Marley--

May I suggest some ways in which you can turn this entire situation into
a positive feedback situation for your staff:

MarleyO wrote:
<snip> As soon as I left shift yesterday . . . .
> Mom pumped.

1.  Commend them for their excellent implementation of BFHI step 5:
mother was shown how to maintain lactation even when infant wouldn't
feed.

Then the nipple shield was used (got a new one, since I threw
> away the first one)

2.  Commend them for use of an important tool in establishing
breastfeeding under difficult circumstances.  Remember that there is
nothing evil in and of the nipple shield itself.  It is inappropriate
use of such tools that we must be concerned about.  Tell them that you
would like to review the JHL articles from vol 12(4), 1996 with them.
There are at least six which deal wih nipple shield use.  Also tell them
that there has been recent discussion of the need for informed consent
when a nipple shield is used.  Ask for a volunteer to research the
issues involved, and have a committee formed to work with you in drawing
up an informed consent checklist and form for mothers to sign when the
nipple shield is used.

<snip> . . .  Mom was very happy that the baby seemed satisfied after
> suckling with the shield.  On my rounds she asked me how long it would take
> to get him off the shield. Arrggh!!!

Isn't it wonderful that this mom now feels successful.  Think how
threatened she must have felt to be unable to get her baby to do
something so "natural."  Her concern is appropriate, but the most
reassuring answer could be "We'll let him get a little more adapted to
the breastfeeding, and then we will begin working on weaning him from
the shield.  Some babies seem to need a shield for only a few feedings
and some need it for a little longer.  These new ultrathin silicone
shields seem to do a pretty good job of allowing an infant to feed.
Sometimes mom doesn't get the stimulation needed for good milk
production, but we'll watch that.


> Immediate steps: Personally placed a call to the local LLL  and gave the
> number to mom.

You are to be commended for modeling the implementation of BFHI Step 10,
referral to a mother support group.  Maybe you would want to explore the
possibility of having some LLLL's who could come in to see moms before
discharge.

> I removed all the nipple shields off the unit and threw away the re-order form!

Oh don't get rid of a useful tool, just because of this incident.  That
turns you into a irrational, zealot, in the eyes of your less enthused
co-workers.  Take a look at the article by Dr. Raj K Anand at the WABA
website.  He describes how to "Transform colleagues into Breastfeeding
Advocates"
The url is
http://bbs.elogica.com.br/aleitamento/acsheet3.htm


> If I sound a bit frustrated, I am!!!
It is very frustrating when our best laid plans are thrown out of
kilter, but each new day has its own set of opportunities.  Best of
luck,
Melinda

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