Oh my goodness, Ro, you have certainly made me appreciate what I have.  I would
be burnt to a crisp in your situation!

Are you in private practice in the community or are you doing this as a
volunteer?  I would think that in order to make any impact in this institution
from the outside, you absolutely need an ally on the inside--is one of the Peds
someone you could talk to and share research with who might be willing to change
his newborn orders?  Perhaps if they had another model of care to compare
outcomes with . . .  The other alternative already mentioned is to somehow
ignite the mothers to complain about their care.  Or is there a local group of
docs who would advertise a prenatal breastfeeding class done by you?  I assume a
hospital this bad wouldn't be holding their own.

Are these mothers pumping to keep up their supply if baby won't go to breast, or
are you also trying to deal with inadequate milk supply at the same time?  If
the supply is adequate, this is an instance where a nipple shield might be a
very good transition tool--gives baby the feel he's looking for in his mouth,
but positions him at the breast.  If he'll nurse through the shield, your
chances are definitely improved--I think most would eventually go directly onto
the breast.

An article recommended by Karen Kerkhoff Gromada several months ago (I just
happened to be going through the vast pile of printouts I've accumulated) might
be helpful.  I haven't gotten around to getting it yet, but it sounds like it
applies to your situation.  Haller, K.B. (1995).  Practice:  Based on facts or
on fantasies and fallacies?  JOGNN, 24(4), 293.

Good luck.

Becky Krumwiede, RN, IBCLC, Wisconsin
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