Hello Lactnetters!
Here I am, working hard at increasing bf rates in a small private hospital in
PR.  We are now allowing some rooming-in and some of the nurses are supportive.
There is a terrible nursing shortage and the Nursery nurses are very overworked.
For this reason, I think they, like anyone who is tired, are not convinced that
changing their protocols and procedures is feasible, much less that it would
reduce their workload.  When the census is low or there is enough staff, some
are very supportive.  But when the stress increases (like with the arrival of
Hurrican Luis), breastfeeding goes out the window.
After the storm I found the (up to now) very supportive Head Nurse giving a
breastfed baby a bottle of abm, saying that the baby had not nursed since 3:00
am (it was now 9:30 am and mom was being discharged) and the Neonatologist (who
usually sees all babies that are having any problems at all) is insisting that
any baby that is not sucking "well"  be given a bottle with abm or glucose to
make sure it can suck.  If not, she says this could be a sign of undiagnosed
infection and a reason to run all sorts of blood tests - and delaying the baby's
discharge, giving antibiotics, etc.
Deliveries at our hospital here are 36% cesarean (lower than the island average
of 60%) and almost 100% of vaginal deliveries are medicated.  I usually find
that if a baby is nursing within 24 hours, even if not at the ideal 6 - 8 times
in 24 hours, things work out.  Now with this Neonatologist's orders, there will
be few babies not recieving bottles or finger-feedings (if I can teach this),
both of which I would like to avoid, especially since there is an inordinate
amount of inverted nipples here.
My experience until moving here was mostly out-patient: LLLL and clinic settings
as a perinatal nurse-educator.  I don't have the degrees not the experience to
debate with this MD.  HELP  (I am drowning - and Hurricane Luis missed our
island!)
Jeanette Panchula, BSW, RN, IBCLC