Amy,
You wrote of a mother who planned on exclusive breastfeeding, and her
hospital nurses who wrote "Breast & Bottle" on the baby's chart and felt
free to give formula in the nursery. You said, '...the RN's in the nursery
were telling me how they think breast and bottle is the best thing and
that's how they did their own children and they never had any problems...'
You asked, 'How do I approach this mother tommorrow w/out sounding
accusatory "What happened? Why did the baby get the bottles yesterday?" '
This sounds like a situation where communication needs to be improved. I'm
hoping that because you're new at this hospital, you can ask some basic
questions and find out who really has the power to decide what babies get
fed.
I have a theory about how "breast & bottle" gets written on babies' charts.
The mother is in labor. The admitting nurse is doing her admission paperwork
and asks "Breast or bottle?" because she has to check a box on the form.
Mother is planning to breastfeed exclusively at first and use expressed milk
in a bottle or use formula in a few weeks or months; she answers "both"
because she's in labor and doesn't want to go into too much explanation. And
once both boxes get checked off, the nurses feel they have have carte
blanche to stuff the baby with formula any time they get their hands on
him/her instead of helping the mother breastfeed. (I am saying this based on
over 10 years' experience working in a hospital where most nurses thought
giving formula to a breastfeeding baby was No Big Deal.)
Nurses are supposed to follow policy, and the nurse-manager (or whatever
they call her in this hospital) is supposed to make sure they do so. There
are probably standing orders for newborn feeding...maybe you can have your
own orders on file in the nursery, or maybe you have to accept what the
other pediatricians have already written.
When talking with the mother tomorrow, I wouldn't ask "what happened?" or
accuse anyone, but treat it as an unfortunate thing that happened and see if
she has any clues about why. Ideally you, the mother, the manager, and the
nurse who wrote "breast & bottle" and the one(s) who gave the formula would
all meet face to face to figure out where the mis-communication occurred,
but I don't think you want to put such pressure on a new mother, and the
nurse-manager probably won't be there on a Sunday.
I would find out who signed off on the formula that was given in the nursery
and perhaps talk to her/them. I'd go in on Monday and find the nurse manager
and make your position very clear...that you recommend exclusive
breastfeeding, and you don't want unnecessary formula given. (This is where
you ask about policies and/or standing orders, since they may have something
in writing about giving formula in circumstances that you don't agree with,
and you may have to figure out how to campaign to change it.)
What you might also do is to ask the mother to write a letter to the
hospital about what happened and to send you a copy. That would give you the
lead-in to follow up the situation with the nurse manager.
Good Luck! Even when the physician is in charge, she may discover she really
isn't!! What a bummer!
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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