May I step in here a minute please? I am responding here to Jennifer. I 
completely agree, Jennifer, that you are correct about accountability. 
This accountability thing is a problem in all areas of the hospital stay; 
in nursing, medicine, and any other area in health care. I am by no means 
excusing any of this or dismissing your concerns. Lack of accountability 
is a problem in just about every career. Let's face it. I don't like it 
but it is there and I have to deal with it no matter what.

However, in looking at your initials, Jennifer, I am assuming that you are 
NOT a nurse and therefor are not really "up close and personal" with all 
that goes on surrounding birthing in this type of environment. I can only 
add my perspective as an IBCLC, a LDRP nurse (who works every day with 
breastfeeding mothers), a mother (an older one at that now), and part of a 
health care team at a very mother/baby friendly hospital. I stay where I 
am because of this philosophy.

However, with medicine where it is now, the new guidelines (for instance) 
from the AAP on jaundice management,and the knowledge that everyone 
approaches everything through their own "experienced" eyes, we are all 
going to have to deal with information, poor advice, supplementation, 
etc.: all of which can (and often does) undermine those first attempts at 
breastfeeding. Good intentions by staff can be thrown out the window by an 
undereducated doctor (and of course nurse), staff inservices can be 
minimal to non-existant because of poor management, new parents get bogus 
information from everywhere.

While I am not excusing any of this, one comes to a time in their career, 
where they just realize that this is always going to happen and we can 
each only do what we can do. All you can do is arm your families with as 
much evidence based information as possible (as I do in my breastfeeding 
class)and support their education in learning to advocate for themselves.

You're right. HCP's often give very poor advice. I hear it every day but I 
have learned to step away from that, give out suggestions when I can, 
teach tidbits when the opportunity arises and go with the flow. I have 
also learned that there are, indeed, two sides to every issue. Yes, that 
baby with the 10% weight loss may need supplementation. It's your job to 
help the mother build a supply anad also work with why the weight loss 
occurred. We all do the best we can.

I am not being a defeatist but I have been in this job long enough to 
realize that you are never going to change everyone. The most change will 
come from consumer demand, not from complaining about the profession's 
lack of accountability.

The people who truly want breastfeeding to work (who don't have any real 
medical issues) will make it work, regardless of whether or not they get 
bad advice from someone you deem to be not accountable. Others will not. I 
have also learned that many try and don't really have the commitment. I 
have had to let those people go and concentrate my efforts on those who 
are committed. 

Part of my monthly breastfeeding class (which was this morning, actually)
includes a bit of time on what I call "bumps in the road." I include this 
information because I know full well that sometimes problems do arise with 
babies that do require us to have to do things which may well undermine 
the breastfeeding (like supplementation for various reasons). I would 
rather have the parents aware of this because then if it does happen, they 
are more likely tho weather this time in a positive way and NOT give up. I 
arm them with knowledge to help them know what to do to support the milk 
supply during this time so that when all the kinks are worked out, mother 
and baby are on the same page.

I guess the bottom line is that you seem to be taking issue and placing 
blame without maybe having the indepth experience that might help you to 
be less frustrated. I don't mean to offend you. I just wish to add some 
additional perspective as to why somethings happen as they do. That are 
not right, you are correct, but nevertheless, they are part of the entire 
picture.

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