BF help but just told either to pump and bottle feed or 
told to supplement. Yet because they do not know how to help someone 
with BF problems, suggesting mom feed baby more is doing their best 
isn't it? So baby doesn't become failure to thrive or die?

Kathy Eng, BSW, IBCLC

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