Here's text of an informed consent form I had hanging around.

Karleen Gribble

Australia



Breast milk is the most appropriate milk for babies. We are committed to
providing mothers with relevant information to enable them to make informed
choices about feeding their babies.



There are risks associated with the use of breastmilk substitutes and so it
is important to give newborn infants no food or drink other than breastmilk
unless medically indicated and the risk of not using the breastmilk
substitute is greater than the risk of using it.



Babies only need a little breastmilk in the first few days of life. Their
small tummy grows as they do. They may be quite sleepy by day and awake and
hungry at night. Good positioning, effective attachment, skin to skin
cuddling and avoiding the early use of a dummy will help build the milk
supply to meet baby’s needs. Crying is not always a sign of hunger, ask the
midwife for help with learning settling techniques.



Occasionally there may be a medical reason why a baby requires a breastmilk
substitute supplement (as well as a breastfeed) or complement (in place of a
breastfeed). It is important to breastfeed or feed expressed breastmilk
before giving the substitute. If the breastmilk cannot be given to the baby
expressing will maintain the milk supply. The supplement/complement will
only be given as long as medically necessary.



A one-time exposure to a breastmilk substitute increases the risk of a baby
developing allergies (including asthma and eczema) and type 1 diabetes. If
either parent has an allergic disease or diabetes please tell the midwife
because this greatly increases the risk. Regular use of breastmilk
substitutes increases the risk of many other illnesses including
gastroenteritis, respiratory illnesses and ear infection.



Use of a breastmilk substitute can also affect a mother’s milk supply
because the baby may be less likely to feed regularly. If milk is not
removed from the breasts they may either not produce sufficient milk or
become very full, uncomfortable and create more problems.



----- Original Message ----- 
From: "Terri Klein" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, October 17, 2007 5:08 AM
Subject: informed consent


Thank you all for your input. I took out the sentence that offering a bottle
after breastfeeding has been established one or two bottles a day should be
ok. I also included from suggestion, WHO recommendations regarding
powdered infant formula. Our hospital only gives liquid ready to feed. but
there
is powdered formula in the breastfeeding support gift bags. I have not been
successful in getting rid of the gift bags. We are going through a
renovation
and with all the noise, interuptions and chaos, our director and staff want
to
give away to keep our satisfaction scores. Don't make me go here.
This isn't written in stone yet. It is just drawn up will need approval by
another CLC, director, physicians and staff before it is policy. I just want
something in the interum besides the regular consent form that is used.
Terri Klein
RN, CLE, CLC

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