As the only IBCLC (our Director will only hire RN, IBCLCs) in our hospital  
it is impossible for me to do it all.  Supplementing happens constantly,  but 
not because of my decision.  I do feel the majority of the day nurses  (they 
spend the most time with me) are less likely to jump the gun and  supplement.  I 
am always walking a tight rope in my job.  I have been  accused of not giving 
the patients choices and therefore not being Patient and  Family Centered 
Care(PFCC)in my job.  ( I am on that committee and am  probably the only nurse in 
our unit that REALLY understands PFCC).  When I  supplement you better 
believe it is for a reason, 99% of the time.  The  other 1% is because the mom is 
not convinced but is trying HER best and I am at  least trying to get her to 
think about weaning off of that stuff when her milk  comes in.  I teach her 
stomach capacity and give her an empty gradufeed to  use instead of letting the 
baby drink or drown!  
 
I supplemented at the breast 3 babies yesterday. Two of which I was not  
surprised.  I suspected by my feeding observations on Thursday what might  happen 
in the next 12 or so hours, but output was good, so I let the dedicated  
parents see how the night went.  Neither succumbed to supplementing but by  Friday 
the babies were fretful, the BMs had stopped and I didn't see much  
swallowing.  So pumping and some formula had to be started.  Both moms  a wee bit 
disappointed but not going to give up.  One mom has a challenge  of that C/S 
swelling and the other is Diabetic.  One of those babies is not  totally organized 
with his suck.  The other was extremely sleepy, he did  great with the SNS 
feeding.  The other was a little more difficult but we  were able to do it and get 
more organization from him.  
 
So....my point...a RN, IBCLC....especially with tons of experience does not  
jump to supplementing.  A new IBCLC might be more nervous, especially in a  
hospital setting where some Doctors/ARNPs may not totally get breastfeeding and  
be on the back of the nurses/IBCLC to supplement.  It isn't easy working in  
a hospital setting.  And the nurses think they are being kind (they want  lots 
of good comments on our patient surveys) so they tend to throw in  that 
formula "just in case" as the parents are leaving.  The do not believe  doing this 
is potentially affecting breastfeeding.  I am tired of saying  the same thing 
over and over.  I am tired of presenting the evidence.   And I guess my 
director is tired of hearing it too because she feels no one  reads my emails....she 
has banned me from doing so anymore.  Sad....I do  know that many of the 
nurses do love the email research info I present and some  even print and keep in 
their files.  Oh, well.....I need that pay  check.  I love what I do.  I just 
keep plodding along the best I  can.  


 
 
Pamela Ann Hendrix Montoya
BA, RN, IBCLC




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