Boy, did I get it today!

One of the Home Health Nurses called me to let me know that she is not
teaching the same information I am because "my mommies are really so very
tired they need their rest!"  So she is telling them to hold the babies off
with a finger, pacifier, walking or giving to dad "until they're good and
hungry".  She is also telling them to "hold off for at least 2 hours,
better 3" because when they're hungry the suck in the correct way and
really can empty the breast in 10- 15  minutes per side (never more than 30
minutes total).  She has had C/sections and knows that this was best for
her and her baby!

She's an NICU nurse also (hinting strongly I'm not REALLY knowledgeable of
these very special babies) and they instruct moms to follow this schedule
when discharged.  "We do follow ups very regularly because these are very
delicate babies and they do very well with this schedule."

She also pointed out to me how "wrong" I had been today giving a mom a
nipple shield - because SHE had been able to latch the baby on that
afternoon....  As she doesn't speak Spanish, and the mom doesn't speak
English, she was not aware that for the last week this mom had been using a
bottle nipple to breastfeed and of course was exhausted as baby was unable
to get more than a few drops every feeding.  

As baby had been unable/unwilling to open mouth wide and I saw from mom's
pain and exhaustion she was ready to quit, I did use the nipple shield,
which got baby on the breast, got mouth open WIDE, he nursed for 30 minutes
on ONE side and promptly fell asleep for the rest of our visit (1.5 hours,
as we were coping with her health problems - infected uterus, infected
vagina, urinary tract infection and PAIN.)  I had instructed mom to try to
get baby on breast after a few successful feeds with the nipple shield - or
if she found she could not cope, I'd be back Tuesday for more help.

By the way, this mom is a real trooper - despite all the pain and
exhaustion, baby had GAINED from birthweight even using the bottle nipple. 

I tried to diplomatically speak to the nurse, but finally (30 minutes of
being lectured to) explained that yes, I HAD taught that which she was
saying (more or less) in the 70's and 80's, but that now with Dr.
Harmann's, Dr. Woolrich's and new studies on effective breastfeeding and
suck, I was teaching based on research - and asked her for HER research.  I
also asked if she was SURE her moms were following the schedule she was
recommending.  

I neglected to point out (thank goodness, I think it was best, in order to
try to keep some sort of communication going) that our Public Health Nurses
were finding moms with babies with inadequate weight gain thanks to her
recommendations - and were succeeding in getting baby's weights up with NO
SCHEDULE and breast compressions...

Of course now I can think of other questions to ask - like how many of
those NICU babies actually stay on exclusive breastfeeding thanks to her
LOG and schedule....

Sorry to vent - but you are my "safety net" of sanity sometimes...

Jeanette Panchula, BSW, RN, IBCLC
Vacaville, CA
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