I had the privilege of speaking at a conference with Carol Melcher from 
Loma Linda University Medical Center in southern California.  I consider 
her way of teaching nurses about supplementing to be sheer genius.

She did surveys of their mothers' feeding choices and made graphs of the 
outcomes, which she presented to their nurses.  The graphs showed 
consistenly that 100% of the mothers requesting their babies be 
exclusively formula fed had their choices honored.  However, on average 
only about 70% of the mothers who requested their babies be exclusively 
breastfed had their choices honored. She told the nurses that this "gap" 
between mother's request and actual practice needs to be closed for the 
sake of patient satisfaction (a "biggie" for most hospitals) and health 
outcomes.  Then she taught them why the American Academy of Pediatrics 
recommends exclusive breastfeeding from a health standpoint.

Suddenly, the issue shifted from "depriving" these poor exclusively 
breastfed babies of adequate nourishment to disrespecting mothers' 
choices. 

In Carol's hospital, a nurse is expected to provide a justification if 
she disrepects a mother's feeding choice.  Carol says this has helped to 
cut down significantly on unnecessary supplementation.

Warmly,
Nancy Mohrbacher, IBCLC
In the stormy Chicago suburbs, where I just got my power pack after two 
solid days without

>
>As the only IBCLC (our Director will only hire RN, IBCLCs) in our hospital  
>it is impossible for me to do it all.  Supplementing happens constantly,  but 
>not because of my decision.  I do feel the majority of the day nurses  (they 
>spend the most time with me) are less likely to jump the gun and  supplement.  I 
>am always walking a tight rope in my job.  I have been  accused of not giving 
>the patients choices and therefore not being Patient and  Family Centered 
>Care(PFCC)in my job.  ( I am on that committee and am  probably the only nurse in 
>our unit that REALLY understands PFCC).  When I  supplement you better 
>believe it is for a reason, 99% of the time.  The  other 1% is because the mom is 
>not convinced but is trying HER best and I am at  least trying to get her to 
>think about weaning off of that stuff when her milk  comes in.  I teach her 
>stomach capacity and give her an empty gradufeed to  use instead of letting the 
>baby drink or drown!  
> 
>I supplemented at the breast 3 babies yesterday. Two of which I was not  
>surprised.  I suspected by my feeding observations on Thursday what might  happen 
>in the next 12 or so hours, but output was good, so I let the dedicated  
>parents see how the night went.  Neither succumbed to supplementing but by  Friday 
>the babies were fretful, the BMs had stopped and I didn't see much  
>swallowing.  So pumping and some formula had to be started.  Both moms  a wee bit 
>disappointed but not going to give up.  One mom has a challenge  of that C/S 
>swelling and the other is Diabetic.  One of those babies is not  totally organized 
>with his suck.  The other was extremely sleepy, he did  great with the SNS 
>feeding.  The other was a little more difficult but we  were able to do it and get 
>more organization from him.  
> 
>So....my point...a RN, IBCLC....especially with tons of experience does not  
>jump to supplementing.  A new IBCLC might be more nervous, especially in a  
>hospital setting where some Doctors/ARNPs may not totally get breastfeeding and  
>be on the back of the nurses/IBCLC to supplement.  It isn't easy working in  
>a hospital setting.  And the nurses think they are being kind (they want  lots 
>of good comments on our patient surveys) so they tend to throw in  that 
>formula "just in case" as the parents are leaving.  The do not believe  doing this 
>is potentially affecting breastfeeding.  I am tired of saying  the same thing 
>over and over.  I am tired of presenting the evidence.   And I guess my 
>director is tired of hearing it too because she feels no one  reads my emails....she 
>has banned me from doing so anymore.  Sad....I do  know that many of the 
>nurses do love the email research info I present and some  even print and keep in 
>their files.  Oh, well.....I need that pay  check.  I love what I do.  I just 
>keep plodding along the best I  can.  
>
>
>  
>

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