"What this means, in effect, is that if we can't get baby to breast before
they send it home without this help, they want it sent home on the
bottle..."

Or the alternative - they won't send home a baby that hasn't learned to
nurse effectively yet. Perhaps a discussion with this neonatologist might
help him to understand that the hospital's (i.e., *his*) responsibility is
to ensure that all babies who are discharged from the unit are able to latch
on & nurse appropriately. Most insurance plans, HMOs, etc. won't pay for
babies to linger around indefinitely (not to mention that it's not good for
the baby to do so!) - and since infant formula is NOT the equivalent of
human milk, I don't see where he has any real alternatives but to discharge
infants home with the optimal alternative feeding method possible. What that
method will for any given baby, in any given circumstance, varies, but it's
foolish to try to insist that it will be a bottle in all cases.

What makes this doctor think it's up to him, or by extension to any of the
hospital's  employees or agents, to dictate to parents the manner in which
they supply their children with nourishment? If he's not "approachable" on
this issue, if he doesn't get it despite your most non-aggressive and
respectful discussion, I have to say that I think I would just go ahead
doing what I know is in the best interests of my patients, without making a
huge stink about it. After all, you have professional ethics and liabilities
of your own to adhere to.

I know there will be responses from others that this is underhanded, sneaky,
unprofessional, etc., etc. But in all honesty, this is a "rule" I would
defy, either openly (which it sounds like you may not be in a position to
do) or subtly. Parents are absolutely entitled to the full range of
information about their options for feeding their non-nursing
hoping-to-be-breastfed babies, and this is not this physician's call to
make.

The analogy that comes to mind is the fuss (now many years ago) over a gag
order prohibiting health care professionals from discussing options for
terminating an unwanted pregnancy with their pregnant clients. Not
acceptable. Not supportable. Wrong.

But maybe this guy is just not well-informed, and once you explain it to him
maybe he'll change his tune. I would definitely approach the subject with
respect and knowledge - arm yourself with appropriate citations & studies,
esp. any you can find from other physicians. And don't be afraid to meet
with him as one professional to another!

Cathy Bargar, RN, IBCLC
Ithaca NY

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