Dear Lactnetters,
   I have posted a couple of times recently but know I should formally
introduce myself. I am an RN and have been working part-time as hospital
breastfeeding nurse for about a year. I will sit for the IBCLC exam this
year. I learned about this list through Jan Riordan's internet lactation
class last semester and have found it to be very inspiring and informative.
I hope that the idea of posting hospital policies, etc. somewhere will
become a reality in the near future!
   We have just recently had an initial meeting of a breastfeeding task
force in the hospital I work at. I feel this meeting went very well, thanks
in a large part due to the input of one special pediatrician. Our hospital
is not now very breastfeeding friendly. We do have a NICU which is way
behind in initiating breastfeeding and a blood sugar policy which requires
a level of 50, among other things.(This is from a neonatologist and will
not be changed I have been informed!) Anyway, this pediatrician has agreed
to go before the next pediatrics committee meeting with the AAP policy
statement with the goal of getting that to be our standard of care. The
managers and staff at the meeting all were eager to do this. (I don't think
any of them had ever seen this document before, even though it is 4 years
old!)He asked the breastfeeding nurses to come with him, and of course we
will, but would like to have any input from any of you that have been
through such a situation before. I will probably go to my grave trying to
get "free formula" out of our hospital and stop staff and families from
bottle feeding formula to breastfed babies! At least we are starting
somewhere, and any words of wisdom will be appreciated as we begin to try
to really improve things!
   Secondly, at work yesterday I saw a mother who had intense nipple pain
when she breastfed. She was a primip, had delivered around 10 p.m the night
before. Infant had nursed in recovery and one other time. Mother stated he
appeared to do well, but she hurt badly. Her nipples did look very abraised
on both ends and her right areola had a diagonal bruise at the 10:00
position. I expected to just help her latch on her baby better, but this
caused her such intense pain that I couldn't even stand it very long! She
was crying and reported the pain to be a level of 9 on a scale of 0-10. The
ob nurse gave her some pain medicine, and we tried ice, then she sat up in
a chair and tried again about 30 min. later. Again the pain was just
terrible. This mother was very motivated to breastfeed. She had undergone
breast augmentation 6 years ago. Her incisions are in her axilla
region..nothing near her areolar area. I do not feel proficient in suck
assessments, but the infant would suck on my finger with a feeling
of "clamping down" at times. She pumped with a Medela Lactina and obtained
about 30 cc which we finger and cup fed the infant. The pump caused her
discomfort, but much less than the infant. We also tried a nipple shield
very briefly, which I have never done this early, but she did not like the
idea of using it at all and stated she would just go through the pain. I
have never seen a mother react this way, and cannot see anyone continuuing
to nurse with this much pain! She did also say that her breasts had always
been "sensitive," even before the augmentation, and she "didn't like her
husband touching her, etc." She was vague on describing the pain, except
that it was "burning."  She felt the infant was latched on OK..and he did
appear to be, for the brief amounts of time I saw him. She tried slow
breathing, counting, etc. at the initial latch but the pain never lessened.
Her husband was going to rent a pump to continue pumping and I gave her my
home phone number and can see her as an outpatient again on Monday. Any
suggestions will be greatly appreciated! Could this be related to the
augmentation surgery? I have checked the archives before posting and even
called Dr. Riordan. This mom was going to use her milk, Lansinoh and warm
tea bag compresses on her nipples, and I thought we may try Dr. Jack's All
Purpose Nipple Ointment...Thanks so much for any replies to either of these
requests!

Kathy Wright, RN
Columbus, KS

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