For: Jeanette Panchula, BSW, LLLL, RN, IBCLC
Jeannette,
I really think I missed my point in so many words, in my posting of
9/1/00.
This final line aroused frustration.
"Not enough time usually to correct something that didn't get taught
before leaving hospital."
I apologize if I implied no one took the time to teach her. what
I need to say was... "something that didn't get learned before she left
the hospital." People learn in different ways. (Had an in service on
that one.)
I'm bummed! I was having such a good day when I posted my message
Fri. I had taken time to work with a mom. Slower than usual day. And I
made a small difference. I know nurses have the same 'not enough time'
problem WIC nutritionists have because of budget cuts & now even busier
schedules .
In your 3 frustrating examples of hospital postpartum patients in
your 9/2/00 posting you stated "ALL THREE stated NO ONE had been there
to help them, the hospital nurses hadn't given them the time of day, and
had I not pointed out that they - all three - had my business card, they
would have said I'd never been in the room..."
That is frustrating when you do your job and then get feedback like
that.
We at our program document BF education & send all PN women an
infant feeding group class (IFG) which compares BF with Formula feeding
on benefits, etc. Then at PP certification moms fill out a pp infant
feeding survey which states no BF education received. Go figure it out.
Maybe they do need some one with them at every class or appointment to
help them remember what was said. (I read that some where.)
However, in my case study of 9/1/00 the mom was 1) not a know it
all, 2) not leaving the hospital to smoke or 3) did not make an early
exit to get out of BF education. (I get your point though) My client
said every nurse had something different to say about her BF problems.
("conflicting statements") She asked for help every chance she could. I
have no idea what BF training her postpartum HCP have received as she
didn't deliver around here. This woman had been planning to BF all
along. She was doing it. She stopped only when the pain got so bad.
She was told she had to hold her breast (no alternative for her problem).
She was having pain in wrist also (thinks it's carpal tunnel syndrome)
and told them.
Surely I didn't invent the rolled up cloth under the breast to keep
breast from falling out of infants' mouth. Works every time with my
clients. (Laziness is the mother of invention. I was always too lazy to
'hold it up' so I let a diaper do the job.)
There are some of us who need showing & explaining over and over or
JUST EXPLAINED WITH JUST A LITTLE DIFFERENT WORDING. example: When we
say "BF more to increase the milk volume," We know what we mean when we
say BF more but do they? Some moms think they are breastfeeding more if
they are BFing every 2 hours. That's more to them. After the second
breast is empty & their baby is still crying they give formula because
they don't realize we meant to tell them "The breast is like a mountain
stream trickling back in as soon as it is emptied." With this
information I proceed to tell them about the several bouts per feeding
needed to increase milk during growth spurts...."When your baby tells you
s/he's hungry with rooting/hunger cues, empty the first breast before
going to the 2nd. After emptying the 2nd breast go back and empty each
breast AGAIN & AGAIN until the baby is full (No more hunger
cues/rooting") Most of our participants state "crying" is the way
their baby tells them they're hungry.
In Friday's case, I proceeded to explain everything we did & why.
With the baby on the pillow, mouth positioned directly in front of
breast, head cradled in crook of mother's arm, I tickled the baby's lower
lip several times. I taught her why she needed to keep her fingers away
from lactiferous sinuses after expressing a few drops of milk to interest
baby. Mom wanted to rush ahead & draw the baby on to the breast at
first till I instructed her to wait for the tongue to be down & over the
lower gums. No one had made sure that she learned that. I instructed
her how & why I wanted the nipple to be pointed at the baby's nose not
the mouth. She was amazed at how there was no pain when there was final
contact. She commented on how easy it was.
Some women tell me they don't want to be shown. They'll do it at
home. If embarrassment is the reason they hesitate, I gain their
confidence & urge them to try it once just to get the hang of what I'm
talking about when I mean tongue down. Most are sure they'd never have
figured it out on their own. That is what I meant when I said "We could
have lost this one but haven't so far." (to successful BF) "This is how
we usually lose them, though. Nothing overly complicated." (Like cleft,
or no milk) They say they want to BF but they blow off any help offered.
"Not enough time usually to correct something that didn't get taught
(learned) before leaving hospital." (We usually don't have any extra
time to spend on them to teach if they're not BFing. We just certify
them as non-BF and give referrals to LLLI or early intervention (VNA).
I confess, I'm constantly getting into trouble for working with them too
long in my office. I've gone to their homes after work to help if they
want, on my own time.)
We (LC's, HCP) have to tell moms about hunger cues. We have to
warn them about little things like growth spurts. If they don't increase
the volume with several bouts each feeding, they give more & more
formula.
I know not all nurses want to give a new born a bottle to cause
nipple confusion. They want the baby fed. At my CLC training the nurses
stated that their PP moms were usually tired and din't want to BF their
infants in P.M. However, I stayed in hospital with my girl friend 1st
night & 'the' nurse wouldn't bring the baby in because mom had had a
C-section and "she needed her sleep." Wouldn't even let me cup feed.
"We don't do that here." Bureaucrats make the rules not the nurses.
Education &/or financial loss are incentives to promote change in BF
management.
We can go on forever telling case studies but we have to work
together and find out what can be done to solve these frustrating cases.
Uniform training of all PP nurses? An IBCLC or two or three at every
hospital with no other duties other than helping babies latch? A friend
of mine does just that in a hospital in the next city. She left WIC for
that job & now gets frustrated with WIC & the free formula. I don't
blame her. We wish we could require all participants to sign a liability
waiver before receiving any nonhuman baby milk. Sounds like there is a
way...Just takes one HCP in each hospital to start the ball rolling for
Baby Friendly Hospital Initiative (BFHI).
As of 4/2000 there are 14,800 UNICEF recognized Baby-Friendly
hospitals world wide. How many are in USA? a)14,000 b) 800 c)
less than 30 The answer...c) 26
Perhaps there are IBCLC's or LLL leaders out there who would help
organize and teach a weekly BF or Infant feeding class in a local WIC
office. We have a model set up for 2x week IFG for all our prenatal
clients. We have an outline, get moms & dads involved with the handling
of dolls. Yes, It was borrowed from Healthy Children 2000. The WIC
nutr. are not always available to give these classes and if there's no
Peer counselor, are rushed and everyone misses out.
Regards,
P.Harris-Swenson, MA, IBCLC, Doula in training
WIC Nutritionist & BF Coordinator
Still behind '69 spring cleaning AND Lactnet mail!
Lowell, MA USA
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
