Background info:
Israel's public health system for mother-baby care is made up of
well-baby clinics known as Tipat (pronounced like teapot) Halav, which
means drop of milk, located in almost every neighborhood. These centers
provide prenatal care, and courses for pregnant moms, and very broad
spectrum care for healthy babies, i.e. weekly weighing, developmental,
hearing and vision tests, nutrition advice, immunizations, etc., all for
a very symbolic yearly fee ( something like $50.00, maybe). They are
staffed by nurses and pediatricians and under the control of the
Ministry of Health. Hillary Clinton was very impressed by the system
when she was here.
Here's the catch: most of the advice given on breastfeeding and
nutrition falls in the category that makes us all gag, and many moms
stop breastfeeding because of incorrect information they receive from
the staff in these centers. Recently, the Health Ministry offered a
course on breastfeeding, based on the UNICEF 40 hour course, to 45
district head nurses of these centers given by 5 IBCLC's and several
physicians . You remember we were all excited about this course a few
months ago. These nurses are supposed to pass this course on to the
front line nurses, those in the Tipat Halav centers. Now you will see
why this is so necessary.
Last week I was called over to the pediatric hospital in our medical
center for a consult. A baby was hospitalized for restlessness and
incessant crying, and no medical reasons for this was found , and since
he is breastfed, they decided that before he is released, I should speak
to the mom.
I found a very confused frightened mom. She had delivered 16 days
earlier in our hospital. CS, 38th week, 1st birth. Baby weighed 2k900g
at birth, 2k700 on release. Even though I see zillions of moms I
remembered her. The baby was a little sleepy the first few days, but
with a little spoonfeeding (which I call marketing colostrum) he latched
on well and was released with instructions for baby-led nursing in
response to hunger cues, and she was given a flyer with a checklist how
to know that the baby is feeding well.
First week according to the parents, he was an angel. He ate well, was
content, diapers were as they should be. At age 10 days the had their
first visit to Tipat Halav to weigh the baby. He weighed 3k100g, a gain
of 400 grams, which is I think about 12 oz or more. Apparently the
nurse asked the mom how the nursing was going and when she heard that
the mom was feeding about 8-10 feeds a day for as long as the baby
wanted, she became very disturbed and felt the need to re-educate the
parents.
She told the mom the following:
-feed the baby every 4 hours
-feed him only 5 minutes on each side. That is more than enough time to
get a full meal for a newborn. ( I am curious why bottle feeders are
allowed to take their time.....does anyone every look at the clock to
see when a bottle feeder should stop?)
-if he cries before 4 hours, give him water or ABM
-the mom was given ABM samples to take home just in case
Poor mom followed these instructions, and suddenly her angel was
screaming when she pulled him off the breast. People told her that
babies become gassy after the first week, so she gave him drops of some
sort. She also gave him water as she was told. He refused the ABM!!!
A follow-up weight check 6 days later showed that he gained only 130
grams. Then she was told that her milk was watery and she had to give
ABM after every feed. During this check up the baby screamed so loudly
that the ped was called in and she said that the baby ( who was hoarse
by now) should go to the ER.
The doc who received him in the ER decided to hold him for observation
until I could see him the following day.
After hearing this story, I was fuming. We put the baby to breast and
he gulped for a half an hour and fell contentedly to sleep. Mom and dad
said he hadn't done that since that first week. I tried to be
diplomatic and help them figure out what had happened, making her
realize what brought about the change in the baby's behavior.
Sent them home with instructions how to get bf back on track and
prepared them for the fact that the baby may be attached non-stop for
the next few days, which he is poor little thing.
Now comes the fun part. This will not go untreated. I decided that
something has to be done through the system about this. I called the
nurse who had taken our course from the heath fund to which this Tipat
Halav belongs. She was horrified, and told me that she would pass this
story on to her supervisor. The supervisor, who had not taken the
course and who, from the sound of her voice was less
breastfeeding-friendly, called me and asked for a full report from the
hospital.
I sat with one of the residents who will write it for me in Hebrew and I
will ask the head of the hospital to sign it. He may or may not agree.
I prepared a package of info to enclose with the letter, including the
AAP statement translated into Hebrew by Miri Leibovich, the flyer that
we give in the hospital, a chart for nurses which shows how to know if
breastfeeding is going well and what should cause concern, the WHO Code
for marketing formula samples, etc.
Any ideas? I may be shooting myself in the foot here, but I refuse to
let these things go any more. I work too hard in the hospital getting
these ladies off to a good start. It makes me crazy to think that one
TH visit and everything is lost. And who suffers in the end? These
poor sweet little babies.
Have any of you done a similar follow-up on cases where incorrect
information from HCP's has caused such outcomes? Do any hospitals have
a protocol or forms for handling breastfeeding crimes?
Sorry this is so long, but it is good to know that there I can share my
frustration with so many people who will understand.
Esther Grunis, IBCLC
Lis Maternity Hospital
Tel Aviv, Israel
mailto:[log in to unmask]
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