I am a non-RN IBCLC working at a community hospital with 2500 births per
year and a level 2 NICU (babies 32+ weeks). The staff in our NICU are
knowledgeable about breastfeeding and quite supportive to the mothers.
However, there seem to be some practices that are not always the most
effective or evidence-based for contributing to breastfeeding success. For
example, breastfeeding is not initiated until babies are able to bottlefeed
successfully (or "nipple," which drives me crazy; they talk about "nippling
60% of feeds"). Once it is initiated, breastfeeding is limited to 2x/day,
with feeds of expressed breastmilk (often fortified with Neosure) at other
feeding times; this is also the standard instruction for discharge. When I
asked about using hindmilk to increase weight gain when mother is pumping
sufficient volumes, I was told it was too difficult for mothers/NICU to do.
I'm sure there are many other opportunities for improvement.

My question is how to start approaching the NICU staff in a way that will
not have them raise their defenses, but open up to learning? I have read
through the Academy of Breastfeeding Medicine's protocol for transitioning
from NICU to home, but I'm not sure how to share it. It is my understanding
that babies are discharged shortly after they are able to take all feeds by
mouth and maintain weight gain (when other health measures are all good), so
I'm not sure about the viability of such recommendations as transitioning to
unfortified human milk for one week prior to discharge and measuring weight
gain. At this point, there is much I don't know about NICU protocols (I
asked yesterday and got some information from a NICU nurse, but she
indicated that there are no written protocols). So I can use help with what
questions to ask, who to talk to (what position), what research or other
materials to provide, how to offer information, and anything else you might
be able to share.

Thank you!

Lisa Mandell, MBA, IBCLC
Havertown, PA USA

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