Hi Donna,
Our department uses a 6-8 hour pumping criteria for medically ill, or
absent infants.  For example: a premie that is transferred to another
facility, or one on oxygen unable to get to mother without compromising
condition.  We also will have a mom with inverted nipples start pumping
prior to latch in order to facilitate a better latch experience.  For
infants with routine birth trauma (forceps, long second stage, medicated
deliveries, etc, unfortunately routine in many instances) we use a longer
timeframe of when to start pumping.  Then we look at the pattern of nursing
over 24 hours, and is it improving.  If not, we have the mom pump to
stimulate breastmilk, either before or after attempts to
breastfeed-depending on the baby and individual situation-but always we
reinforce the skin-to-skin benifit to establishing Br Mk and in the baby's
progress towards establishing nursing.  The hardest part in all of this is
keeping mom cool, and the nurses comfortable in believing that the baby is
not at risk in waiting for baby to feel better to nurse.  Of course if it
becomes evident that the baby IS medically at risk then calories-hopefully
Br Mk/colostrum- is offered as needed.

I want to congratulate you on you positive attitude regarding being called
the "police".  I also feel that people view me as the "police" but in my
instance it seems that it is more of a negative...The Staff borders on
insecurities about lack of knowledge (and fear of what I might DO the them
if they ask a question) and the belief that since they've been in nursing
for 20+ years that there isn't anything I could possibly teach or know more
than them! (Forget the fact that R**S has been 'educating' them for the
past 20+ years, and that nothing else in nursing has stayed the way it was
20 years ago).  Part of my problem is that in doing my job as you mentioned
'advocating for the breastfeeding mother' I am percieved as projecting
guilt on to mother's who bottle feed.  I believe my unit/director would be
more comfortable if I just was a Fluff Nurse, as you described, that many
units have just for PR purposes.  My integrity doesn't allow me to do that,
and it does cause me lots of sad work days and sleepless nights at times.
Especially when my evaluation is peppered with comments about "well, people
are intimidated because you're so strong on breastfeeding".

Sorry to vent so long, things here have been tense, I have a committee
working towards Baby Friendly status, and people feel threatened by all
sorts of issues, are recieving mixed messages (one being "THis will never
happen" from the director of our department, but her seeming to support our
efforts too), so I have been down about the whole Lactation positon in
general.

Lucy

----------
> From: Donna Cordoba <[log in to unmask]>
> To:
> Subject: Pumping
> Date: Wednesday, November 05, 1997 2:45 PM
>
> Hi all...I have lurked for the better part of a year .....and now that I
am
> getting some knowledge under my belt but still have a long way to go...I
> thought I would ask you  all what your opinion on a pumping issue in our
> hospital.
>
> If a baby is not able to latch on either because  too sleepy, sore head,
etc
> and has never latched since birth, when do you initiate pumping?  This is
an
> issue that our LC's can't all agree on.  Some say give the mom and babe
24
> hours and then start pumping and milk supply will not be affected at all.
>  Others say you should initiate pumping in 6-8 hours if breastfeeding has
not
> occured in order to cue the prolactin receptor sites.  What is your
opinion?
>
> By the way...I have been called the "Breastfeeding Police" lately in my
> hospital by some of the Pediatricians and instead of being offended....I
> think I will take it as a compliment.   I must be doing my job well as an
> advocate for mother's who need support and since we would not need the
> "Breastfeeding Police" if everyone would look at lactation as a science
> instead of a "fluffy" service that the hospital offers to the their new
> mothers.
>
> Off the soap box for now....
>
> Donna Cordoba RN BSN (new) IBCLC
>