Laurie, Don't give up!!  My understanding is that bilirubin is excreted
mostly via stooling, some through urine.  the natural laxative effect of
breast milk wins in my mind as the food of choice with high bilirubin.
However, any milk coating the intestine will prevent re-absorption of the
bilirubin thus helping the levels to come down.
      The pain med problem should be easily addressed by Hale.  Either it
is safe during lactation, or, if it is demerol, the MD should please
order a different pain med, one that is compatible with breastfeeding as
many are.
     Be satisfied with small changes.  Find a colleague who shares a
passion for lactation for support.  Vent to the supervisor who hired you
if she is a safe person, enlist her support in changing and implementing
policies.
     You may have to bring in the pump kit and pump on your rounds for
the women who need to be pumping, then hopefully, the staff will also
follow proper protocols.  Be professional and matter-of-fact, of course
pumping is the right thing for this patient and fulfills HER desire to
breastfeed!
Patient satisfaction is a big thing nowadays.
     Start a committee to improve breastfeeding practices, make it a
quality of care measurement.
     Hang in there, girl.
     Yours in the same battle in hospital-based lactation,
     Susan   in Minnesota
      rn ibclc

             ***********************************************
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