Barb Fibich wrote:
<I work at a hospital that is striving to become baby friendly.  Next
month, my partner and I <will be spending 3 hours with each labor and
delivery RN to do some "hands on" training.
<
<One of the things that the L & D RN's would like is some suggestions
for a short and sweet <conversation about feeding choices when they
admit the mother.  Right now, they just ask how she <is planning to feed
the baby. They do the best they can under the circumstances to encourage
her <to try breastfeeding, but as you can imagine, it is not always the
best time to be going into <great detail.  They are a great group and
are really interested in promoting breastfeeding, so <we feel very
lucky.
<
<I know the question should be open-ended, not "breast or bottle", but
I'm wondering if anyone <out there has scripted it for their staff or if
any of you have your own successful ways of <addressing the issue that
you would be willing to share.

Reply:
Barb, you asked about a 'script' for L&D nurses to use discussing
feeding choices as they admit/care for women in labor. This is a great
question, and it's really exciting that your nurses want to be part of
Baby-Friendly.

My thoughts are purely theoretical, and I'll be interested to see other
people's ideas.

My colleague Lori Feldman-Winter, pediatrician in New Jersey, suggests
that any caregiver can ask a mother "How can I help you breastfeed?"
This open-ended question leaves the door open for a follow-up if the
mother says, "Oh, I'm not going to breastfeed!" since you can say "not
even once? Just to give the baby some colostrum?" etc., then following
any opening that the mom might give that shows you what there is about
breastfeeding that has turned her off. If the mother is worried about
pain, the L&D nurse can reassure her by saying she or her colleagues
will be right there to help. If the mother who thinks bf is too
time-consuming, the nurse can point out that one feeding in the first
hour won't make that much difference to her life-style. The script
should have a sentence about bonding, and one about the value of
suckling to control mom's bleeding, and one about colostrum and immune
properties (baby's first immunization), and one about welcoming the baby
into the world by letting it do what it's been practicing for for
months...

The idea here is not to load the mom with another "benefits" lecture,
just to go where she leads and to let her know that her decision not to
breastfeed doesn't really have to be final until lactogenesis II has
come and gone.

Mom is probably focused on contractions, fear, embarassment, excitement,
etc. at this point, so the idea is to let her know that beginning to
breastfeed is one of the things that people do in L&D, that she'll have
the opportunity and all the help she needs. This approach has the added
benefit of reassuring moms who do want to breastfeed that the L&D unit
considers breastfeeding help to be an integral part of their care. (I
remember having the feeling with my first baby that I was breastfeeding
in spite of the hospital, not because they were doing anything to help
me, and certainly not because it was their policy to help me.)

Now here's my contribution to the discussion. My colleagues think this
happens a lot in South Jersey. Mom is being admitted; L&D nurse has to
fill out her admission papers, and asks "Breast or bottle?" Mom,
thinking about the year ahead, says "Both." She wants to breastfeed but
knows she's going back to work later on. The nurse, thinking about the
next 2-4 days in the hospital, checks both boxes. BUT once both boxes on
the admission form are checked, people who do not support exclusive
breastfeeding will use that as carte blanche to feed formula in the
nursery any time the baby is away from the mother's side.

SO before checking any box, the nurse should probe a little. Why is the
mother planning on bottles? And when? Here are some things she might
ask. "Will you be going back to work or school after the baby is born?"
"Is Dad saying he wants to feed the baby too?" "Have you bottle-fed
before?" "Have you breastfed before?" "What is your plan for using
bottles?" Then use her answer as a hook to reinforce the value of
exclusive bf in the hospital, and indeed for the first two weeks until
the milk surge is over. Nursing in L&D doesn't commit the mom to nursing
"forever." Exclusive bf in the hospital doesn't commit her to exclusive
bfing for the next six months. But we would all agree that even one feed
after birth has value, and even two days of exclusive bf have value, and
they should be our standard of care.

The journey of a thousand miles begins with a single step.


Chris Mulford, RN, IBCLC
LLL Leader Reserve
working for WIC in South Jersey (Eastern USA)
Co-coordinator, Women & Work Task Force, WABA

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