I find that I am very gradually making some inroads educating the nurses and
doctors. Not all of them, but some. For example, the nurses are beginning to
get upset when a certain pediatrician will not discharge a 3 day old healthy
baby with a bili of 10. He puts the baby under phototherapy. The next day it
is 9.8 and he lets the baby go home. If it goes to 10.8 for example, he
keeps the baby another nite. 10 being the magic number. Overnite the mother
has to express and be separated from her baby. The nurses are beginning to
question this and even cheered when I called the doctor to try to reason
with him (bargain for the baby to be retested in office), and assure him the
baby was observed several times by me and nursing well, mom with ample
colostrum. (He still wouldnt' budge - even though no pathology at all). Well
the reason they know more about this is becoz I have educated them, talked
about jaundice, why it occurs, how it resolves, bf vs breastmilk jaundice,
and gave them the articles to read themselves.
I also write reports to the docs which serve to educate them about bf, I
think. I cc the report to the Ob doc as well. My report today concerned a 37
wk gestation infant, birthwt 5-11, discharge wt 5-7. The baby was weighed
at the ped's office 2 days after discharge, fully clothed with a dirty
diaper and weighed 5-12. (I had identified some concerns on phone f/u and
called the pedi who agreed to see the baby). The mother reports the pedi
stated the colostrum is causing the jaundice and the mother is to give water
for the juandice, bf and top off with formula. I brought her in today due to
concerns identified on a second followup call. today's wt 5-4. In my report,
therefore, I include assessment of the baby, the fdg, and my plan. I used
statements such as "the mother has milk and a good letdown, however her
supply is low due to poor positioning and latch, and the use of an
ineffective breastpump (Evenflow) whcih the mother reports yields no milk."
I also state something like "I have advised the mother to discontinue the
water, whcih is displacing the milk/calories in the baby's diet and is no
longer recommended as a treatment for jaundice." Anyway, I often leave a
copy of my report for the nsy if the baby is still an inpatient, with a
"FYI" and they learn as well if they read it. BTW, this baby had a milk
transfer of 10cc each breast, and I did recommend comps for now (he's 9 days
old), post feed pumping, and wt check on Monday. We should be able to
gradually decrease the comps and get the baby fully to bf soon.
Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA
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