Debra has described a hostile breastfeeding environment in her hospital which is not that uncommon these days. One always wonders if there is any recourse for this type of situation. In my work with hospitals I have found that there are a number of possibilities to look at to see if there can be some improvement such as:

- approach your Quality Improvement Department to see if improved evidence-based lactation care and services could be selected as a QI project, especially to showcase when Joint Commission comes calling
- approach your ethics committee to see if incorrect and outdated lactation services violate the medical ethics that underlie the duty to patients
- approach your Risk Management Department to see if this type of care places the health of patients at risk
- do a follow-up survey of patients discharged from your hospital who have received this misinformation. Look at how many are exclusively breastfeeding at discharge and up to 3 months postpartum. Compare this to the HP 2010 goals and the CDC breastfeeding stats. Ask the hospital if they are fulfilling their mission and obligation to their patients when so many have had their health placed at risk
- ask patients to describe their breastfeeding experiences and send in letters of complaint
- remind management that as an IBCLC you have certain obligations to your patients. The restrictive, incorrect breastfeeding management engaged in by the hospital is objectionable and violates your standards of practice. Some nurses have looked at signing a conscientious objection form to avoid having to engage in substandard care
- approach your hospital's legal department to see if providing such inappropriate care increases the liability risk for the hospital when adverse health outcomes are traced back to substandard care
- if all else fails, consider reporting the substandard breastfeeding care to your state department of public health

Hospitals should not be permitted to get away with this type of mistreatment of patients.

Marsha Walker, RN, IBCLC
Weston, MA



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