Attie
To address your problems and where to start first:
I agree to tackle something simple. It will keep you motivated. The biggest
thing is keeping mothers and babies together. This will prevent many many
problems. Seeing clients antenatally will give you the opportunity to stress
that this is so important. It may actually decrease the need for your
services postpartally. What about a support group that you offer or refer to
one? Going back to your 10 questions:
1. I think it is OK to suppl the premies with a bottle, if they cannot
directly bf, or cannot fully bf. Gavage feeds are great if needed for short
term. Try to introduce the concept of cup feeds or supply lines but don't
stress if this cannot be done right now.
2. If ebm not available, I use standard formula to suppl if med. necessary.
3. C/S: No separation is very important. If you can get that accomplished,
you've accomplished alot. Bear in mind some parents don't want this, and
some staff believe the mom needs to rest and the baby needs to be monitored
on a warmer. So again this is an attitude change. You can address this with
prenatal ed like I said above.
4. If the baby is not kept with the mother, then you will have to return the
babes to mom if blood sugar goes low. But just the stress of separation and
cold stress etc will surely not be good for the baby, and can lead to low
sugar. This is a foreign concept where I'm at. Babies are often apart from
mom for 12 hrs or more.
5, 6, 7. hypoglycemia - a very complex subject. lots of high risk
categories, and can be iatrogenic, that is we are causing it by separation,
stress, and delayed feeds. Try to minimize it with mother- baby
togetherness. Make this a quality improvement topic? Form a committee? This
will not be a simple thing to change.
8. Teaching staff - any amount of this you can do is always very helpful.
Also try to leave articles etc around for all to read, esp. the manager.
Maybe a bulletin board or an easy one page newsletter.
9. How much supplement - I use minimal supps first 24 hrs, but then I get
generous esp. with at risk babies. I use a standard formula of about 2.5 oz
per pound per day. (convert to metric).
10. jaundice - if this is not a big problem, count yourself lucky at least
on this one. Cyber hugs to you!
Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA
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