Evi,
Your request that we continue to discuss the ABM administration in hospitals
leads me to include the following:

At our hospital we initiated a form which mom fills out and signs in the Labor
and Delivery Room.  At this time she requests "Exclusive Breastfeeding"  or
"Bottlefeeding" and even signs if she wants "breastfeeding with supplementation
of ___ABM  ___ Glucose ___ Sterile water".  She also requests Rooming in or
standard visitation.

Problem:  Mom comes in, has not been to one of our prenatal classes or to one of
my pre-admission classes, so she signs for EVERYTHING "just in case".

Problem: Mom has written her wishes, but the pediatrician signs for "early
feeds" and with mom recovering from cesarean or a rough delivery, she can't come
to the lactation room for "early feeds", so the nurses give a bottle.

Problem: Pediatrician orders that baby cannot go to mom unless he/she has
checked the baby.

Problem: Pediatrician writes order of formula/breastfeed (they write this
automatically unless they remember that mom wanted something different), or
their "standing orders" are formula/breastfeed and the baby is born in the
middle of the night and the ped, is not called for specific orders until the AM.

So when it comes to lawsuits, it is important that  the pediatrician's orders
specifically state breastfeeding only.  As long as they continue to write their
usual orders, the hospital attorneys have a way out.

Also - letters to the Administrator usually get good results.  Get his/her name
and write directly.
The Director of Nursing (or whoevere is the supervisor) usually gets a note
attached to a copy of the letter asking for an explanation.  That can make some
heads turn and take notice.

Jeanette Panchula, BSW, LLLL, RN, IBCLC
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Puerto Rico