I have been following the discussions regarding the formula bottle cap
contests, the book on breastfeeding from a formula company, and the private
posts regarding materials formula companies are giving to nurses and
physicians declaring that supplementing causes mothers to breastfeed longer.
Somewhere or another we have to draw the line on these activities as well as
the increasing practice of hospitals, physicians, and insurance carriers
making the rules on what nurses, LCs and childbirth instructors can and
cannot tell patients.

Perhaps the nurses who win the bottle cap contest can also follow all the
babies they have pushed the formula on and win a prize for the one who has
the most visits to the pediatrician in the first year of life.

I have also received numerous calls from nurses, LCs, and childbirth
instructors regarding what they are allowed to tell patients about epidural
anesthesia. We have one discipline telling another what it can and cannot do.
We have known for years that epidurals affect the behavior of babies.
Epidural studies so far have not used breastfeeding as an outcome, but use
instead scores on a neurobehavior assessment. However, we know that
bupivacaine reaches the fetus within 10 minutes of being administered to the
mother. Bupivacaine, fentanyl, sufentanyl, etc are all measurable in materal
serum, cord blood, and the newborn's blood at 24 hours. These medications
pass out of the epidural space, cross the placenta, enter the baby, and are
taken up by various compartments including the infant's brain. ALL of this is
documented in anesthesiology literature but we cannot tell mothers any of
this. Why? These drugs have an effect on the baby. The longer they have been
administered in labor the more effect they have. What do people think? - that
the medication stays in the epidural space and is drained out after delivery?
Why is it topped off if it does not go anywhere? Use of epidural medication
needs a balanced presentation just as use of formula does.

I think it may be time for us to ask our respective institutions why
withholding information from patients is occuring and to think about having
this issue addressed by an ethics committee. An ethicist from outside the
institution can be consulted for the committee and present this at grand
rounds. Institutions where the anesthesiology department is controlling what
patients learn may also need nurses to check with their state nurses
association to see if this violates the Nurse Practice Act.

Bottle cap contests can be discussed by the ethics committee to see if
commercial interests are dictating health care in their institution. I find
this disgusting that patient care is influenced by marketing reps who should
not be allowed access to the maternity floor of a hospital and who bear no
responsibility for the outcome of their promotional practices. I think
mothers deserve better than this. Employees whose jobs are threatened because
they have taught patients both sides of an issue may have legal recourse.

Breastfeeding task forces and multidisciplinary working groups often help to
get the ball rolling and the formula reps out of the loop of patient care.
Workshops conducted by ethics experts would be welcomed.